Alan Soo

Intra aortic balloon pump: literature review of risk factors related to complications of the intraaortic balloon pump.

The increasing use of the intra aortic balloon pump is attributed to the relatively easy percutaneous insertion and the low threshold of use over the past few years, especially in elderly patients with multi-vessel diseases and an affected ejection fraction.Unfortunately, the clinical assessment of the complications associated to the use of this supporting device, underestimates the frequency of such complications.This report has looked at the current literature and attempt to identify incremental risk factors related to the development of adverse effects during support with an intaaortic balloon pump.The paper concludes that in contrary to early reports, newer studies have shown that complications following intraaortic balloon pump treatment, is decreasing. Moreover the literature suggests that the thrombosis and infective complications are relevant to the duration of the pump treatment, while the ischemic problems of the limbs are mostly linked to the atherosclerotic status of the common femoral artery.

Brief review on systematic hypothermia for the protection of central nervous system during aortic arch surgery: a double-sword tool?

Antegrade selective cerebral perfusion in conjunction with hypothermia attenuate postoperative neurological injury, which in turn still remains the main cause of mortality and morbidity following aortic arch surgery. Hypothermic circulatory arrest however could be a useful tool during arch surgery, surgery for chronic thromboembolic disease, air on the arterial line during CPB, during cavotomy for extraction of renal cell carcinoma with level IV extension, or when dealing with difficult trauma to the SVC or IVC. Cerebral protective effects with hypothermic procedures including inhibition of neuron excitation, and discharge of excitable amino acids, and thereby, prevention of an increase in intercellular calcium ions, hyperoxidation of lipids in cell membranes, and free radical production.The authors are briefly discussing the fundamental principles of using hypothermia as an adjunct tool of the cardiothoracic surgeons practice. The relationship between temperature, flow, metabolic requirements and adverse effects is addressed.

Bronchoplastic procedure for an unusual indication – Wegener's granulomatosis

Wegeners granulomatosis (WG) is a systemic vasculitic condition that commonly affects the lung and kidneys. With improvement in medical therapy, airway complications are increasingly encountered and are difficult to manage. Here, we present a case whereby a patient presenting with airway complication is successfully treated with surgery.

Ascending aorta thrombus: A diagnostic and treatment dilemma.

Due to its position, a mass lesion in the ascending aorta poses a diagnostic and treatment dilemma. We describe the management of a symptomatic mass in the ascending aorta in a 35-year-old man who presented with a cerebrovascular accident.

Intra-aortic balloon pump (ΙΑΒΡ): from the old trends and studies to the current “extended” indications of its use

This report outlines the well defined indications of using IABP and also favours extending the indications of IABP use, to include not only “therapeutically” the aging unstable patients but also “prophylactically” patients with low EF or high Euroscore.

Complete right ventricular obstruction caused by a giant cardiac myxoid sarcoma

Myxoid sarcoma is a very rare variant of primary malignant sarcoma of the heart, which presents like a myxoma. We describe the case of 21-year-old man with a giant myxoid sarcoma occupying most of the right ventricle. He underwent emergency surgery to resect the tumor and replace the tricuspid valve which was infiltrated. Chemotherapy and radiotherapy were given postoperatively.

Superior Sulcus Tumour with some Emphasis on the Anterior Approach

Superior sulcus tumours are rarely encountered in clinical practice, representing < 5% of all bronchogenic carcinomas [1, 2]. In 1932, Pancoast [3] published his classic article in which he reported four patients who had a similar presentation including pain in the shoulder and arm, weakness and wasting of the muscles of the hand, and ipsilateral Horner syndrome together with a lesion situated at the apex of the lung. Pancoast [3] rejected the pulmonary origin of the tumour that was recognised by Tobias [4], who described the same clinical syndrome in four other patients.

The Impact of Arterial Grafts in Patients Undergoing GABG

Recent trials such as the SYNTAX have shown that CABG is superior to PCI in most circum‐ stances of coronary artery disease. Although there are certain anatomical lesions such as isolated left main disease treatment options to be elucidated, CABG remains the gold standard treatment for severe coronary artery disease. Data from studies such as SYNTAX and ART confirmed by the National Cardiothoracic Surgery Database have also shown the low mortality risk of CABG.

Depicting adverse events in cardiac theatre: the preliminary conception of the RECORD model

Human error is a byproduct of the human activity and may results in random unintended events; they may have major consequences when it comes to delivery of medicine. Furthermore the causes of error in surgical practice are multifaceted and complex. This article aims to raise awareness for safety measures in the cardiac surgical room and briefly “touch upon” the human factors that could lead to adverse outcomes. Finally, we describe a model that would enable us to depict and study adverse events in the operating theatre.

Translocation of dehisced aortic prosthesis to left ventricular outflow tract

Transthoracic echocardiography in a 49-year-old woman with previous aortic valve replacement, revealed dehiscence of the mechanical prosthesis with severe paravalvular leak and severe aortic regurgitation. The rocking dehisced aortic prosthesis protruded deep into the left ventricular outflow tract with each heartbeat. The annulus of the prosthetic valve, corresponding to the noncoronary cusp, had slipped into the left ventricle and adhered to the undersurface of the anterior mitral leaflet. This resulted in tethering and loss of coaptation of the mitral leaflets, causing severe mitral regurgitation with an eccentric jet directed posteriorly (Figure 1). Angiography delineated an enlarged aortic root and ascending aorta (Figure 2), confirmed on computed tomography, measuring 4.4 cm. The aortic prosthesis was replaced. Intraoperatively, it was confirmed to have dehisced circumferentially, translocated to the left ventricular cavity, and was floating free in the left ventricular outflow tract, attached to the anterior mitral leaflet by dense fibrous tissue only.