Guerreroschofield9360

This is a case of a young man who underwent preoperative computed tomography evaluation for sinus venosus type of atrial septal defect, and was found to have associated chronic constrictive pericarditis. Association of these two entities is rare and changes the management approach.The Nordic-Baltic-British left main revascularization trial (NOBLE) is a prospective, randomized, multicentre, non-inferiority trial comparing percutaneous coronary angioplasty (PCI) with coronary artery bypass grafting (CABG) for revascularization of patients with unprotected left main coronary artery (LMCA) stenosis. The primary outcome was a combined endpoint of all-cause mortality, stroke, non-procedural myocardial infarction and repeat revascularization. CABG was found to be superior to PCI with respect to the 5-year MACCE rates (28% vs. 19%) with a hazard ratio (HR) of 1.58 (95% CI 1.24-2.01). All-cause mortality rates were similar, but PCI was associated with increased occurrence of non-procedural myocardial infarction (p = 0.0002) and repeat revascularization (p = 0.0009). There was no difference in the stroke rates (p = 0.11) at 5 years. Currently, European Society of Cardiology and the European Association for Cardio-Thoracic Surgery (ESC/EACTS) guidelines on myocardial revascularization assign a class 1A recommendation to PCI in patients with unprotected LMCA stenosis with a SYNTAX score less then  23. The findings of the NOBLE trial challenge this premise.A combination of tetralogy of Fallot with diaphragmatic hernia represents a very rare entity. We present a case of 18-month-old child presenting late with cyanosis and respiratory distress. Chest X-ray and computed tomography angiography showed tetralogy of Fallot with small left pulmonary artery with right lung aplasia with congenital diaphragmatic hernia with liver and bowel loops in right chest cavity. The patient was managed with central shunt on cardiopulmonary bypass and was discharged uneventfully.Congenitally corrected transposition of the great arteries (CCTGAs) is a condition, which includes atrioventricular and ventriculoarterial discordant connections along with ventricular septal defect (VSD), pulmonary stenosis (PS), or pulmonary atresia (PA). Without treatment, progressive systemic ventricular failure begins, which is followed by sudden cardiac death by the fourth or fifth decade. We report a case of a 4-year-old with CCTGA, VSD, and PS operated by Senning procedure and pulmonary root translocation (PRT) with uneventful postoperative recovery. PRT overcomes problems with the right ventricle to the pulmonary artery conduit and maintains pulmonary valve function and growth capacity. Our initial experience with PRT in CCTGA indicates that it is a feasible surgical alternative for such patients.Pseudocoarctation of the aorta (PCOA) is a rare anomaly of the aortic arch and its presentation is often an incidental finding. We present the case of a 66-year-old patient with a history of high blood pressure, who was admitted for surgical management of bicuspid aortic valve disease with severe insufficiency and who was incidentally detected to have a PCOA. It was decided to manage the latter conservatively and go ahead with surgical aortic valve replacement, to address the problem that led to his admission to the hospital. The patient had a favorable postoperative course and was discharged in a stable condition with an advice for periodic follow-up as out-patient consultations.This case report is a description of an uncommon delayed presentation of penetrating trauma of lower limb with history of inciting event being 45 years ago, as there are only 4 such reported cases in the literature. A 65-year-old male presented with progressive enlargement of swelling over the anterior aspect of the right thigh with difficulty in walking due to mechanical effects and paraesthesia in the affected limb. Clinical signs of a large lump in the right anteromedial thigh with no pulsations were present. Computerised tomographic angiography revealed the presence of a superficial femoral artery pseudoaneurysm. The open surgical management involved resection of the pseudoaneurysm and autologous vein patch angioplasty. The rarity of incidence and paucity of physical signs suggest that a high index of suspicion, careful clinical review and radiological investigation is indispensable to diagnose and treat this condition.The extension of aortic dissection into common carotid arteries can cause thrombus formation in false lumen. This may result in perioperative cerebral malperfusion and stroke. At present there are no specific management guidelines in this situation. We report our experience of operative and non-operative management of thrombosis of carotid arteries in type A acute aortic dissection in 3 patients.The presence of interatrial communication is considered obligatory in total anomalous pulmonary venous connection (TAPVC). Even a restriction in this communication leads to obstructive TAPVC. We report a rare case of obstructed supracardiac TAPVC with the absence of interatrial communication and with multiple ventricle septal defects (VSDs) in a 3-month-old child.We report a case of a 24-year-old man who had an exploratory laparotomy 3 years earlier for a penetrating hypogastric wound. He presented with congestive heart failure that had progressed over the past 4 months. Transthoracic echocardiography and computed tomography (CT) angiography of the aorta demonstrated a wide arteriovenous fistula between the right common iliac artery and the iliocaval confluence, resulting in the dilatation of the inferior vena cava and of the right heart chambers. The patient was treated by surgical ligation of the right common iliac artery above and below the fistula in conjunction with aortoiliac bypass, thus excluding the shunt.Coronary sinus rupture (CSR) is a rare operative complication, and a standard procedure for its treatment has not been established. We report successful repair of a CSR in a 68-year-old man who underwent total arch replacement for type A acute aortic dissection. CSR was caused by the coronary sinus cannulation for retrograde cardioplegia and was detected during cardiopulmonary bypass weaning. We applied an elastomeric sealant with a bovine pericardium patch on the beating heart. After manual compression for 2 min, complete hemostasis was achieved. Fasudil A clampless and sutureless hemostasis for repairing coronary sinus rupture is a simple, fast, and effective technique.