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Objectives To retrospectively review 14 cases, describe preoperative imaging, anatomic findings and confirmation at surgery, surgical technique, and outcomes. Materials and Methods We describe anatomic variations in mixed-type total anomalous pulmonary venous return and surgical outcomes in a case series from 2 centers. Mixed-type total anomalous pulmonary venous return is classified based on the pattern of pulmonary venous drainage. Type I refers to '2+2' drainage of venous pairs, type II refers to '3+1' and type III refers to all other variants. Six patients (43%) had type I "2+2" drainage; 2 patients had 2 supra-cardiac and 2 cardiac connections, and 4 patients had 2 infra-cardiac connections and 2 cardiac. 4 patients (29%) had type II "3+1" drainage. Three patients had 3 cardiac and 1 supra-cardiac variants and one had a rare supra-cardiac pulmonary venous combination. 4 patients (29%) had type III morphology. 2 patients of them had 3+2 anatomy with 3 supra-cardiac and 2 cardiac connections, both of which included 3 right-sided pulmonary veins. The remaining 2 patients had unique anatomy, one with tri-level attachment to cardiac, supra-cardiac, and infra-cardiac and the last with all supracardiac pulmonary venous drainage but in a "3+1+1" pattern. Results In previous publications, mixed-type total anomalous pulmonary venous return has a higher mortality rate, with univariate analysis of mixed-type versus cardiac type with statistically significant hazard ratios of 2.88 in previous study and mortality as high as 42-50%. We achieved improved outcomes, with overall survival of 79% and no intraoperative mortality. Both patients who had complex intracardiac lesions (1 with ventricular septal defect and 1 with tetralogy of fallot) ultimately died. Of the remaining patients, 29% developed pulmonary venous obstruction on echocardiography follow-up with 3 requiring interventions with cardiac catheterization. Conclusion Mixed-type total anomalous pulmonary venous return has a wide variety of connections, which contributes to the complexity of planning and surgical correction. Further studies are needed to better understand the different morphologies of the disease. Keywords:Mixed type, outcome, surgical management, total anomalous pulmonary venous return: [ABSTRACT FROM AUTHOR]

Atrial septal hematoma is uncommon complication that may happen after any cardiac intervention. Although it is rare, it can pose a challenging situation in the postoperative care. Multiple management approaches has been described with different outcomes. Here we are reporting a boy, aged 13 years, with dilated aortic root who underwent aortic root replacement with valve preservation. Postoperative course was complicated by atrial septal hematoma. A nonsurgical management approach was chosen based on the patient clinical condition. Regression in size with complete resolution of the hematoma was observed during the follow up. [ABSTRACT FROM AUTHOR]

A 32-yr-old, previously healthy man with severe chest pain of sudden onset was found to have purulent pericarditis and pleural effusions. Several days later, an esophagogram revealed a perforation of the thoracic esophagus. Endoscopy showed a picture highly suggestive of a late stage of an extensive herpes simplex virus (HSV) esophagitis. Biopsies revealed evidence of massive HSV infection, confirmed by immune microscopy and virus culture. At surgery, a mediastinal abscess was found, and an esophageal perforation was identified. These findings suggest that the etiology of the perforation was an unusually severe herpetic infection. To our knowledge, HSV esophagitis has not previously been implicated as the cause of spontaneous esophageal perforation. [ABSTRACT FROM AUTHOR]

Aims: Mechanical complications (MCs) are rare but potentially fatal sequelae of acute myocardial infarction (AMI). Surgery, though challenging, is considered the treatment of choice. The authors sought to study the early and long-term results of patients undergoing surgical treatment for post-AMI MCs., Methods and Results: Patients who underwent surgical treatment for post-infarction MCs between 2001 through 2019 in 27 centres worldwide were retrieved from the database of the CAUTION study. In-hospital and long-term mortality were the primary outcomes. Cox proportional hazards regression models were used to determine independent factors associated with overall mortality. The study included 720 patients. The median age was 70.0 [62.0-77.0] years, with a male predominance (64.6%). The most common MC encountered was ventricular septal rupture (VSR) (59.4%). Cardiogenic shock was seen on presentation in 56.1% of patients. In-hospital mortality rate was 37.4%; in more than 50% of cases, the cause of death was low cardiac output syndrome (LCOS). Late mortality occurred in 133 patients, with a median follow-up of 4.4 [1.0-8.6] years. Overall survival at 1, 5, and 10 years was 54.0, 48.1, and 41.0%, respectively. Older age (P < 0.001) and post-operative LCOS (P < 0.001) were independent predictors of overall mortality. For hospital survivors, 10-year survival was 65.7% and was significantly higher for patients with VSR than those with papillary muscle rupture (long-rank P = 0.022)., Conclusion: Contemporary data from a multicentre cohort study show that surgical treatment for post-AMI MCs continues to be associated with high in-hospital mortality rates. However, long-term survival in patients surviving the immediate post-operative period is encouraging., (© The Author(s) 2024. Published by Oxford University Press on behalf of the European Society of Cardiology.)

Objectives: Papillary muscle rupture (PMR) is a rare but potentially fatal complication of acute myocardial infarction. The aim of this study was to analyse the patient characteristics and early outcomes of the surgical management of post-infarction PMR from an international multicentre registry., Methods: Patients underwent surgery for post-infarction PMR between 2001 through 2019 were retrieved from database of the CAUTION study. The primary end point was in-hospital mortality., Results: A total of 214 patients were included with a mean age of 66.9 (standard deviation: 10.5) years. The posteromedial papillary muscle was the most frequent rupture location (71.9%); the rupture was complete in 67.3% of patients. Mitral valve replacement was performed in 82.7% of cases. One hundred twenty-two patients (57%) had concomitant coronary artery bypass grafting. In-hospital mortality was 24.8%. Temporal trends revealed no apparent improvement in in-hospital mortality during the study period. Multivariable analysis showed that preoperative chronic kidney disfunction [odds ratio (OR): 2.62, 95% confidence interval (CI): 1.07-6.45, P = 0.036], cardiac arrest (OR: 3.99, 95% CI: 1.02-15.61, P = 0.046) and cardiopulmonary bypass duration (OR: 1.01, 95% CI: 1.00-1.02, P = 0.04) were independently associated with an increased risk of in-hospital death, whereas concomitant coronary artery bypass grafting was identified as an independent predictor of early survival (OR: 0.38, 95% CI: 0.16-0.92, P = 0.031)., Conclusions: Surgical treatment for post-infarction PMR carries a high in-hospital mortality rate, which did not improve during the study period. Because concomitant coronary artery bypass grafting confers a survival benefit, this additional procedure should be performed, whenever possible, in an attempt to improve the outcome., Clinical Trial Registration: clinicaltrials.gov: NCT03848429., (© The Author(s) 2021. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.)