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The article describes the case of an 18-year-old man who presented with blunt chest trauma and whose computed tomography features are highly suggestive of an avulsed right inferior pulmonary vein.

Temporary epicardial pacing wires are used after cardiothoracic surgery to maintain a stable cardiac rhythm. They must be distinguished from the more commonly encountered transvenous temporary pacing wires, which are often used in coronary care units for the same purpose. Patients with temporary epicardial pacing wires may be transferred to hospital wards where these wires are not usually encountered, such as COVID wards, the general intensive care unit, the coronary care unit or general surgical wards if a laparotomy was required in the early period following cardiac surgery. Serious complications may arise in managing patients with temporary epicardial pacing wires, which are well known in the cardiothoracic unit but not so well known elsewhere in the hospital. This article discusses the dangers associated with the management of temporary epicardial pacing wires in adult patients, some of which are common to temporary transvenous pacing wires and others are unique to temporary epicardial pacing wires. [ABSTRACT FROM AUTHOR]

Strut chordae, on their own, are not typically thought to aid mitral valve competence. The aim of this study is to assess whether strut chordae aid mitral valve competence during acute annular dilation. Twelve porcine hearts were dissected and tested using an in vitro simulator, with the mitral annulus tested in either a 'normal' or a dilated configuration. The normal configuration included a diameter of 30 mm, a posterior leaflet 'radius' of 15 mm and a commissural corner 'radius' of 7.5 mm; the dilated annular template instead used dimensions of 50 mm, 25 mm and 12.5 mm, respectively. Each mitral valve underwent ten repeat tests with a target systolic pressure of 100 mmHg. No significant difference in the pressure was detected between the dilated and regular annuli for the mitral valves tested (95 ± 3 mmHg cf. 95 ± 2 mmHg). However, the volume of regurgitation for a dilated annulus was 28 ml greater than for a valve with a normal annulus. Following severing of strut chordae, there was a significant reduction in the systolic pressure withstood before regurgitation by mitral valves with dilated annuli (60 ± 29 mmHg cf. 95 ± 2 mmHg for normal annular dimensions; p < 0.05). In conclusion, strut chordae tendineae may play a role in aiding mitral valve competence during pathophysiology. [ABSTRACT FROM AUTHOR]

The aim of this study was to perform an initial assessment, in vitro, of the feasibility of using a glutaraldehyde cross-linked porcine mitral valve to retain acute functionality, focusing on assessing mitral regurgitation. Six porcine hearts were tested using an in vitro simulator. Testing was repeated following cross-linking of mitral valves; where cross-linking was achieved by placing them in a glutaraldehyde solution. The simulator enabled systolic pressure on the ventricular side of the valve to be mimicked. Following testing, mitral valve leaflets underwent Scanning Electron Microscopy of the ventricular surface of both the anterior and posterior leaflets (1 cm2 samples). The peak pressure withstood by cross-linked valves was significantly lower than for untreated valves (108 mmHg cf. 128 mmHg for untreated valves; p < 0.05). The peak pressure was typically reached 0.5 s later than for the untreated valve. While both cross-linked and untreated valves exhibited endothelium denudation, the unfixed valve had less endothelial loss. Glutaraldehyde cross-linking of porcine mitral valves may be of potential value in assessing improved bioprosthetic mitral valve replacements. However, a more immobile valve exhibiting endothelial denudation (i.e. sclerosis) was a possible concerns identified following in vitro acute assessment. [ABSTRACT FROM AUTHOR]

The aim of this study was to assess whether the mechanical properties of mitral valve chordae tendineae are sensitive to being cross-linked under load. A total 64 chordae were extracted from eight porcine hearts. Two chordae (posterior basal) from each heart were subjected to uniaxial ramp testing and six chordae (two strut, two anterior basal and two posterior basal) were subjected to dynamic mechanical analysis over frequencies between 0.5 and 10 Hz. Chordae were either cross-linked in tension or cross-linked in the absence of loading. Chordae cross-linked under load transitioned from high to low extension at a lower strain than cross-linked unloaded chordae (0.07 cf. 0.22), with greater pre-transitional (30.8 MPa cf. 5.78 MPa) and post-transitional (139 MPa cf. 74.1 MPa) moduli. The mean storage modulus of anterior strut chordae ranged from 48 to 54 MPa for cross-linked unloaded chordae, as compared to 53–61 MPa cross-linked loaded chordae. The mean loss modulus of anterior strut chordae ranged from 2.3 to 2.9 MPa for cross-linked unloaded chordae, as compared to 3.8–4.8 MPa cross-linked loaded chordae. The elastic and viscoelastic properties of chordae following glutaraldehyde cross-linking are dependent on the inclusion/exclusion of loading during the cross-linking process; with loading increasing the magnitude of the material properties measured. [ABSTRACT FROM AUTHOR]

The article describes the case of a 33-year-old man who sustained a ruptured thoracic aortic isthmus in a road traffic accident, displayed immediate hoarseness following the accident which persisted and was found to be a result of left recurrent laryngeal nerve palsy.

The mitral valve is a complex anatomical structure whose physiological functioning relies on the biomechanical properties and structural integrity of its components. Their compromise can lead to mitral valve dysfunction, associated with morbidity and mortality. Therefore, a review on the morphometry of the mitral valve is crucial, more specifically on the importance of valve dimensions and shape for its function. This review initially provides a brief background on the anatomy and physiology of the mitral valve, followed by an analysis of the morphological information available. A characterisation of mathematical descriptions of several parts of the valve is performed and the impact of different dimensions and shape changes in disease is then outlined. Finally, a section regarding future directions and recommendations for the use of morphometric information in clinical analysis of the mitral valve is presented. [ABSTRACT FROM AUTHOR]

The aim of this study was to determine the regional variation in viscoelastic properties of mitral valve leaflets over a range of physiological and patho-physiological frequencies. This included comparisons to be made between anterior and posterior leaflets, anterior leaflet clear and rough zones, and radial and circumferential leaflet orientation. Dynamic mechanical analysis was used to determine frequency-dependent viscoelastic properties. The valve leaflets were dissected from eight porcine hearts. The leaflets were loaded under a sinusoidal tensile displacement, with a mean dynamic peak to trough strain of 11%, applied to all leaflet samples at nine different frequencies, ranging from 0.5 to 10 Hz. The anterior leaflet has higher storage and loss stiffness than the posterior leaflet. The storage stiffness of circumferential tissue is greater than that of radially oriented valve tissue (2.0 ± 1.6 N/mm cf. 1.7 ± 0.9 N/mm; p < 0.05); however, the loss stiffness is greater for radial tissue (0.15 ± 0.07 cf. 0.14 ± 0.09 N/mm; p < 0.05). Likewise, the storage stiffness of the anterior leaflet clear zone is greater than that of the rough zone (2.4 ± 1.6 cf. 2.1 ± 1.2; p < 0.05), but the loss stiffness is greater for the rough zone (0.17 ± 0.09 N/mm cf. 0.14 ± 0.08 N/mm; p < 0.05). In conclusion, the viscoelastic properties of porcine mitral valve leaflets have regional variations, with dynamic stiffness being dependent on circumferential or radial orientation and on location at a clear or rough zones. [ABSTRACT FROM AUTHOR]

A patient with severe aortic regurgitation due to rapidly progressive staphylococcal endocarditis demonstrated an unusual physical sign of prominent diastolic venous pulsation. We suggest that this venous pulse is the result of diastolic ventricular interaction in which inflow of blood into the right ventricle is arrested in the latter part of diastole due to extreme left ventricular distension. We wish to highlight this sign so that others can look for it with the aim of improving our understanding and treatment of ventricular interaction associated with heart failure. [ABSTRACT FROM AUTHOR]

Background: Refractory post-cardiotomy cardiogenic shock (PCCS) is a relatively rare phenomenon that can lead to rapid multi-organ dysfunction syndrome and is almost invariably fatal without advanced mechanical circulatory support (AMCS), namely extra-corporeal membrane oxygenation (ECMO) or ventricular assist devices (VAD). In this multicentre observational study we retrospectively analyzed the outcomes of salvage venoarterial ECMO (VA ECMO) and VAD for refractory PCCS in the 3 adult cardiothoracic surgery centres in Scotland over a 20-year period. Methods: The data was obtained through the Edinburgh, Glasgow and Aberdeen cardiac surgery databases. Our inclusion criteria included any adult patient from April 1995 to April 2015 who had received salvage VA ECMO or VAD for PCCS refractory to intra-aortic balloon pump (IABP) and maximal inotropic support following adult cardiac surgery. Results: A total of 27 patients met the inclusion criteria. Age range was 34-83 years (median 51 years). There was a large male predominance (n = 23, 85 %). Overall 23 patients (85 %) received VA ECMO of which 14 (61 %) had central ECMO and 9 (39 %) had peripheral ECMO. Four patients (15 %) were treated with short-term VAD (BiVAD = 1, RVAD = 1 and LVAD = 2). The most common procedure-related complication was major haemorrhage (n = 10). Renal failure requiring renal replacement therapy (n = 7), fatal stroke (n = 5), septic shock (n = 2), and a pseudo-aneurysm at the femoral artery cannulation site (n = 1) were also observed. Overall survival to hospital discharge was 40.7 %. All survivors were NYHA class I-II at 12 months' follow-up. Conclusion: AMCS for refractory PCCS carries a survival benefit and achieves acceptable functional recovery despite a significant complication rate. [ABSTRACT FROM AUTHOR]

Repair of the mitral valve is defined (loosely) as a procedure that alters the valve structure, without replacement, enabling the natural valve itself to continue to perform under the physical conditions to which it is exposed. As the mitral valve is driven by flow and pressure, it should be feasible to analyse and assess its function, failure and repair as a mechanical system. This article reviews the current state of mechanical evaluation of surgical repairs of the failed mitral valve of the heart. This review describes the anatomy and physiology of the mitral valve, followed by the failure of the mitral valve from a mechanical point of view. The surgical methods used to repair failed valves are introduced, while the use of engineering analysis to aid understanding of mitral valve repair is also reviewed. Finally, a section on recommendations for development and future uses of engineering techniques to surgical repair are presented. [ABSTRACT FROM AUTHOR]

Young's modulus and structural stiffness were determined for chordae tendineae of the mitral valve from young (18-26 weeks) and old (over 2 years) porcine hearts. For chordae from the posterior leaflet of the valve, the Young's modulus values were significantly higher (p < 0.05) for the thinner marginal chordae (59 ± 31 MPa young; 88 ± 21 MPa old) than for the thicker basal chordae (31 ± 4 MPa young; 28 ± 9 MPa old). Marginal chordae (both anterior and posterior) had significantly higher (p < 0.05) value for their Young's modulus in old (88 ± 21 MPa anterior and posterior) than in young (62 ± 17 MPa anterior, 59 ± 18 MPa posterior) pig hearts. There was no significant difference in structural stiffness between marginal and basal (anterior and posterior leaflets) or between strut chordae (that are associated with anterior the leaflet only) and marginal and basal chordae. However, the value of structural stiffness of chordae was significantly higher (p < 0.05) for old (2.2 ± 0.2 kN/m) than for young (2.0 ± 0.4 kN/m) chordae. These results show that aging affects the properties of chordae and that all chordae need to be included in finite element models of valve function. [ABSTRACT FROM AUTHOR]

The article describes the case of 49-year old man whose postoperative recovery from surgical aortic valve replacement was complicated by high output pleural effusion and hepatic hydrothorax which was treated by decompressive talc pleurodesis.

Bilateral thoracotomies spaced at least 4 weeks apart are often required for the resection of bilateral pulmonary metastases. The anatomic distribution of the metastatic disease may rarely permit excision of bilateral pulmonary deposits through one thoracotomy incision. We demonstrate a successful bilateral pulmonary metastasectomy in the right upper lobe, right middle lobe, and left upper lobe through a right thoracotomy in a 40-year-old man with a past history of rectal adenocarcinoma and of left open pulmonary metastasectomy 1 year previously. The left upper lobe was approached by opening the pleura anterior to the ascending aorta. [ABSTRACT FROM AUTHOR]

A 72-year-old man who had undergone a three-vessel coronary artery bypass grafting, aortic valve replacement, and tricuspid valve repair became comatose 1 week after the procedure. Signs of intraabdominal sepsis developed 6 days later, leading to laparotomy on his 12th postoperative day. The Intraoperative finding was a perforating injury to the transverse colon caused by the ventricular temporary pacing wires. A defunctioning double-barreled transverse colostomy was performed, after which the patient started to recover. He was discharged home 2 weeks later. [ABSTRACT FROM AUTHOR]

Lung hernia is a rare condition. Approximately one third of cases occur in the cervical position. We report a case of bilateral cervical lung hernia associated with neuralgic pain that was repaired using bovine pericardium and biological glue. [Copyright &y& Elsevier]

A left completion pneumonectomy for primary lung cancer (left lower lobectomy) was complicated by sudden loss of ability to ventilate the patient through the double-lumen endotracheal tube. The problem could not be overcome by the anesthesiologist. In the face of impending cardiorespiratory arrest, a single-lumen tube was introduced through an incision in the left main bronchus through to the right main bronchus. This life-saving maneuver safeguarded the airway and permitted a successful outcome to the operation. [Copyright &y& Elsevier]

The trachea is readily accessed through a right thoracotomy. Further exposure of the distal trachea may be accomplished using a median sternotomy through a transpericardial approach. We report our experience of a case of iatrogenic tracheal rupture in a patient with a large left-sided posterior mediastinal tumor. Surgical resection of the mass and subsequent repair of the tracheal rupture was accomplished through a left thoracotomy. [Copyright &y& Elsevier]

Abstract: Pericardial diseases can be difficult to differentiate from myocardial conditions. Diagnosis can be challenging and often requires the use of different imaging modalities. Here, we describe a case which presented with common cardiac symptoms which were shown to be the result of a rare condition. A 62-year-old lady presented with left femoral artery embolism. Post-embolectomy she developed cardiac failure. Three months previously an acellular, sterile pericardial effusion had been drained. In 1993 a left mastectomy and axillary node clearance was performed for breast cancer. Adjuvant chemotherapy and radiotherapy were administered. Examination revealed a raised jugular venous pressure (JVP) with rapid Y descent and Kussmaul''s sign. CT chest and abdomen found no recurrence of breast carcinoma. Cardiac MRI demonstrated thickened pericardium. At cardiac catheterisation haemodynamic responses consistent with constrictive pericarditis were seen. Pericardiectomy was performed. Histology revealed pericardial epithelioid malignant mesothelioma. 18-FDG-PET CT post-operatively was negative in the pericardium and pleura. Chemotherapy with pemetrexed and carboplatin was given. The patient died 9 months after presentation. Radiotherapy and asbestos exposure are both associated with pericardial mesothelioma and the aetiology in this case was not clear. The condition carries a poor prognosis and is invariable fatal although newer chemotherapeutic regimens have prolonged survival times. [Copyright &y& Elsevier]

The article presents the results of the computed tomography scan that confirm the presence of air in the right ventricle after a man was shot with an air rifle.