[In dubio pro malum - a clinical case to reflect].

Patients with cardiac pathology alone are already complex, when this is associated with oncologic pathology, or it's mere suspicion, the patient becomes even more complex. We present a clinical case of a patient with severe aortic stenosis with suspected cancer disease, whose diagnostic study could not be performed due to the patient's clinical condition. The option to intervene surgically was widely debated, never being a consensus among surgeons.

[Thymic lesions: A 4 years-review].

Introduction: The difficulty in differentiating invasive from non-invasive thymic tumours solely by histological features, leads to the decision of resecting suspected lesions except in the presence of: (a) diffuse metastasis; or (b) typical imaging findings of thymic hyperplasia or after recovering from some recent stress. Therefore, the role of radiology is of the utmost importance in the initial evaluation and staging of thymic mediastinal masses.

Methods: The objective of this study was to elaborate a retrospective analysis of the cases of thymic lesions that underwent surgery at the Cardiothoracic Department of Centro Hospitalar Vila Nova de Gaia/Espinho (CHVNG/E), from January 2013 to December 2016, illustrating their main radiologic findings with computed tomography (CT) images.

[Thoracic nocardiosis - a clinical report].

Nocardia genus microorganisms are ubiquitous, Gram positive aerobic bacterias, responsible for disease mainly in immunocompromised hosts, with cellular immune response commitment. Inhalation is the main form of transmition and pulmonary disease is the most frequent presentation. Dissemination may occur by contiguity and also via hematogenous.

Mid-term outcomes of mitral valve repair in a low-volume hospital.

Introduction: Mitral valve repair is feasible for all patients with mitral regurgitation and its advantages are well documented; however, there is general agreement that it is technically demanding and that success rates are related to volume/ experience centers. The aim of this study was to evaluate the clinical and echocardiographic mid-term outcomes of patients who underwent a mitral repair in a low-volume hospital.

Methods And Results: Between 2009 and 2014, 55 patients (23 female) with mitral regurgitation underwent mitral repair.

Paraplegia due to spinal cord infarction following cardiac surgery.

Paraplegia is an extremely rare complication following any surgery, especially cardiac surgery. The underlying mechanisms remain poorly understood and even though spinal infarction has been reported previously, it is almost always associated with the use of intra-aortic balloon pump. We report the clinical case of a 75 year-old male, who developed paraplegia secondary to spinal infarction, following cardiac surgery (coronary artery bypass grafting and aortic valve replacement) in whom the intra-aortic balloon pump was not used and few other predisposing factors were present that could anticipate that complication.

Bilateral internal mammary artery grafting: Comparison between different surgical techniques.

Background: Increasing evidence continues to demonstrate a survival advantage for bilateral internal mammary artery (BIMA) over single internal mammary artery (SIMA) for coronary artery bypass grafting (CABG). However, there are still doubts about which surgical strategy is the best one to use with BIMA grafting. This study aims to compare immediate and mid-term outcomes with BIMA CABG, using different surgical techniques, through transit-time flow measurement (TTFM) and clinical follow-up.

Thoracoscopic left atrial appendectomy.

In patients with non-rheumatic atrial fibrillation, efficacy of stroke prevention with oral anticoagulant therapy has been proved. However, there are patients who are not candidates for long-term oral anticoagulation, namely patients with high risk of bleeding complications or previous hemorrhagic stroke. In those patients, percutaneous closure of left auricular appendage (LAA) has demonstrated to be safe and efficacious preventing cardioembolic events.

[Endovascular management of a thoracoabdominal aortic aneurysm in a chronic contained rupture using the "Sandwich technique"].

Objective: The authors report the prompt diagnosis and endovascular treatment with the "Sandwich" technique of a chronic contained rupture of a thoracoabdominal aortic aneurysm in an unfit patient for open surgery.

Methods: A 57-year-old male patient with severe pulmonar and cardiac comorbilities presented at the emergency department with a contained rupture of a type V thoracoabdominal aneurysm, involving the celiac axis. A "Sandwich" technique was performed deploying a ViaBahn graft through a transbrachial access interlayed by two Gore TAG endoprothesis.

Thoracoscopic removal of an intrathoracic Kirschner wire. Case report.

We report the clinical case of a clinical case of a 50-year-old woman who had a very rare complication related to the insertion of Kirschner wires for fixation of a left humerus fracture. Sixteen years after the placement of the Kirschner wires, a routine chest X-ray revealed that one of the Kirschner wires had migrated through the pleural cavity. Chest computed tomographic scans confirmed the presence of a metallic wire inside the left lung parenchyma, adjacent to the superior pulmonary artery.

[Surgical treatment of a complete aortic arch interruption].

We describe the clinical case of a 48-year-old woman referred to our centre due to a recently diagnosed severe symptomatic aortic stenosis. Her past medical history included arterial hypertension diagnosed when she was eighteen years old. On preoperative study a complete interruption of the aortic arch was found, distal to the origin of the left subclavian artery.

[Influence of processed EEG monitoring in the anesthetic management and its cost in off-pump coronary surgery: a research protocol].

Backgroud: Although in some studies intraoperative processed EEG monitoring has shown advantages such as less use of hypnotic drugs and decrease duration of both anesthetic emergency and recovery times, there is controversy on the incidence of awareness. It has not been demonstrated that this type of monitoring interferes with length of hospital stay, morbidity and mortality. Processed EEG monitoring, such as the bispectral index (BIS) has been widely accepted in assessing anesthetic depth, yet its usage is not part of the standard monitoring of the American Society of Anesthesiologiy (ASA).

[Pulmonary artery sarcoma. A rare cause of syncope].

Pulmonary artery sarcomas (PAS) are extremely rare and the prognosis of patients seems to be very poor. Their clinical appearance is highly nonspecific and variable, rendering the diagnosis difficult. Surgery remains the mainstay of treatment for PAS since early radical resection could offer the only chance of a potential cure.

[Patency of Coronary Artery Bypass Graft].

Introduction: Coronary heart disease is the leading cause of death and disability in the U.S. and Europe.

[Cardiac papillary fibroelastoma of the mitral valve. Case report].

Cardiac papillary fibroelastomas (CPF) are rare primary cardiac tumors with predilection for heart valves, being increasingly incidentally discovered due to the widespread use of echocardiography. Most of them are asymptomatic, but they are a potential source of systemic emboli, stroke, myocardial infarction and sudden death. This report describes the case of a 70-year-old female with previous transient ischaemic attacks and an echocardiographic finding of a mass in the mitral valve.

[Unruptured symptomatic abdominal aortic aneurysms].

Objectives: The authors aim to present a case series of patients with unruptured symptomatic abdominal aortic aneurysms with atypical presentation or clinical manifestations.

Methods: A retrospective analysis from 2010 to 2013 of unruptured symptomatic abdominal aortic aneurysms was made in a Vascular Surgery department.

Results: 4 clinical cases were selected, all male, mean age of 72.

Double transcatheter valve-in-valve implantation for degenerated aortic and mitral bioprostheses.

Transcatheter valve-in-valve implantation for degenerated bioprostheses is an appealing alternative to reoperation in high-risk patients, and is technically feasible in both aortic and mitral positions. However, concurrent aortic and mitral transcatheter valve-in-valve procedures are seldom described. We aim to report our first case of double transapical valve-in-valve procedure for concomitant malfunction of aortic and mitral bioprostheses, in the same session.

[Bockenheimer's syndrome. A clinical report].

The authors report the clinical case of a 12-year-old boy with an extensive superficial venous network in almost every area of the body, present since birth and worsening in recent months, with the occurence of superficial venous thrombosis. No other changes on physical examination were noted, no symptoms and no analytical or imaging findings were found. Histological examination of the lesions revealed ectatic superficial veins without any proliferation of endothelial cells and the amount of elastin in the walls of these veins was decreased.

Successful implantation of a CoreValve prosthesis through direct aortic access via ministernotomy.

The use of tanscathether aortic valve implantation (TAVI) to treat severe aortic valve disease is increasing exponentially. Peripheral vascular access for TAVI is not always possible, and when transapical approach is contraindicated, other access options can be considered like the central transaortic access. The authors describe a successful implantation of a CoreValve prosthesis through direct aortic access via ministernotomy, addressing particular attention to the implantation procedure, potencial complications, advantages and limitations of the method.

A rare cause of acute heart failure.

We describe a rare clinical case of ruptured sinus of Valsalva aneurysm (RSVA) into the right ventricle, complicated with severe aortic regurgitation (AR) and myocardial ischaemia. The AR was caused by a hemodynamic effect solely, in which the shunt of blood flow through the ruptured site pulled the right aortic cusp away from closure. The pathological mechanism of the AR was clearly visualized by transesophageal echocardiography.

Surgical treatment of non-small cell lung cancer in octogenarians - safety and prognosis.

Background: Reluctance to recommend surgery for the elderly is partly based on the expectation that the rate of complications and mortality is higher in this group of patients and on the impression that the life expectancy of an octogenarian with lung cancer is limited by death from natural causes.

Methods: Between 2007-2011, we operated on 57 patients over 80 years who underwent thoracotomy with curative intent for lung cancer. Mean age was 82.

Surgery for thoracic empyema: personal experience and current highlights.

Thoracic empyema remains challenging for thoracic surgeons. The principles of empyema treatment are early diagnosis and early treatment. Decision-making involves a triad consisting of the etiology of empyema, general condition of the patient and stage of disease.