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Spontaneous interatrial hematoma is a rare clinical entity leading to the obliteration of the left atrial cavity and causing haemodynamic compromise, necessitating immediate surgical intervention. Herein, we report a patient with acute chest pain with normal coronaries and echocardiographic evidence of left atrial mass. The investigations revealed the mass to be a thrombus rather than tumour. The patient underwent surgery to remove a large thrombus completely enclosed within the interatrial septum. The septum was then repaired using a pericardial patch. No apparent etiological factor was found. Spontaneous atrial wall dissection should be considered in the differential diagnosis of acute chest pain., Competing Interests: Conflicts of interest: None declared., (© 2024 Saudi Heart Association.)

Background: Evaluating outcomes of concurrent Cox-Maze procedures in elderly patients undergoing high-risk cardiac surgery., Mehods: We retrospectively identified patients aged over 70 years with Atrial Fibrillation (AF) from 2011 to 2017 who had two or more other cardiac procedures. They were subdivided into two groups: 1. Cox-Maze IV AF ablation. 2. No-Surgical AF treatment. A propensity match score was used to generate a homogeneous cohort and to eliminate confounding variables. Heart rhythm was assessed from Holter reports or 12-lead ECG. Follow-up data was collected through telephone consultations and medical records., Results: There were 239 patients. Median follow up was 61 months. 70 patients had Cox-Maze IV procedures (29.3%). Demographic, intra- and post-operative outcomes were similar between groups although duration of pre-operative AF was shorter in Cox-Maze group (p = 0.001). There was no significant 30-day mortality difference in propensity matched cohorts (n = 84. P = 0.078). Sinus rhythm at annual and latest follow-up was 84.9% and 80.0% respectively in Maze group - 160 patients (66.9%) were alive at long-term follow-up with good survival outcomes in Cox Maze group. There was a high proportion of patients in NYHA 1 status in Cox-Maze group. No differences observed in freedom from stroke (p = 0.80) or permanent pacemaker (p = 0.33) between the groups., Conclusions: Surgical ablation is beneficial in elderly patients undergoing high-risk surgery - promoting excellent long-term freedom from AF and symptomatic / prognostic benefits, without added risk. Therefore, surgical risk should not be reason to deny benefits of concomitant AF-ablation., Clinical Trial Registration: Not required., (© 2024. Crown.)

Acute aortic valve regurgitation due to thrombosed prosthetic valve can present as a surgical emergency. This article reports a successful and unusual management of a young pregnant female patient who presented with acute aortic valve regurgitation due to a thrombosed mechanical aortic valve. As the patient had previous multiple cardiac surgeries, the options were limited for repeat aortic valve or aortic root replacement. The patient had caesarean section followed by implantation of a mechanical valve-on-valve in a previously placed composite valved conduit. This technique may be useful for reoperative valve replacement in the setting of a prior mechanical Bentall patient., (Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

Coronary-cameral fistula is an abnormal fistulous communication between a coronary artery and a cardiac chamber. Significant fistulae require closure either percutaneously or surgically to avoid any complications. We describe the case of a 19-year-old male patient with tetralogy of Fallot, who presented with a complex coronary-cameral fistula, which precluded percutaneous occlusion. By means of a hybrid approach, the fistula was easily located and closed surgically. Where surgical correction of such fistulae is warranted in the setting of other cardiac defects, a hybrid approach to isolate the fistula followed by surgical intervention will reduce operative time, thereby potentially lowering perioperative complications., (Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)

A best evidence topic in cardiac surgery was written according to a structured protocol. We addressed the following question: in patients who are diagnosed with carcinoid heart disease (CHD), do valvular surgeries improve their prognosis? Fifty percent of the patients with clinically diagnosed carcinoid syndrome had cardiac involvement which was present either as valvular dysfunction or as cardiac metastases. These patients often require surgery due to their heightened risk of cardiac disease. Altogether 217 relevant papers were identified as a result of the below-mentioned search, of which 10 papers represented the best evidence to answer the question. The author, journal, date and country of publication, patient group studied, study type, relevant outcomes, results and study weaknesses were tabulated. Of the patients who were identified to have carcinoid heart disease in different studies, 193 patients had valve procedure, mainly replacements at tricuspid, mitral and aortic valve positions and either valvuloplasty or replacement at pulmonary valve. Tricuspid and pulmonary valves represented the majority of the excised valves among patients undergoing valvular surgery for CHD. The pathology of carcinoid valve was attributed to the presence of plaque, causing thickening and retraction. Pure regurgitation was the most common finding in all the valves except pulmonary valve which had both stenosis and insufficiency. Thirty-day mortality was 17% (range 1-63%) and long-term survivors were reported to be alive at an average of 58 months (28-80 months) after the valve surgery. The evidence demonstrates that surgical intervention can lead to improved prognosis and reduce the symptoms of heart failure. Postoperative mortality was mainly due to the carcinoid disease itself and not as a complication of the surgery. Therefore, surgery could be considered for symptomatic palliation in carefully selected individuals., (© The Author 2014. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)

Surgically repairing Bland-White-Garland syndrome (anomalous origin of the left coronary artery from the pulmonary artery) is a challenge if there are variations in the origin of the anomalous artery. We report the successful repair of this congenital abnormality in a 19-year-old woman who presented with an acute anterior myocardial infarction. The anomalous artery originated from the anterior-facing sinus of the pulmonary artery, which precluded typical repair by direct reimplantation or fashioning an intrapulmonary tunnel. We created an extrapulmonary tunnel, using a strip of pulmonary artery anteriorly and an aortic flap posteriorly. Three years postoperatively, the anastomosis was patent and the patient was asymptomatic. Our modified technique might serve as an alternative method during similar surgical circumstances.

Lung infarction after intrathoracic surgery is a life-threatening complication that needs urgent intervention. Although the exact etiology is not known, pulmonary infarction may be suspected for patients presenting with consolidation of the lung after intrathoracic surgery. We report a very rare case of pulmonary infarction after successful surgical treatment of a type B aortic dissection. The pulmonary infarction was treated by intrapericardial pneumonectomy. This article discusses possible etiology and management of such patients. A high index of clinical suspicion and timely investigations may allow early detection of this unusual event and avoid fatal outcomes., (Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.)