Asymptomatic giant hiatal hernia with double heart shadow.

Giant hiatal hernias are rare, accounting for 0.3% of all hiatal hernias. We report a case of giant hiatal hernia in an elderly male diagnosed incidentally on evaluation of polytrauma.

Combined approach for a left pneumonectomy and carinal reconstruction.

Tumor involving the carina is a real challenge to thoracic surgeons due to the complexity of airway reconstruction and management. Carinal resection is a safe procedure in highly selected patients with acceptable morbidity and mortality and good long-term survival. A 32-year-old lady with adenoid cystic carcinoma arising from the left main bronchus underwent carinal pneumonectomy using a combined thoracotomy and midline sternotomy approach without the use of cardiopulmonary bypass.

Four-decade-old benign tracheomediastinal fistula.

A 70-year-old male with a nagging cough of 40-year duration was evaluated and found to have a tracheomediastinal fistula. He gave history of rigid bronchoscopy 40 years back. He underwent successful resection of the fistula and was fully relieved of his symptom.

In-stent restenosis: surgical and histopathological perspective.

Background In-stent restenosis has been recognized as a distinct clinical entity that warrants a repeat procedure either in the form of percutaneous reintervention or coronary artery bypass grafting. Multivessel grafting with endarterectomy and explantation of the stent is rarely performed, with few cases reported in the literature. We aim to study the pathomorphology of the stent-vascular interface in coronary vessels undergoing in-stent restenosis. Methods Over a period of 3 years, 3 patients who had undergone angioplasty for diffuse coronary artery disease developed in-stent restenosis and were advised coronary artery bypass. The mean age was 53 years, the average time from the previous intervention was 77 months. Coronary endarterectomy with stent removal and concomitant multivessel coronary artery bypass was performed. Results Histology showed significant proliferation of the well-endothelialized intima as the reason for in-stent restenosis. There were no signs of local thrombus formation or increased inflammatory activity in any of the specimens. After coronary artery bypass, all patients were asymptomatic at a mean follow-up of 32 months. Conclusion Coronary endarterectomy with stent explantation and multivessel coronary artery bypass is a procedure that requires attention because the need is increasing due to the rise in the number of angioplasties. The complexity of this procedure increases to the extent that the adventitia is involved during stent explantation.

MitraClip and mitral annuloplasty device as a bridge to transplantation.

A 42-year-old man with dilated cardiomyopathy and endstage heart failure was evaluated for heart transplantation. He received a MitraClip and Carillon annuloplasty device for functional mitral regurgitation as palliation for his heart failure. Subsequently, he underwent successful heart transplantation.

Intralobar sequestration with situs inversus totalis.

Pulmonary sequestration is a relatively rare congenital lesion of the lung. The occurrence of intralobar pulmonary sequestration coincidentally with situs inversus totalis is an interesting combination. We report a case of intralobar sequestration with situs inversus totalis a 30-year-old lady, which was treated successfully in our institution.