Victor K. Alimov

Surgical pitfalls of excising an intramyocardial lipoma

References 1. Bouzas B, Kilner PJ, Gatzoulis MA. Pulmonary regurgitation: not a benign lesion. Eur Heart J. 2005;26:433-9. 2. Abd El Rahman MY, Abdul-Khaliq H, Vogel M, Alexi-Meskishvili V, Gutberlet M, Lange PE. Relation between right ventricular enlargement, QRS duration, and right ventricular function in patients with tetralogy of Fallot and pulmonary regurgitation after surgical repair. Heart. 2000;84: 416-20.

Unexpected traumatic rupture of left atrium mimicking aortic rupture

Left atrial (LA) rupture is rare following blunt chest injury. We describe a case of blunt LA rupture that was treated surgically. This report is intended to alert practitioners for a need of a close multiple disciplinary collaborations among them for optimal management of patients with this type of trauma; because other non-cardiac injuries involving the head, abdomen, or extremities are considered covariates for in-hospital mortality. As in the present case, the patient eventually died from associated extrathoracic injuries. The diagnosis of LA rupture is by exclusion. However, the initial radiological reading may be misinterpreted, because this injury can easily be mistaking for an aortic rupture. The final reappraisal of the chest imaging studies should be interpreted by a skilled radiologist to avoid misdiagnosis. Subtle radiological features can help distinguish aortic thoracic injury as illustrated in this patient. These factors may be useful to the practicing surgeon in deciding surgical approach.

Is there a role for surgery in the management of giant B-cell right atrial lymphoma?

Abstract  We describe a case of a giant right atrial large B‐cell lymphoma treated with initial surgical excision followed by postoperative chemotherapy. The patient had no clinical evidence of recurrence through 87 months after her hospital discharge. To our knowledge, this is the first reported case of long‐term survival following this method of disease management. The discussion reviews the current status of chemotherapy for cardiac lymphomas and the pros and cons of treatment option algorithms. (J Card Surg 2011;26:166‐168)

Preserving a Well-Functioning 33-Year-Old Starr-Edwards Aortic Prosthesis in Repeat Aortic Root Aneurysm Repair

We report the case of a 61-year-old obese male patient in whom we found a well-functioning 33-year-old Starr-Edwards aortic prosthesis during repeat aortic surgery. Rather than explant the prosthesis, we remodeled the aortic root, almost completely removing the aortic sinuses and leaving only a pillar of aortic tissue around the coronary ostia. The proximal end of a Hemashield tube-graft was then scalloped to accommodate the remaining aortic tissue. The patients heart function was excellent after his weaning from cardiopulmonary bypass. Simplifying the repeat aortic root repair, by preserving a well-functioning Starr-Edwards valve, might lead to a better outcome in similar cases. We also discuss other instances of this valves durability.

Alternative perfusion technique without axillary artery cannulation during combined aortic root and total arch replacement.

This report describes an effective cerebral perfusion method using an additional 4th side limb graft sewn to a trifurcated graft in patients undergoing redo aortic root reconstruction combined with total aortic arch replacement. This method is useful in cases where the origin of the innominate artery is unsuitable for clamping or when axillary perfusion is not employed, and assures continuous brain protection and minimizes circulatory arrest time. doi: 10.1111/jocs.12114 (J Card Surg 2013;28:427–429)

Myocardial Abscess 14 Years After Coronary Bypass Grafting

We report the case management of a patient with a methicillin-resistant Staphylococcus aureus intramyocardial abscess adjacent to a previously grafted native right coronary artery. The diagnosis was eventually established by obtaining a gallium scan. This case illustrates the need for maintaining a wide-ranging view of potential causes of bacteremia after cardiac surgery, especially in elderly patients with multiple comorbidities.

Helpful maneuvers for controlling bleeding from operative or traumatic vascular injuries.

Surgical management of severe hemorrhage resulting either from vascular wall tears on decannulation or from penetrating traumatic vascular injuries can be challenging. Conventional surgical management such as using partial side-biting vascular clamp for immediate control of the tears may not be sufficient to provide bloodless field for proper and definitive repair, because of either lack of anatomic access as in the case of aortic arch location, or because of inability to place a vascular clamp. Most experienced surgeons have their own versions of managing this problem; most commonly it involves applying finger pressure before placing sutures under one finger thereby controlling hemorrhage. Unfortunately, handling any type of needle especially in urgent situations risks occupational exposures through needle stick injuries or contact with splashed blood to the personnel in the operating room. We describe two simple and effective bailout techniques as alternative options to traditional repair procedures to be considered for temporary control of intraoperative aortic tears after decannulation, but that are also applicable by extrapolation, to any portion of the vascular tree. These techniques eliminate the surgeon’s handling of needles with its attendant risks, and they are also useful in small penetrating traumatic vascular injuries.