Fatal hyperacute left main thrombosis after aortic root surgery.

Acute aortic root thrombosis is a potentially lethal condition due to the possibility of thrombosis into the ascending aorta branches, resulting in various clinical manifestations. A 29-year-old male patient was admitted to our center with hyperacute left main thrombosis after elective Bentall procedure. Due to massive left ventricular infarction, the patient was supported by extracorporeal membrane oxygenation, but without success to recovery. The patient's blood analyses revealed a high level of the Factor VIII. In conclusion, Factor VIII levels in the blood are elevated by genetic abnormalities, infectious diseases such as severe acute respiratory syndrome-coronavirus 2 infection, and vascular inflammation. This pathological condition may be a reason for hyperacute thrombosis.

Case Report: Giant cholesterol granuloma in the anterior mediastinum.

Cholesterol granuloma is a rare entity, which can develop in many regions of the body, accounting at most 1% of all mediastinal tumors. Etiology of this granuloma is still not clearly understood. The gold standard choice of treatment for cholesterol granuloma is total surgical resection. Symptomatic mediastinum granuloma can be easily diagnosed, but if mass effect is not evident then diagnosis of this tumor is really challenging. We present a rare case of huge cholesterol granuloma in the anterior mediastinum of the patient who underwent on elective coronary artery graft bypass surgery.

Surgical treatment of right ventricle thrombus in a patient with iron-deficiency anaemia.

Right ventricle organized thrombus is a rare pathological condition diagnosed in patients with a risk factor. The most common are right ventricle (RV) failure, autoimmune disease (Behcet disease), hypercoagulable disorder, anaemia, RV pacing leads, pulmonary artery catheters, RV infarction, and ventricular arrhythmogenic cardiomyopathy. The literature describes the impact of iron-deficiency anaemia on thrombosis. We described surgical extirpation of the organized right ventricle outflow tract (RVOT) thrombus in a patient with iron-deficiency anaemia. Supplementary Information: The online version contains supplementary material available at 10.1007/s12055-022-01460-w.

Large Lipoma of the Lateral Space of the Neck.

Giant lipoma is characterized by asymptomatic growth and compared with other parts of the body rarely occurs on the neck. If the tumor is localized in the lateral segment of the neck, it can show symptoms in the form of dysphagia and dyspnea. Preoperatively, it is important to perform computed tomography (CT) diagnostic to determine the size of the lesion and makes the plan for operative treatment. The paper presents the case of a 66-year-old patient with a tumor in the neck area as well as swallowing disorders and suffocation during sleep. Palpation revealed a tumor of soft consistency, and based on a CT scan of the neck, the differential diagnosis confirmed giant lipoma. Clinical picture and CT findings of giant neck lipoma are clear in most cases. Due to the atypical localization and size, the tumor should be removed to prevent possible functional disturbances. The treatment is operative, and a histopathological examination should exclude malignancy.

Influence of Three Different Surgical Techniques on Microscopic Damage of Saphenous Vein Grafts-A Randomized Study.

Background and Objectives: The saphenous vein is one of the most common used grafts (SVG) for surgical revascularization. The mechanism of the SVGs occlusion is still unknown. Surgical preparation techniques have an important role in the early and late graft occlusion. Our study analyzed the influence of the three different surgical techniques on the histological and immunohistochemical characteristics of the vein grafts. Methods: Between June 2019 and December 2020, 83 patients who underwent surgical revascularization were prospectively randomly assigned to one of the three groups, according to saphenous vein graft harvesting (conventional (CVH), no-touch (NT) and endoscopic (EVH)) technique. The vein graft samples were sent on the histological (hematoxylin-eosin staining) and immunohistochemical (CD31, Factor VIII, Caveolin and eNOS) examinations. Results: The CVH, NT, and EVH groups included 27 patients (mean age 67.66 ± 5.6), 31 patients (mean age 66.5 ± 7.4) and 25 patients (mean age 66 ± 5.5), respectively. Hematoxylin-eosin staining revealed a lower grade of microstructural vein damage in the NT group (2, IQR 1-2) in comparison with CVH and EVH (3, IQR 2-4), (4, IQR 2-4) respectively (p < 0.001). Immunohistochemical examination revealed a high grade of staining in the NT group compared to the CVH and EVH group (CD 31 antibody p = 0.02, FVIII, p < 0.001, Caveolin, p = 0.001, and eNOS, p = 0.003). Conclusion: The best preservation of the structural vein integrity was in the NT group, while the lowest rate of leg wound complication was in the EVH group. These facts increase the interest in developing and implementing the endoscopic no-touch technique.

Same-Day Carotid Artery Stenting and Coronary Artery Bypass Surgery.

BACKGROUND: The optimal treatment strategy for patients with severe carotid artery disease undergoing coronary artery bypass grafting is still problematic. The important question is whether it is necessary to treat significant carotid disease in patients who have undergone coronary artery bypass grafting. This study analyzed short- and midterm results after same-day carotid artery stenting and coronary artery bypass grafting. METHODS: From 2013 to 2020, a total of 69 patients were enrolled in the study. Same-day carotid artery stenting and coronary artery bypass grafting were performed in all patients. The study's primary end points were the evaluation rate of stroke, myocardial infarction, and death within short- and midterm periods after the procedures. RESULTS: The 30-day mortality was 0%. The occurrences of perioperative adverse events, namely stroke, myocardial infarction, and transient ischemic attack, were 1 (1.4%), 1 (1.4%), and 4 (5.8%), respectively. Mean (IQR) follow-up time was 28 (IQR, 17-43) months. Six (8.8%) patients died during this period. Fatal stroke was registered in 2 cases, and 1 patient experienced a disabling stroke with a fatal outcome. The other 3 patients died because of chronic renal disease, a traffic accident, and for an unknown reason, respectively. Midterm survival in the group was 91.2%. CONCLUSION: The study showed that same-day carotid artery stenting and coronary artery bypass grafting for concomitant carotid and coronary disease treatment could be a promising and feasible therapeutic strategy.

Long-term results after simultaneous carotid and coronary revascularisation.

BACKGROUND: The revascularisation strategy for concomitant carotid and coronary disease is unknown. Simultaneous or stage coronary artery stenting and carotid endarterectomy are the most common revascularisation approach in the CABG population. This study aimed to evaluate long-term results after simultaneous carotid artery stenting or carotid endarterectomy in patients who underwent coronary artery bypass surgery. METHODS: This is a prospective cohort non-randomised single-institution study. During the period from 2012 to 2015, sixty consecutive patients (65.9 ± 7.41 mean) underwent simultaneous carotid artery stenting and coronary artery bypass surgery (n = 30) or simultaneous carotid endarterectomy and coronary artery bypass surgery (n = 30). The primary endpoints were short- and long-term rates of adverse events (transient ischemic attack, stroke, myocardial infarction, and death). The mean follow-up was 62.05 ± 11.12 months. RESULTS: In-hospital mortality was insignificantly higher in the carotid endarterectomy, and coronary artery bypass surgery group (6.6% vs. 0%), the rate of stroke and myocardial infarction was similar (13.3% and 0% in the carotid endarterectomy and coronary artery bypass surgery group vs. 6.6% and 3.3% in the carotid artery stenting and coronary artery bypass surgery group, respectively). The intensive care unit readmission was significantly higher in the surgical revascularisation approach; it was an independent predictor of hospital mortality. The overall mortality during the follow-up period was 14.28% in both groups. Freedom of the composite adverse outcomes (stroke, myocardial infarction, and death) was 78.55%. CONCLUSION: Comparing two revascularisation strategies is not straightforward due to different anatomical indications for carotid artery stenting and endarterectomy. We consider that each technique has an essential role in carotid revascularisation. Good selection of patients, according to indications, contributes to satisfactory short- and long-term results.