Frozen Elephant Trunk: A technique which can be offered in complex pathology to fix the whole aorta in one setting

We report a case of treating complex aortic pathology with the use of the Frozen Elephant Trunk technique in a patient with chronic type B aortic dissecting aneurysm associated with arch and ascending aorta dilatation, proximal aortic disease and coronary disease. The case was further complicated due to the involvement of the abdominal vessels and preexisting femoral to femoral crossover bypass. In addition the patient had a tracheostomy for laryngeal cancer

Cor triatriatum presenting as heart failure with reduced ejection fraction: a case report

Cor triatriatum is a rare congenital cardiac malformation and it usually refers to the left atrium. We report an unusual case of cor triatriatum in a 33 - year old woman presented with congestive heart failure caused by left ventricular systolic dysfunction

Skeletonization of radial and gastroepiploic conduits in coronary artery bypass surgery

The use of a skeletonized internal thoracic artery in coronary artery bypass graft surgery has been shown to confer certain advantages over a traditional pedicled technique, particularly in certain patient groups. Recent reports indicate that radial and gastroepiploic arteries can also be harvested using a skeletonized technique. The aim of this study is to systematically review the available evidence regarding the use of skeletonized radial and gastroepiploic arteries within coronary artery bypass surgery, focusing specifically on it's effect on conduit length and flow, levels of endothelial damage, graft patency and clinical outcome. Four electronic databases were systematically searched for studies reporting the utilisation of the skeletonization technique within coronary revascularisation surgery in humans. Reference lists of all identified studies were checked for any missing publications. There appears to be some evidence that skeletonization may improve angiographic patency, when compared with pedicled vessels in the short to mid-term. We have found no suggestion of increased complication rates or increased operating time. Skeletonization may increase the length of the conduit, and the number of sequential graft sites, but no clear clinical benefits are apparent. Our study suggests that there is not enough high quality or consistent evidence to currently advocate the application of this technique to radial or gastroepiploic conduits ahead of a traditional pedicled technique

Is the thoracic aorta a safe site for the proximal anastomosis for bypassing the mesenteric arteries in patients with chronic mesenteric ischaemia?

A best evidence topic in cardiovascular surgery was written according to a structured protocol. The question addressed was whether the thoracic aorta is a safe site for the proximal anastomosis when bypassing the mesenteric arteries in patients with chronic mesenteric ischaemia. Five articles reported the use of the thoracic aorta as the site of proximal anastomosis in 35 patients with chronic mesenteric ischaemia. All of these studies were retrospective case reports or case series. The ascending aorta was the site for the proximal anastomosis in 7 patients with the descending thoracic aorta being used in the other 28 patients. The ascending aorta was used when there was disease of the descending thoracic aorta. Out of the 35 patients there was only 1 perioperative death (3%). Rates of graft patency and freedom from recurrent symptoms were excellent. The published literature supports the use of the thoracic aorta as an option for the site of the proximal anastomosis when bypass from elsewhere is not possible

Surgical repair of distal arch psendoaneurysm from ruptured penetrating aortic ulcer with the frozen elephant trunk technique

Ruptured Penetrating Ulcer and aortic arch pseudo-aneurysm is a rare condition but one which carries a high risk of rupture. We report the case of a 74-year-old man with aortic arch pseudo-aneurysm, in which a Frozen Elephant Trunk procedure was successfully performed. There were no postoperative complications at 6 months follow-up. The Computed Tomography Angiogram demonstrated thrombus formation in the pseudo-aneurysm lumen, with no endoleak on the stented part of the descending thoracic aorta and complete patency of all branches of aortic arch. This case demonstrates that the Frozen Elephant Trunk technique may be the treatment of choice when treating such complex aortic arch lesions provided there is no absolute contraindication to radical surgical intervention. However, long-term clinical efficacy and safety have yet to be confirmed

Surgical management of superior vena cava syndrome following pacemaker lead infection: a case report and review of the literature

Superior vena cava (SVC) syndrome is a known but rare complication of pacemaker lead implantation, accounting for approximately less than 0.5% of cases. Its pathophysiology is due to either infection or endothelial mechanical stress, causing inflammation and fibrosis leading to thrombosis, and therefore stenosis of the SVC. Due to the various risks including thrombo-embolic complications and the need to provide symptomatic relief, medical and surgical interventions are sought early. We present the case of a 48-year Caucasian male who presented with localised swelling and pain at the site of pacemaker implantation. Inflammatory markers were normal, but diagnostic imaging revealed three masses along the pacemaker lead passage. A surgical approach using cardiopulmonary bypass and circulatory arrest was used to remove the vegetations. Culture from the vegetations showed Staphylococcus epidermidis. The technique presented here allowed for safe and effective removal of both the thrombus and infected pacing leads, with excellent exposure and minimal post-procedure complications

Minimal access excision of aortic valve fibroelastoma: a case report and review of the literature.

Papillary fibroelastomas are rare primary tumours of cardiac origin accounting for approximately 10% of all primary cardiac neoplasms. Due to a high thromboembolic risk, surgical excision is the mainstay of treatment in these patients and median sternotomy the most widely used approach. We describe the case of a 43 year-old lady presenting with acute myocardial infarction secondary to aortic valve papillary fibroelastoma subsequently excised using a minimal access technique. From our experience mini-sternotomy offers excellent exposure and allows for safe resection in such cases, improving cosmesis without compromising either intra or post-operative outcome

Single stage repair for aortic root aneurysm in a patient with coexisting coarctation incorporating the Cabrol technique: a case report

Background A 44 year old man who presented with a history of chest pain and dyspnoea was found to have an aneurysm of the aortic root, aortic valve insufficiency, and coarctation of the aorta. Case presentation The patient underwent a single stage procedure to treat the aortic root, valve and coarctation with a composite valved conduit and extra-anatomic bypass of the coarctation. The modified Cabrol technique was necessary to attach the coronary buttons due to grossly abnormal anatomy. The patient made a remarkable recovery and was discharged on the 8th post-operative day. Conclusion This case report highlights the feasibility and efficacy of performing a single stage procedure on complex coarctation with associated cardiac defects. To the best of our knowledge, this is the first report of the modified Cabrol technique being used in this particular setting