Search

This study sought to compare the morbidity and mortality of redo aortic valve replacement (redo-AVR) versus valve-in-valve trans-catheter aortic valve implantation (valve-in-valve TAVI) for patients with a failing bioprosthetic valve. A multicentre UK retrospective study of redo-AVR or valve-in-valve TAVI for patients referred for redo aortic valve intervention due to a degenerated aortic bioprosthesis. Propensity score matching was performed for confounding factors. From July 2005 to April 2021, 911 patients underwent redo-AVR and 411 patients valve-in-valve TAVI. There were 125 pairs for analysis after propensity score matching. Mean age was 75.2±8.5 years. In-hospital mortality was 7.2% (n=9) for redo-AVR vs 0 for valve-in-valve TAVI, p=0.002. Surgical patients suffered more post-operative complications, including IABP support (p=0.02), early re-operation (p

Reports are few of chylothorax complicating stab wounds to the left suprascapular region. We report a case of traumatic chylothorax following a stab wound to the suprascapular region in a 14-year-old boy. He presented with progressive dyspnoea and signs of a pleural effusion. This was confirmed by radiology and thoracocentesis to be a hemothorax. The hemothorax was drained by tube thoracostomy. He developed chylothorax on the third day after inserting the chest tube. Biochemical analysis confirmed chylothorax, which was managed conservatively. The chest tube was removed after it stopped draining. We discuss the pathogenesis of this form of chylothorax and the management options. Keywords: Chylothorax, Poirier’s triangle, Stab, Trauma

Background: Patent ductus arteriosus (PDA) is quite a common acyanotic congenital heart disease (CHD). Its ligation in Sub-Saharan Africa is challenging due to lack of adequate cardiothoracic surgeons. We, therefore, present our experience and our challenges in our center with limited resources. Objectives: To determine the challenges and outcome of surgical ligation of PDA in our center. Methods: This was a retrospective review of all PDA ligations done from January 2012 to December 2017. Data were extracted from the operation theater register and patients files. Information such as age, sex, symptoms at presentation, intraoperative findings, and outcome of surgery were analyzed. Discordances between echocardiography and intraoperative finding of PDA were noticed in only two cases, and these were excluded from the study because PDA was not seen intraoperatively and they were referred for further evaluation. Statistical Package for the Social Sciences version 16 was used for data entry and analysis. Results: Twenty-five patients had PDA ligation during the study period; the subjects comprised 17 females and 8 males with a male-to-female ratio of 1:2. Two adult cases were recorded. Three cases had other associated CHD. All surgeries were carried out successfully and only a single case of complication was reported (4%, chylothorax). Conclusion: PDA ligation is relatively safe if properly done with successful outcome.

Few cases of true superior gluteal artery (SGA) aneurysms have been described in the English-language literature. This is the twenty-second reported case. SGA aneurysms can pose diagnostic problems, specifically when they are non-pulsatile and also therapeutic challenges when they are large. Although more aneurysms are being subjected to endovascular therapies, SGA aneurysmectomy or aneurysmorrhaphy still remain valid therapeutic options, especially in resource-poor settings. Surgery provides quick symptom resolution and still is the only means by which tissue for definitive histological diagnosis can be obtained.

Background: Peripheral vascular injuries (PVIs) are infrequent but their management could be hampered by delayed presentation and fraught with untoward morbidity or death. Herein, we describe the factors contributing to the morbidity and mortality of PVIs in this environment. Materials and Methods: Data relating to patients with PVIs between March, 2012 and March, 2018 were retrospectively collected from case folders and analyzed. Results: The records of 16 patients were analyzed. There were 13 (76.9%) males and 3 (23.1%) females. The male/female ratio was 4.3:1. The median age was 30 years (range, 10–52). The median duration between injury and presentation was 2.5 days. Nine (56.3%) PVIs were secondary to stab wounds; two (12.5%) occurred in intravenous drug abusers while the others were each of different etiologies. The superficial femoral artery was the most frequently injured vessel (six cases; 37.6%). Fourteen (87.5%) patients required surgery ranging from patch arterioplasty to reversed saphenous vein interposition graft. Two (12.5%) patients were managed conservatively. The mean length of stay for the overall patient population was 11.7 days. Ten patients (62.5%) had surgical site infections (SSIs) causing prolonged hospital admission. There were three deaths (18.8%), all occurring in patients with co-morbidities like chronic kidney disease (CKD) and sepsis. Conclusion: PVIs were infrequent in this environment and presentation is delayed. Reasonable limb salvage rates are possible depending on the severity of ischemia. SSIs may suggest prolonged hospital stay. Mortality appears to be heightened if there are underlying co-morbidities. More patients would however be required to statistically correlate these findings.

Construction of an enterostomy is a common procedure in pediatric surgery. However, caring for the child with a stoma is challenging for parents in developing countries. Modern devices such as colostomy bags and accessories are expensive and not readily available. The purpose of this study was to describe methods of effluent collection and peristomal skin protection used by the mothers of colostomy patients. A prospective, descriptive study was conducted between January and December 2011 during the first three postoperative outpatient clinic visits among mothers of children who had a colostomy constructed in the authors' hospital. The mothers of 44 children (27 males, 17 females, median age 3.3 months, range 2 days to 11 years) consented to participate. Demographic and clinical data were obtained from the records, and mothers were interviewed and asked to describe their preferred methods of colostomy effluent collection and peristomal skin protection. The stomas also were inspected at each clinic visit. Anorectal malformations were the most common indication for a colostomy (32, 72.73%), followed by Hirschsprung's disease (11, 25%). Forty-two (42) patients had a divided sigmoid colostomy (95.45%); two patients had a right loop transverse colostomy (4.55%). Nine mothers alternated between two different collection methods. The diaper collection method was described most frequently (22 out of 53; 41.51%), followed by wraparound waistbands (19; 35.85%) and improvised colostomy bags (12; 22.64%). Peristomal skin excoriations were commonly seen within the first 3 weeks postsurgery and had mostly disappeared by the week 6 postoperative visit. Petrolatum jelly was the most commonly used barrier ointment. These locally available, acceptable, and affordable collection methods may be useful for children in other developing countries.