Randall Moshinsky

Non-operative management of tube thoracostomy induced pulmonary artery injury

Tube thoracostomy insertion is a common procedure in the management of air and fluid collections in the pleural space. Pulmonary artery injury is a rare but serious complication following intercostal catheterisation. This complication is usually managed surgically. We report a case of successful non-operative management of a pulmonary artery injury after tube thoracostomy.

Urgent and emergency coronary artery bypass grafting for acute coronary syndromes.

Background:  Urgent and emergency coronary artery bypass grafting may be associated with significant mortality and morbidity. We report our recent experience with this group of patients.

Novel Sternal Protection Device for Cardiac Surgery Via Median Sternotomy Incision

Objective Sternal bleeding during cardiac surgery is currently controlled using bone wax or other chemical substances that may result in adverse effects and affect wound healing and recovery. The purpose of this study was to identify a safe, cost-effective, and easy-to-use technique to reduce sternal bleeding and sternal trauma during cardiac surgery. Methods After sternotomy, a sternal protection device was placed over each hemisternal section before insertion of the retractor and remained in situ until the end of surgery. Sternal bleeding and ease of use were assessed and recorded during surgery. Sternal trauma was assessed and recorded within 5 minutes of removal of the device, and overall satisfaction (Global Impression) and any intraoperative adverse events or device malfunction were reported at surgery completion. Patients were followed up 24 hours and 4 weeks after surgery. Results Twelve patients completed the study. Adverse events reported were not considered related to the device. No sternal trauma was identified in any patient. In 9 of 11 patients, sternal bleeding was reduced after insertion of the device. The device was generally considered easy to use, although some difficulty was encountered when used with the Internal Mammary Artery retractor. Conclusions Our data suggest that the device is safe and able to reduce sternal bleeding during surgery using sternal retractors. We recommend further studies in a larger population of patients with a control group to evaluate the devices ability to reduce the morbidity associated with sternal bleeding and sternal trauma.

Sheathless transcatheter aortic valve implantation via the direct aortic approach

Transcatheter aortic valve replacement (TAVR) has become an accepted alternate treatment modality to surgical aortic valve replacement in high surgical risk patients. There remains, however, a subset of patients in whom safe delivery of a TAVR device cannot be achieved by the femoral or subclavian routes. In such cases the direct aortic or transapical routes can be used though this still requires suitable anatomy. We present the first reported case of a direct aortic TAVR using a sheathless technique in order to provide sufficient distance to safely deliver the prosthesis.

Compensatory lung hypertrophy following pneumonectomy.

A girl presented with a chest Xray demonstrating a spontaneous pneumothorax extending into the contralateral hemithorax (Fig. 1). She had undergone a left pneumonectomy on the second day of life for cystic adenomatiodmalformation of the lung. CT scan of her chest showedmassive compensatory hypertrophy of her right lung with the right upper lobe occupying the left chest. Cystic change in the right upper lobe was identified as the likely cause for the spontaneous pneumothorax (Figs. 2 and 3).