Systolic anterior motion of mitral valve with calcified annulus in octogenarians.

Systolic anterior motion of the mitral leaflet causing left ventricular outflow tract obstruction is commonly seen in hypertrophic cardiomyopathy and also in patients with advanced mitral valve disease with excessive anterior leaflet tissue or a reduced aortic-mitral angle. We describe 2 octogenarians who presented with systolic mitral leaflet anterior motion in advanced mitral valve disease with severe mitral annular calcification and associated asymmetrical septal hypertrophy.

The risk and outcomes of reoperative tricuspid valve surgery.

Background: Outcomes after tricuspid valve reoperation have not been published before. This study examines our 32-year experience in this cohort of patients.

Methods: Between May 1979 and January 2011, a total of 68 patients who had previous tricuspid valve surgery (49 repairs and 19 replacements) had reoperations on their tricuspid valves.

Concomitant mitral valve surgery in patients undergoing surgical ventricular reconstruction for ischaemic cardiomyopathy.

Objectives: Ischaemic mitral valve regurgitation is associated with a significant reduction in survival and its treatment in patients undergoing surgical ventricular reconstruction is usually associated with higher perioperative morbidity and mortality. We evaluated our 11-year experience in this cohort of patients.

Methods: Between January 2000 and December 2010, a total of 282 patients underwent surgical ventricular reconstruction, of which 45 (16%) had concomitant mitral valve surgery.

Left apical pedunculated thrombus with normal ventricular function mimicking an intracardiac tumor.

Left ventricular thrombus formation in the presence of normal ventricular function is a rare phenomenon, with only seven cases described in the literature. Their morbidity arises from the embolic sequelae that ensues. The management of these patients is complex, and requires the decision-making process of both the medical and surgical teams.

Does pre-operative estimation of oesophageal tumour metabolic length using 18F-fluorodeoxyglucose PET/CT images compare with surgical pathology length?

Purpose: The aim of the study was to compare the pre-operative metabolic tumour length on FDG PET/CT with the resected pathological specimen in patients with oesophageal cancer.

Methods: All patients diagnosed with oesophageal carcinoma who had undergone staging PET/CT imaging between the period of June 2002 and May 2008 who were then suitable for curative surgery, either with or without neo-adjuvant chemotherapy, were included in this study. Metabolic tumour length was assessed using both visual analysis and a maximum standardised uptake value (SUV(max)) cutoff of 2.

Transcaval migration of an acupuncture needle from the abdominal cavity to the heart.

We report the case of a patient who was noted to have inserted an acupuncture needle into his abdomen. The needle migrated to the heart and was removed from the right ventricle using cardiopulmonary bypass.

Have improvements in myocardial protection influenced a surgeon's choice of coronary artery bypass surgery?

The aim of this study is to determine whether improvements in myocardial protection strategy have influenced the surgeon's choice of coronary artery bypass surgery. Between February 2002 and April 2009, a total of 662 patients underwent coronary artery bypass surgery under the provision of a single consultant surgeon. Operative mortality was defined as in-hospital death and comparison was made based on both the observed and expected mortalities as derived from the logistic EuroSCORE.

A surgeon's case volume of oesophagectomy for cancer does not influence patient outcome in a high volume hospital.

The aim of this study is to assess if individual case volume of oesophageal resections influences the operative mortality rate in a high volume hospital. Between June 1994 and June 2006, 252 total thoracic oesophageal resections (75% male, mean age 63 years) were performed by five surgeons in tertiary referral centre. Operative approach was standardised in all cases and consisted of left thoracolaparotomy, resection of all intrathoracic and abdominal oesophagus and left cervical incision for anastomosis.

Bilateral thoracoscopic sympathectomy: results and long-term follow-up.

The aim of this study is to evaluate the efficacy of bilateral thoracoscopic sympathectomy in alleviating symptoms and improving quality of life in patients with hyperhidrosis or facial blushing and to investigate the occurrence, severity and possible underlying factors to compensatory sweating after surgery. One hundred and sixty-three patients in a single institution underwent bilateral thoracoscopic sympathectomy with a mean follow-up period of 51 (5-140) months. Indications were for palmar hyperhidrosis (41%), axillary hyperhidrosis (17%), combined palmar and axillary hyperhidrosis (27%) and facial blushing+/-facial hyperhidrosis (15%).

Traumatic left anterior descending artery-to-pulmonary artery fistula with delayed pericardial tamponade.

Traumatic coronary artery fistulas are rare, but 80% are secondary to penetrating injuries. Although the left coronary artery is involved in 46% of cases, these are usually associated with fistulas to the right ventricle. We describe a successful repair of a traumatic fistula from the proximal left anterior descending artery to the pulmonary artery after delayed presentation.

Primary mediastinal synovial sarcoma.

Synovial sarcoma occurs predominantly in the soft tissues of the extremities, but is exceedingly rare in the mediastinum. It has overlapping histological and immunophenotypic features with other tumours in the differential diagnosis. We report a case of a patient who had an incidental finding of such a tumour.

Treatment of a persistent false lumen with aneurysm formation following surgical repair of type a dissection.

We describe the case of a 68-year-old man who developed aneurysmal dilatation of the proximal descending thoracic aorta 8 years after repair of a type A dissection. The aneurysm was due to an anastomotic leak at the distal end of the previous repair in the ascending aorta with antegrade perfusion of the false lumen. Surgical repair of the anastomotic leak partially obliterated the false lumen and computed tomography scan demonstrated thrombosis in a large proportion of the false lumen aneurysm.

Spontaneous aortic dissection in a 14-year-old adolescent.

We describe a case of a 14-year-old boy with a spontaneous aortic dissection. The diagnosis was suspected and confirmed with an urgent transthoracic echocardiogram and computer tomography (CT). He underwent an immediate surgery with tube graft replacement of the ascending aorta using a biological glue to reinforce the distal false lumen.