Surveillance for moderate-sized thoracic aortic aneurysms: Equality is the goal.

Comprehensive clinical and imaging-based surveillance represents a fundamental aspect in the management of thoracic aortic aneurysms (TAAs), affording the opportunity to identify intermediate-sized TAAs before the onset of worrying symptoms or devastating acute aortic dissection/rupture. Currently, size-based indices are favored as the major determinants driving patient selection for surgery, as supported by aortic guidelines, although it is recognized that smaller subthreshold TAAs may still confer substantial risks. Prophylactic aortic surgery can be offered within set timeframes at dedicated aortic centers with excellent outcomes, to mitigate the threat of acute aortic complications associated with a repeatedly deferred intervention. In this commentary, we discuss a recent article from the Journal of Cardiac Surgery that highlights important socioeconomic disparities in TAA surveillance and follow-up.

Uniportal VATS retrieval of an endobronchial coil migrated through pericardium.

Endobronchial insertion of nitinol coils is a minimally invasive treatment strategy for selected patients with advanced emphysema. Although coil migration into the pleural space has been described by Marchetti et al. (Endobronchial coil penetration into the pleural space. Thorax 2018;73:890-1) [ 1], breach through the pericardium has not been reported to date.

Suspended animation: the past, present and future of major cardiothoracic trauma.

About 50% of the trauma victims die at the scene mostly because of exsanguinating haemorrhage. Most trials of resuscitation fail in face of the ongoing bleeding. Ongoing research/studies to save these victims by inducing rapid hypothermia using cardiopulmonary bypass as an emergency initial measure along with delayed resuscitation show improved outcomes. A comprehensive review of this research and analysis of studies showed that rapid induction of hypothermia within 5 min of cardiac arrest is associated with better survival and improved neurological outcome. This led us to conclude that suspended animation is a lifesaving modality for the treatment of trauma victims, otherwise hurtling towards certain death. This should be integrated into regular clinical practice. The US Food and Drug Administration has given its approval for clinical trials on such an intervention.

A rare case of occult splenic rupture after left pneumonectomy.

Cardiopulmonary resuscitation (CPR) techniques are now well-established and play a crucial role in improving survival in cardiac arrest. Recognized complications associated with CPR include injury to the upper abdominal viscera, including the liver, stomach and spleen. We present a rare case of occult splenic rupture following cardiac arrest in a 63-year-old male immediately after left pneumonectomy. We discuss potential mechanisms predisposing the spleen to injury in this case, and highlight the difficulty of promptly identifying such a traumatic injury within the confines of a cardiac arrest scenario. Clinicians should be aware that anatomical changes following thoracic surgery may render the intra-abdominal viscera at increased risk of injury following CPR.