Biologic Valve Leaflet Perforation Causing Persistent Aortic Insufficiency After Successful Transcatheter Closure of Paravalvular Leak.

Persistent paravalvular leak after aortic valve replacement prompted transcatheter closure with an Amplatzer VSD device. Although technically a successful procedure, aortic insufficiency persisted, leading to surgical reexploration and valve replacement.

Right thoracotomy approach for repair of recurrent or complex coarctation of the aorta using an extra-anatomic ascending aorta to descending aorta bypass graft off-pump.

A previously described but rarely used surgical technique for the repair of complex or recurrent coarctation of the aorta through a right thoracotomy approach is presented in detail. It has the advantages of being simple and avoiding left chest re-entry, median sternotomy and cardiopulmonary bypass altogether.

Chylopericardial tamponade masquerading as hemopericardium: an uncommon complication of cardiac surgery.

Chylopericardial tamponade occurs very rarely after heart surgery. It may be the result of lymphatic duct interruption during mammary artery harvest, division of a large thymic remnant, or thrombosis of the subclavian or internal jugular vein by an indwelling central line. Although relatively straightforward when the pericardial aspirate has the usual milky appearance, the correct diagnosis can easily be overlooked particularly early after surgery when the patient is still fasting. We present a case report that illustrates the importance of sending all aspirates for chemical analysis irrespective of their color to arrive at the correct diagnosis and institute the appropriate medical management of this rare condition.

Acute aortic dissection early after off-pump coronary surgery: true frequency underestimated?

Since the adoption of off-pump coronary artery bypass surgery (OPCAB), numerous investigators have compared its short- and long-term results with those of on-pump coronary bypass surgery. Some reports of OPCAB were quite favorable, whereas others were critical, claiming that it resulted in incomplete revascularization and reduced venous graft patency. A potentially serious complication of OPCAB, not heretofore sufficiently confronted, is the increased incidence of early postoperative acute aortic dissection, in comparison with the more familiar intraoperative and late-occurring aortic dissection after conventional on-pump bypass surgery.Early postoperative acute aortic dissection after OPCAB appears to be more frequent than was initially thought. Its clinical manifestations can be unusual and often neurologic in nature-rendering diagnosis difficult, causing delays in surgical intervention, and resulting in a high mortality rate.When the physician notes unusual developments in patients after OPCAB that lead to the suspicion of aortic dissection, immediate computed tomography of the chest and surgery should occur if dissection is confirmed. If not detected early, this sequela almost certainly leads to rapid death from aortic rupture. Prevention lies in the strict control of systolic blood pressure during the performance of proximal anastomoses; avoidance of aortic clamping through the use of sequential all-arterial grafts or new-generation mechanical connectors; and, at times, aggressive replacement of the aorta with a prosthetic graft.Herein, we present the cases of 4 patients who sustained acute aortic dissection early after OPCAB. We review the pertinent medical literature.