Large pericardial cyst in an asymptomatic child: a case report.

We present a case report of a nine-year-old asymptomatic girl with a large cystic lesion of the left hemithorax, occupying almost 80% of the left hemithorax, first believed to be a parasitic cyst that was operated and proved to be of parietal pericardial origin. Mediastinal cysts and pericardial cysts in particular are mostly discovered accidentally and so was the case with our patient. The diagnosis included not only clinical examination but also the utilization of computed tomography and magnetic resonance imaging. The only treatment for pericardial cysts is surgical excision and patients recover fully with no complication.

Surgical treatment of the atrial septal defect in adults: effective reduction in cardiac size and excellent overall clinical outcome.

OBJECTIVE: Atrial septal defect (ASD), one of the commonest congenital heart lesions, is asymptomatic in most cases and therefore remains undiagnosed until adulthood in a significant number of patients. Despite the employment of transcatheter modalities in its treatment, surgery remains a reliable alternative. This study summarizes our experience in surgical correction of ASD in adult patients. METHODS: Over a 9-year period (September 1997-August 2006), 171 patients, 73 males and 98 females, aged 18-72 (median 35) years, underwent surgical repair of ASDs'. Of these, 141 patients (82%) had ASD of the secundum type and 30 (18%) sinus venosus ASD with partial anomalous pulmonary venous connection (PAPVC). Fifteen patients with different principal diagnoses and concomitant ASD's were excluded, as were those with ostium primum ASDs'. Eighty six patients (50%) were asymptomatic and 11 (6.4%) had established arrhythmias. Two patients had recurrent lesions, 5 had a previously failed attempted transcatheter closure of which 3 were admitted as emergencies. All underwent complete surgical repair. RESULTS: Two patients (aged 53 and 69 years) with chronic atrial fibrillation suffered embolic strokes (1.16%), with one of the two subsequently dying from cerebral haemorrhage (0.6%). Other postoperative complications (including atrial arrhythmias) were treated successfully. Median ICU and hospital stay were 1 and 6 days respectively. Significant reduction in heart size was noted postoperatively as defined by the reduction in the cardiothoracic ratio (p=0.003). At mean follow up of 55+/-28 months, there was one late death from heart failure in a patient with advanced preoperative disease. All other patients remain in excellent clinical condition. CONCLUSION: Surgical correction of ASD is associated with low morbidity and mortality. Arrhythmias and their complications could be prevented by early surgical treatment.

Tetralogy of Fallot: influence of right ventricular outflow tract reconstruction on late outcome.

Surgical repair of Tetralogy of Fallot (TOF) is followed by very good early and medium-term results (perioperative mortality < or =5%), but there is increasing awareness of the occurrence of late adverse events: many patients experience progressive right ventricular (RV) dilatation/dysfunction leading to symptomatic right ventricular failure, arrhythmias, need for reoperation(in 5-15% of patients within 5-20 years after initial correction ), and late death. Although some predisposing factors such as complexity of anatomy (borderline pulmonary artery (PA) size, right ventricular outflow tract (RVOT) hypoplasia), age at operation, or prior shunting appear to affect early or late outcome adversely, it is debatable if other factors such as type of repair or use of a transannular patch correlate with poor late outcome or increased reoperation rates. Obviously, if careful study reveals specific modifiable factors predisposing to adverse late events (e.g. component of surgical technique), appropriate modification in surgical management may lead to improved late outcome.

Minimally invasive long saphenous vein harvesting using a laryngoscope.

BACKGROUND: Traditional open incisions for long saphenous vein (LSV) harvesting are common sources of post operative complications after coronary artery bypass grafting (CABG). To reduce pain and wound healing complications, minimally invasive harvesting techniques are being developed. We have investigated the use of a conventional laryngoscope for cost effective saphenous removal using short incisions and long subcutaneous tunnels. METHODS: The LSV was exposed through small incisions connected by long subcutaneous tunnels. Soft tissue retraction, visualization and illumination were provided by a sterilized laryngoscope with a #3 or #4 Macintosh blade. Dissection was performed with standard instruments while branch ligation was performed with vascular clips. Thirty two patients undergoing CABG between October 1997 and January 1998 underwent minimally invasive vein harvesting assisted by a laryngoscope. Clinical outcomes were evaluated. RESULTS: There were 27 males and 5 females with a mean age of 62.6 +/- 9.3 years in this study. Adequate saphenous vein was removed in 29 of 32 cases. (In three patients, the vein was so superficial that an open incision proved easier). The length of harvested conduit averaged 38.2 +/- 11.01 centimeters (21-55 centimeters). Harvesting time average 37.1 minutes (+/-10.8 minutes; range from 20 to 62 minutes). Postoperatively, There were no wound dehiscences, infections, cellulitis, or major hematomas. Pain and leg edema were considerably less than with traditional open harvest. CONCLUSIONS: Minimally invasive vein harvesting is less traumatic to the extremity with fewer complications and superior patient satisfaction. Although commercial disposable systems are now available to permit minimally invasive harvesting of the saphenous vein, a conventional laryngoscope can be used with much reduced costs.