David Horne

Laparoscopic nephroureterectomy in a patient with a left ventricular assist device

Left ventricular assist device (LVAD) therapy is an established treatment option for select patients with advanced heart failure. Advances in technology and patient management have resulted in improved post-implant outcomes. Consequently, more patients with LVADs are presenting for evaluation and care of non-cardiac surgical disease. However, there is a paucity of literature regarding the optimal perioperative and surgical management of such patients. We present the case of a 71-year-old male with a HeartMate II (Thoratec Corporation, Pleasanton, CA) LVAD, who underwent a laparoscopic left nephroureterectomy for an upper urinary tract transitional cell carcinoma. His perioperative course was uneventful due to the multidisciplinary efforts of cardiac surgery, cardiac anesthesia, nephrology and urology. To our knowledge, this is the first reported case of a laparoscopic nephroureterectomy in a patient with a HeartMate II LVAD.

Air Transported Pediatric Rescue Extracorporeal Membrane Oxygenation: A Single Institutional Review

Background: Pediatric extracorporeal membrane oxygenation (ECMO) programs are sophisticated endeavors usually found only in high-volume cardiac surgical programs. Worldwide, many cardiology programs do not have on-site pediatric cardiac surgery expertise. Our single-center experience shows that an organized multidisciplinary rescue-ECMO program, in collaboration with an accepting facility, can achieve survival rates comparable to modern era on-site ECMO. Methods: A retrospective review was conducted of all patients initiated on rescue-ECMO from 2004 to 2009 in a single academic pediatric hospital without a pediatric cardiac surgery program. All aspects of ECMO were formalized using Failure Mode Effects Analysis. Results: Eight patients were initially cannulated for ECMO at our institution. Six were subsequently transported by air to the receiving facility 1,305 km away. Extracorporeal membrane oxygenation was initiated in 0.2% of our Pediatric Intensive Care Unit admissions and in 0.52% of all our pediatric cardiac patients. Mean age was 4.0 years (7 weeks to 15 years). Indications for ECMO initiations were cardiogenic shock (n = 5) and acute respiratory distress syndrome (n = 3). Six had veno-arterial- and two had veno-veno ECMO. Two patients were not transported (one death and one weaned locally). Six patients were successfully transported within 2 to 24 hours, with a survival to hospital discharge rate of 67% (four of six). Median total time on ECMO was 5.5 days. Complication rate was 50% (4/8). Conclusions: Our rescue-ECMO survival results were comparable to that of current published results from established pediatric ECMO programs. Air transport of ECMO patients can be performed safely using an organized multidisciplinary team approach.

Adult Presentation With a Bilobed Membranous Ventricular Septal Aneurysm

Membranous ventricular septum aneurysm (MVSA) is an uncommon cardiac abnormality primarily associated with the spontaneous closure of a small membranous ventricular septal defect in childhood. Diagnosis of an idiopathic MVSA in an adult is exceedingly rare. We report on a man, aged 38 years, with a bilobed MVSA diagnosed by transesophageal echocardiography and gated computed tomography, with separate aneurysm sacs extending into the right atrium and right ventricle.

Multimodality Imaging of a Right Atrial Myxoma With Pulmonary Embolization

Multimodality Imaging of a Right Atrial Myxoma With Pulmonary Embolization David Horne, MD, DCH, Davinder S. Jassal, MD, FRCPC, Suresh Mysore, MBBS, FRCPC, Iain D.C. Kirkpatrick, MD, FRCPC, Darren H. Freed, MD, PhD, FRCSC, and Farrukh Hussain, MD, FRCPC a Section of Cardiac Surgery, Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada b Section of Cardiology, Department of Internal Medicine, University of Manitoba, Winnipeg, Manitoba, Canada c Department of Radiology, University of Manitoba, Winnipeg, Manitoba, Canada d Institute of Cardiovascular Sciences, St Boniface Research Centre, University of Manitoba, Winnipeg, Manitoba, Canada e Department of Pathology, University of Manitoba, Winnipeg, Manitoba, Canada

Multimodality cardiac imaging of a ventricular septal rupture post myocardial infarction: a case report

BackgroundVentricular septal rupture (VSR), a mechanical complication following an acute myocardial infarction (MI), is thought to result from coagulation necrosis due to lack of collateral reperfusion. Although the gold standard test to confirm left-to-right shunting between ventricular cavities remains invasive ventriculography, two-dimensional transthoracic echocardiography (TTE) with color flow Doppler and cardiac MRI (CMR) are reliable tests for the non-invasive diagnosis of VSR.Case presentationA 62-year-old Caucasian female presented with a late case of a VSR post inferior MI diagnosed by multimodality cardiac imaging including TTE, CMR and ventriculography.ConclusionWe review the presentation, diagnosis and management of VSR post MI.

A Simple Effective Protocol to Increase Prenatal Detection of Critical Congenital Heart Disease

Prenatal diagnosis of congenital heart disease (CHD) during routine obstetric sonography has been aptly named the sonographer’s Achilles heel. Although CHD occurs more commonly than any other major congenital abnormality, the detection rate remains low. The goal of this study was to improve the prenatal diagnosis of CHD during routine obstetric sonography through the development and implementation of a simple and effective screening protocol.

Advancing Prenatal Detection of Congenital Heart Disease: A Novel Screening Protocol Improves Early Diagnosis of Complex Congenital Heart Disease

Prenatal diagnosis of complex congenital heart disease (CHD) during routine obstetric ultrasound (US) examinations improves postnatal outcomes, but sensitivity is low (<40%). Our objective was to improve our prenatal detection of complex CHD with implementation of a specific screening protocol.

Multimodality Imaging of a Cardiac Pheochromocytoma

![Figure][1] [![Graphic][3] ][3][![Graphic][4] ][4] A 50-year-old man presented with difficult-to-control hypertension. In the work-up for secondary causes of hypertension, the patient was found to have elevated levels of normetanephrine. Computed tomography of the chest

Unanticipated intra-operative finding of pulmonary artery tumour thromboembolism during radical nephrectomy and caval thrombectomy: Case report and management.

We report a case of an unanticipated intra-operative transesophageal echocardiography (TEE) finding of pulmonary artery thromboembolism in a 72-year-old woman being prepared for radical nephrectomy and caval thrombectomy. Upon intra-operative TEE to evaluate the extent of caval thrombus, we found a pulmonary artery tumour thromboembolism in an otherwise asymptomatic patient after induction and prior to surgery. A chest computed tomography confirmed a large saddle tumour thromboembolus. A multidisciplinary approach was used to facilitate radical nephrectomy with caval thrombectomy and pulmonary artery thromboembolectomy. This case shows the importance of adequate perioperative imaging and use of intra-operative TEE to evaluate the extent of disease. To our knowledge, we are the first to present a case of RCC with cava tumour thrombus in which the pulmonary artery tumour thromboembolism was detected incidentally on intraoperative TEE.

506 Depression and Cardiac Surgery: Predictors and the Impact of Physical Activity

ment for differences in baseline and operative characteristics, administration of the current formulation of PPC brand heparin was associated with the highest likelihood of receiving FFP (A OR 1.00; B OR 1.73, p 0.04; C OR 1.94, p 0.01; D OR 1.01, p 0.98) and PLT (A OR 1.00; B OR 1.88, p 0.03; C OR 2.44, p 0.001; D OR 1.26, p 0.42). CONCLUSION: In patients undergoing cardiac surgery, PPC brand heparin resulted in increased heparin dosing, peri-operative bleeding and peri-operative blood product transfusion in patients undergoing cardiac surgery. The results of this study suggest that an alternative to PPC brand heparin be used when placing patients on cardiopulmonary bypass.