Cerebral Infarction Following Correction of Aortic Coarctation Surgery in Children

Background: Coarctation of the aorta (CoA) is a congenital heart defect. Due to the narrowing of the descending aorta, blood flow mainly reduces after the stenosis, and CoA can occur at any region in the thoracic and abdominal aorta. Cardiac surgeons and cardiologists are familiar with postoperative complications of CoA;however, there are also some other complications that have not been reported to date. Case Presentation: The present study investigated three cases of CoA undergoing reconstructive surgery. Nevertheless, a couple of days after the surgery, they manifested symptoms suspected of cerebral infarction. Ischemic infarction was observed after performing brain computed tomography. Additionally, we discuss possible pathophysiology and reasons that can lead to this problem. Conclusions: In this case report, we presented three cases of CoA patients who underwent reconstructive surgery and manifested cerebral infarction as an adverse effect of the reconstructive surgery.

The Orvil end-to-side anastomosis for Ivor-Lewis minimally invasive esophagectomy: technique, considerations, and challenges

Novel modification of the end-to-end anastomosis (EEA) circular stapler anvil for transoral passage significantly bypassed the technical challenges of intracorporal anvil placement for minimally invasive upper gastrointestinal anastomoses. Since commercialization of this concept as the Orvil (Covidien, Minneapolis, MN, USA), circular double-stapled techniques have been utilized for reconstruction following Ivor-Lewis minimally invasive esophagectomy (MIE). Despite its relative simplicity and popularity, the anastomosis has received critique for the issue of overlapping staple lines, which may increase rates of leak and stricture. Although these concerns have validity, their impact can be greatly reduced with strong consideration of procedural nuances. Meticulous care is needed to reduce microvascular trauma, maintain proper alignment, and eliminate tension. Overall construction of a successful anastomosis is a dynamic process which is dependent on a combination of numerous patient and technical factors. Based on the most recent literature, rates of both clinically significant leak and stricture are approximately 4% for the Orvil double-stapled esophagogastric anastomosis. Here we present our own technique and highlight the technical challenges which must be considered for successful creation of the Orvil EEA double-stapled anastomosis during Ivor-Lewis MIE. With proper understanding of technical aspects, experience, and practice refinement, the anastomosis adds an effective and convenient reconstructive option to the esophageal surgeon's repertoire. © 2022 Journal of Innovation Management. All rights reserved.