Giant Mediastinal Myxoid Pleomorphic Liposarcoma

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Management of glucose 6-phosphate dehydrogenase (G6PD) deficient patients undergoing open-heart surgery

Background: There are scarce studies on the management of glucose 6-phosphate dehydrogenase (G6PD) deficient patients during cardiac surgery. The purposes of this retrospective study were to present and evaluate our experience with G6PD deficient patients who underwent cardiac surgery with cardiopulmonary bypass (CPB). Methods: We included 20 patients with G6PD deficiency who had cardiac surgeries from 2015 to 2019. We used free radical scavenging strategy and careful perioperative management. The patients were compared to a control group of 20 patients with normal G6PD enzyme activity who underwent the same type of operations in the same period. Results: Males represented 80% of G6PD deficient patients. There were significant elevations in preoperative total bilirubin (1.03±0.33 vs. 0.57±0.11 mg/dl, p< 0.001) and reticulocytes (1.87±0.62 vs. 0.54±0.18%) in G6PD deficient patients. Valve surgery was done for 60% of G6PD deficient patients. There were no significant differences between both groups regarding the type of surgery, aortic cross-clamp, CPB, and total operative time. G6PD deficient patients had significantly lower postoperative hemoglobin levels (9.44±0.94 vs. 10.0±0.59 g/dl, p= 0.04) and significantly higher postoperative total bilirubin (1.51±0.51 vs. 0.98±0.45 mg/dl; p=0.002) and reticulocytes (1.85±0.51 vs. 0.57±0.13%; p< 0.001). There was no significant difference regarding postoperative urea and creatinine levels. Ventilation time (10.3±2.7 vs. 8.2±1.9 hours; p=0.01), ICU stay (3.1±0.87 vs. 2.3±0.71 days; p=0.004), and hospital stay (3.1±0.87 vs. 6.0±1.02 days; p<0.001) significantly increased in G6PD deficient patients. The mortality rate was 5% (one patient) in G6PD deficient patients. Conclusion: Despite the management strategy, G6PD deficient patients undergoing cardiac surgery are more liable to hemolysis and hypoxia with more need for blood transfusion and longer ventilation time, ICU, and hospital stays when compared to patients with normal G6PD enzyme activity. Further research to improve the outcomes in G6PD deficient patients is required

Persistent Pneumothorax: Alveolar pleural fistula due to a hole in a bulla

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6. Endovascular treatment for acute traumatic transection of the thoracic aorta: The safety of delayed stenting

The current recommendation is immediate surgical treatment of acute traumatic transection (ATT) of the aorta. Open surgical repair carries high morbidity and mortality. Endovascular repair (TEVAR) has emerged as a safer option. The timing of intervention remains a matter of debate We review our outcomes of delayed endovascular repair of ATT. Methods: From 2011 to 2013, 7 patients underwent delayed TEVAR for ATT. All patients had their records reviewed retrospectively regarding mechanism of injury, concomitant injuries, technical details, post-operative complications and long term follow up. Results: The mean age was 30.29 years (range 24–51 years) and 6 out of 7 patients were male. The mechanism of injury was motor vehicle collision in 6 patients. The median time from injury to TEVAR was 8.7 days and there was no mortality during this period. Technical success was 100%. None of the patients suffered any neurological events, arrhythmias, acute renal injury, distal ischemia or endoleak. The median hospital stay was 10 days and all patients were discharged home with no hospital mortality. Mean follow up was 12 months and all patients were alive at follow up and none required re-intervention. Conclusion: The delayed approach has been safe with no patients lost during the waiting period. Patients with ATT who make it to the hospital and are stable from the aortic point of view may be managed safely with delayed TEVAR if immediate therapy is not available or possible

Ortner’s syndrome: Cardiovocal syndrome caused by aortic arch ps

72-year-old hypertensive presented with two weeks history of left sided chest pain and hoarseness. Workup demonstrated a pseudoaneurysm in the lesser curvature of the distal aortic arch opposite the origin of the left subclavian artery from a penetrating atherosclerotic ulcer. Following a left carotid-subclavian bypass, endovascular stenting of the aorta was performed excluding the pseudoaneurysm. Patient had excellent angiographic results post-stenting. Follow up at 12 weeks demonstrated complete resolution of his symptoms and good stent position with no endo-leak. Ortner’s syndrome describes vocal changes caused by cardiovascular pathology. It should be included in the differential diagnosis of patients with cardiovascular risk factors presenting with hoarseness. This case demonstrates the use of endovascular stents to treat the causative pathology with resolution of symptoms. In expert hands, it represents low risk, minimally invasive therapeutic strategy with excellent early results in patients who are high risk for open procedure

Giant Intrathoracic Lipoma

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Anomalous Origin of the Right Coronary Artery from the Left Coronary Sinus : Case report

The anomalous origin of the right coronary artery from the left coronary sinus is a rare congenital disorder and can often result in sudden death upon initial presentation. We report a 19-year-old male patient who was referred to the Sultan Qaboos University Hospital, Muscat, Oman, in 2015 with multiple episodes of exertional angina. He was diagnosed as having an anomalous right coronary artery arising from the left coronary sinus following an intraoperative transesophageal echocardiogram. An unroofing ostioplasty of the anomalous right coronary artery was successful. Details of the surgical management of this anomaly are discussed

Alternative access options for transcatheter aortic valve replacement in patients with no conventional access and chest pathology

ObjectiveAortic stenosis is the most common valvular pathology in the elderly. Transcatheter aortic valve replacement has emerged as a safe and feasible alternative for high-risk patients. However, a significant number of patients are still not transcatheter aortic valve replacement candidates because of poor peripheral access and chest pathology. We report the use of alternative access options for such patients.MethodsSeven patients who had poor peripheral access and chest pathology had transcatheter aortic valve replacement using alternative access techniques. Five patients had the valve delivered by direct cannulation of the aorta via a mini-sternotomy, and 1 patient had the valve delivered via a mini–right thoracotomy. In 1 patient, the right subclavian artery was cannulated. Intraprocedural and 30-day outcome data were analyzed.ResultsThe mean age of patients was 85.00 ± 9.59 years, with a Society of Thoracic Surgeons score of 16.81% ± 6.87% and logistic European System for Cardiac Operative Risk Evaluation of 21.59% ± 8.46%. Procedural success was 100%. Procedural and 30-day mortality were zero. There were no access-related complications or neurologic events. Two patients had worsening renal function that did not require dialysis. All patients were discharged with a median hospital stay of 7 days. In our experience of 138 transapical or alternative access patients, 7 died (5%) and for 257 transfemoral patients, 1 died (0.4%).ConclusionsDespite the high surgical risk of the study population, these techniques had excellent outcome with no mortality and acceptable morbidity. With the use of currently available technologies, these approaches are promising and offer alternative options in patients with no access and prohibitive chest pathology or pulmonary function