Transapical cannulation for surgical repair of chronic type B aortic dissection

Open surgery for chronic type B aortic dissection has been shown to have considerable risks of cerebrovascular complications. Because retrograde perfusion is a potential cause of intraoperative cerebrovascular events, we report our transapical cannulation strategy for descending aorta replacement in chronic type B aortic dissection repair with circulatory arrest. This technique provides an easy and quick establishment of cardiopulmonary bypass by way of a left thoracotomy, and prevention of cerebrovascular event. Transapical cannula can be also used as a vent to ensure a bloodless field during proximal anastomosis and to prevent extension of left ventricle during rewarming. Transapical cannulation is a useful option in open repair of the descending aorta for chronic type B aortic dissection by way of left thoracotomy.

Off-Pump HeartMate 3® LVAD Implantation via Left Thoracotomy to Descending Aorta: Transition from Transaxillary Impella 5.0® LVAD

A 62-year-old man with a prior history of Coronary Artery Bypass Grafting (CABG) presented in cardiogenic shock. A percutaneous left femoral Impella CP® Left Ventricular Assist Device (LVAD) was placed with modest improvement in hemodynamics. The LVAD was upgraded to an open right transaxillary Impella 5.0® with hemodynamic stabilization. Cardiacfunction was assessed with serial echocardiography demonstrating persistent severe left ventricular dysfunction. In view of previous CABG with patent Left Internal Mammary Artery (LIMA) graft the decision was made to place a HeartMate 3® LVAD via left thoracotomy with LV apical inflow and descending aortic outflow. This approach was completed without the need for Cardiopulmonary Bypass (CPB). The postoperative course was uneventful and discharge to a rehabilitation center occurred on the ninth postoperative day.

Double Aortic Arch with Coarctation of Aorta in an Adolescent: Unraveling the Vascular Ring

We report the case of a 12-year-old girl with balanced double aortic arch with coarctation of the aorta presenting with symptoms of respiratory and swallowing difficulty. On investigation, the patient had a double aortic arch with coarctation and clinically nonsignificant disease in the infrarenal aorta. Division of the nondominant aortic arch was done through a left thoracotomy, along with resection of the coarctation segment and placement of an interposition Dacron tube graft.

Reconstruction of the Aortic Arc through Left Thoracotomy in Patients with Isolated Coarctation and Aortic Arch Hypoplasia

Background. The choice of surgical approach for the reconstruction of aortic arch hypoplasia is a rather controversial issue. Traditionally, left lateral thoracotomy is used to correct aortic coarctation with hypoplasia of one or more arc seg-ments. However, in recent years, more and more clinics have begun widespread use of median sternotomy for the surgical treatment of aortic arch hypoplasia. The purpose of the research was to analyze the immediate and long-term results of surgical treatment of isolated hypoplasia of the aortic arch in infants through left thoracotomy. Materials and methods. From 2010 to 2019, 159 infants with coarctation and hypoplasia of one or more segments of the aortic arch underwent reconstruction of the aortic arch at the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine and Ukrainian Children’s Cardiac Center. The study included only patients with biventricular physiology and subsequent biventricular correction. There were 108 male patients (68%) and 51 female patients (32%). The mean age of the patients was 2.4 ± 0.9 months, the mean body weight was 4.7 ± 2.0 kg. The main method of diagnosis, i.e. determining the defect and assessing the immediate and long-term results, was echocardiographic examination. The study group consisted of 155 patients (97.5%) in whom the reconstruction of the aortic arch was performed through left thoracotomy, in the remaining 4 patients (2.5%) the intervention was performed through median sternotomy. Results. In-hospital mortality was 0.6% (n = 1). The average time of the operation was 126 ± 40 minutes, the aortic cross-clamp time was 24.7 ± 5.1 minutes. The mean duration of mechanical ventilation after the surgery was 41 ± 15.9 hours. The mean follow-up period ranged from 1 month to 13 years. There were no deaths in the long-term period. Ten (6.4%) patients developed aortic arch restenosis in the postoperative period. In 8 patients, the narrowing was treated by endovascular dilatation. Two patients underwent repeated aortic arch repair using median sternotomy. There were no cases of compression of the trachea, main bronchi, neurological complications in the follow-up period. Conclusions. Reconstruction of the aortic arch hypoplasia through left thoracotomy is an effective and safe treatment option in infants associated with good immediate and long-term results. The study indicates that this surgical strategy can be used in most patients with hypoplasia of the isthmus and distal aortic arch.

Mycobacterium Other Than Tuberculosis (MOTT) – A Case Report: الجرثومة الفطرية غير الدرنية - تقرير حالة

Patients with chronic obstructive pulmonary disease (COPD) and bronchiectasis are considered at risk of non-tuberculous mycobacterial lung disease especially those on inhaled corticosteroids. We described a case of a 69-year-old male, Ex. a heavy smoker with past history of pulmonary tuberculosis, COPD with diffuse centro lobular emphysema; status post left thoracotomy for hydropneumothorax, left-sided bullectomy done 8 months back. Patient admitted in our hospital " King Fahad General Hospital, Jeddah " with a history of chronic productive cough with an increased SOB, on/ off fever, night sweats and loss of weight in the last 3 months. No hemoptysis. On examination, he was conscious, oriented, afebrile, positive clubbing. Vitally stable. Chest examination showed a scare of left thoracotomy clean with small chest wall bulge; decreased breath sounds with bilateral ronchi and dullness in the left lower chest. Laboratory investigations showed hyperleukocytosis of 14.6 and serology for HIV was negative. CT scan chest showed left lobulated pleural effusion with empyema necessities, a diffuse emphysematous lung disease with bilateral thick wall cavities and pulmonary nodules as well as left bronchiectasis changes with underlying consolidation collapse. US-guided left pleural aspiration done showed exudative polymorph inflammation. Pleural fluid AFB and PCR was negative and two samples of AFB sputum were positive (2+), PCR was negative, 2 Bactec cultures were positives with the rapid growth of MOTT. Mycobacterial Avium Complex has been identified (Mayoclinic lab. in USA) which is sensitive to Rifampicin*, Clarithromycin* and Ethambutol* but resistant to Moxifloxacin and to Linozelid*. Patient treated with a combination of Rifampicin + Ethambutol* +Clarithromycin* for 18 months with clinical and radiologic improvement and good tolerance. This Study is a "case report study" aimed to report a very rare case, to report a new case of MOTT in Saudi Arabia for the purpose of statistics and for scientific benefit.