Neglected inferior sinus venosus atrial septal defect diagnosed late after surgical closure of secundum ASD

We descried neglected inferior sinus venosus a trial septal defect in a patient with history of surgical repair of secundum type ASD nineteen years ago. The defect was in the inferior portion of the interatrial septum just at the orifice of the inferior vena cava, far from the previous surgical patch of the secundum ASD repair. Preoperative and/or intraoperative transesophageal echocardiography is necessary for detection of multiple ASDs and reveals the successful repair of sinus venosus defects

Thromboendarterectomy in chronic pulmonary thromboembolism

Chronic pulmonary thromboembolic disease in entrapment of thrombus in pulmonary arteries from a single episode or repeated embolic episodes that subsequently organize, or thrombi that develop inside the pulmonary arteries into firm, fibrous tissue that becomes incorporated into the vessel wall. We operated 7 patients with stage chronic pulmonary thromboembolism over a two year period at our center. Four patients had good function class after operation on follow up at 6 to 12 months and we administered warafarin prophylaxis [with international normalized ratio, INR, of 3] for them. Three patients died in hospital postoperatively. We used extracorporeal membrane oxygenation [ECMO] for one of them but it failed on the third postoperative day

Timely diagnosis of left ventricular posterior wall rupture by echocardiography: a case report

Left ventricular free wall rupture is responsible for up to 10% of in-hospital deaths following myocardial infarction. It is mainly associated with posterolateral myocardial infarction, and its antemortem diagnosis is rarely made. One of the medical complications of myocardial infarction is the rupture of the free wall, which occurs more frequently in the anterolateral wall in hypertensives, women, and those with relatively large transmural myocardial infarction usually 1-4 days after myocardial infarction. We herein present the case of a 66-year-old man suffering inferior wall myocardial infarction with abrupt hemodynamic decompensation 9 days after myocardial infarction. Emergent transthoracic echocardiography revealed massive pericardial effusion with tamponade, containing a large elongated mass measuring 1 x 8cm suggestive of hematoma secondary to cardiac rupture. In urgent cardiac surgery, the posterior wall between the left coronary artery branches was ruptured

Midterm results and surgical technique considerations in pulmonary Thromboendarterectomy. Is hypothermic circulatory arrest always necessary?

Pulmonary Thromboendarterectomy is a curative surgery. However, it is associated with high mortality and morbidity. It's accomplished under a period of circulatory arrest, thereby increasing the risk of surgical complications, especially neurologic squeal. In present study the surgical results of this procedure without the use of circulatory arrest has been presented. Eleven patients with the mean age of 34 +/- 11 year underwent pulmonary Thromboendarterectomy using CPB, moderate hyperthermia, and low pressure perfusion by single surgery from April 2005 to June 2008 in the Rajaee Heart Center, Tehran. Half the patients had the evidence of involvement of segmental branches of pulmonary artery in CT angiography. Most patients presented in the NYHB class III. The mean pre-op PA pressure was 91.3 +/- 26mmHg. All patients were followed between 3-36 months. There were three mortality cases in this study and the first two, were among the early experiences of the surgeon. The most common cause of mortality was respiratory failure and right-sided heart failure secondary to residual pulmonary hypertension., NYHA class improved in all survived. The mean post-op PA pressure was 39 +/- 13 mmHg. Patients were intubated on the average of 75 +/- 4 hours. No neurologic complications were seen. One patient required extracorporeal life support system [ECLS] to wean porn CPB off. Two patients had significant post-op bleeding due to coagulopathy and in the third one surgical source resulted in re-exploration. In this series, mortality was more than one expected however with increased experience and the use of meticulous surgical technics and improvement in peri-operative cares, mortality reduced significantly. Sufficient Thromboendarterectomy is feasible without the use of circulatory arrest, while decreasing probable complication of TCA, especially neurologic ones. Failure to ameliorate pulmonary hypertension during surgery, results, in high mortality and morbidity