Native pulmonary valve endocarditis requiring pulmonary valve replacement in adulthood: a case series

Native pulmonary valve endocarditis is a rare phenomenon as native valve endocarditis tends to typically affect the left sided heart valves. However, the right-sided heart valves can be affected in patients with a history of intravenous drug use, whereby the tricuspid valve is most commonly affected. We present two cases who were diagnosed with native pulmonary valve endocarditis in the absence of congenital heart disease. In the first case, the native pulmonary valve endocarditis was probably a derivative of compounding factors of an enlarged underlying pulmonary artery and staphylococcal bacteraemia. In the second case, a common causal organism of native valve endocarditis following dental treatment and the resultant echocardiography findings was of significant interest. In summary, native pulmonary valve endocarditis is relatively rare complication in the adult population, especially in the absence of congenital heart disease.

Off-pump external pericardial patch repair for post-infarct left ventricular free wall rupture: a case series

We describe an off-pump surgical approach to this challenging condition supported by our results from a case series, which would add to existing literature in the management of this life-threatening complication. We identified seven patients who underwent surgical intervention for left ventricular (LV) free wall rupture at our institution. They were all diagnosed to have cardiac tamponade secondary to free wall rupture of the LV in the presence of acute myocardial infarction. The surgical technique comprised of utilizing an external pericardial patch which was secured using surgical biological glues (fibrin-based sealants or gelatin hydrogels). The 30-day mortality, 1-year survival and 2-year survival were 57, 42 and 42%, respectively. Advanced age, female gender and use of cardiopulmonary bypass were characteristics that were not significantly associated with survival. We advocate the use of an off-pump external pericardial patch repair strategy as a ‘bridge to recovery’ in this extremely high-risk group of patients.

Delayed cardiac tamponade following blunt chest trauma due to disruption of fourth costal cartilage with posterior dislocation

Cardiac tamponade is a recognised sequelae of non-penetrating and penetrating chest trauma. Delayed cardiac tamponade has been described following blunt chest trauma. We present a 29 year-old gentleman who had initially presented to peripheral district general hospital following direct blunt chest wall trauma. His initial trauma CT demonstrated a small mediastinal haematoma and large left haemopneumothorax and disruption/dislocation of the costal cartilage. He initially underwent a thoracoscopic procedure uneventfully. He then had worsening chest radiograph appearances with enlarging cardiac contours. Transthoracic echocardiography confirmed cardiac tamponade. He underwent creation of a pericardial window and excision of the protruding fourth costal cartilage.

Laser fluorescence angiography reveals perfusion defects in retrograde cardioplegia

BACKGROUND

Adequate perfusion of the right ventricle with retrograde cardioplegia has always been questioned. However, clinical studies suggested sufficient protection and, up to now, intraoperative assessment of cardioplegia distribution has been difficult.

METHODS

As a pilot study in 14 patients, we used indocyanine green laser fluorescence angiography (ICGLA) to assess vascular and myocardial perfusion of different areas of the right anterior ventricular wall. Regions of interest were analyzed quantitatively using a new software package.

RESULTS

ICGLA allowed rapid and reliable visualization of cardioplegic flow and distribution. Retrograde cardioplegia revealed perfusion defects in the territory of the right anterior cardiac veins when compared to antegrade delivery and to areas close to the left anterior descending vein(s), confirmed by quantitative analyses of maximal fluorescence intensity. Five patients were excluded from quantitative analyses. The learning curve, pitfalls, limitations and special image details are described.

CONCLUSION

A larger study is necessary to examine the relevance of perfusion defects to metabolic changes in affected myocytes and to global right ventricular function.

Primary pleural lymphomas

Two patients are presented with primary low grade pleural B cell lymphomas with no history of a pyothorax.