retropharyngeal abscess. J Laryngol ... icardial bronchogenic cyst compressing the superior vena cava. The cyst was resected via median sternotomy, alleviat-.
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Redo ‘beating heart’ minimally invasive mitral valve surgery – An Australian experience Robert B. Xu, MBBS *, Justin Chan, FRACS, Robert Stuklis, FRACS, James Edwards, FRACS * Corresponding author. Redo cardiac surgery is becoming increasingly prevalent as the population ages. Re-entry median sternotomy is associated with significant potential morbidity and mortality, especially if patent coronary artery grafts are present(1). Dissection of adhesions can be time-consuming and technically challenging, especially if the aorta must be exposed for cannulation or cross-clamping. However, in most cases of redo cardiac surgery, the right pleura will be previously untouched. In addition, in patients with poor ventricular function, as is often seen in long-standing valvular disease or history of coronary artery disease, myocardial protection becomes a concern and cardiac arrest will place the patient at risk of ischaemiareperfusion injury and postoperative low cardiac output(2). In cases of redo surgery for mitral valve intervention, a right anterolateral thoracotomy incision with surgery done on a ‘beating heart’, provides excellent exposure while avoiding the risk of redo sternotomy, limits the need for extensive adhesiolysis, and cardioplegia reperfusion injury. From 2006 to 2013, 25 cases of reoperative mitral valve surgeries were performed on patients through a right thoracotomy utilising a no cross-clamp, beating heart approach. Preoperative patient factors, perioperative outcomes, as well as complication rates, were identified through retrospective case note review. Our technique of redo mitral valve surgery through a right mini-thoracotomy approach, performed on a beating heart, was introduced as a means to facilitate simpler operations with shorter CPB and overall operation times, reduce adhesiolysis, and minimise ischaemia-reperfusion injuries. This series has shown it to be a safe and effective option for cardiac surgeons. http://dx.doi.org/10.1016/j.hlc.2014.12.108 Pyopneumothorax secondary to misplaced stoma care swab in patient with speaking prosthesis
Abstracts
combined terms “pyopneumothorax” and “foreign body” in all fields yielded 4 results. Results: A 57 year-old man presented with a four week history of shortness of breath and cough with haemoptysis. This was on a background of a laryngeal squamous cell carcinoma for which he had a total laryngectomy and iatrogenic trachea-oesophagel fistula fashioned for a speaking prosthesis, which had recently been dislodged. He was commenced on antibiotics for suspected aspiration and a chest CT scan revealed a left pyopneumothorax. He proceeded to theatre for decortication, where he was found to have a foreign body communicating between the lung parenchyma and the pleural space. The patient underwent formal decortication and parietal pleurectomy for his loculated empyema. The foreign body was removed, leaving a bronchopleural fistula in the lateral basal segment of the left lower lobe, which was repaired with a Teflon pledgetted 4-0 prolene. On review, the foreign body was identified as a wooden wound care swab which the patient had misplaced during stoma care. He recovered well post-operatively without any significant residual air leak and completed a course of intravenous antibiotics. Discussion: This is the first report of a pyopneumothorax secondary to a foreign body in Australia. It emphasizes the importance of having a high index of suspicion given that presenting symptoms may be nonspecific, and further affirms that surgical intervention and extended antibiotic therapy is the definitive management in such cases. References [1] Liu SF, Lai YF, Wong SL, Lin AS, Chao TY. Pyopneumothorax associated with unsuspected endobronchial foreign body: a case report. Changgeng Yi Xue Za Zhi 1995 Sep;18(3):292–6. [2] Kawakami M, Chigira H, Nitta S, Sato H, Takahashi H, Nakada T. Pyopneumothorax due to perforation of the esophagus with an ingested fish bone. A case report. Sci Rep Res Inst Tohoku Univ Med 1978 Sep;25 (12):1–4. [3] Lokman S, Sani A, Sidek DS. Pyopneumothorax–a rare sequelae of retropharyngeal abscess. J Laryngol Otol 1993 May;107(5):460–2. [4] Wellington JL. The shrapnel awakes: pyopneumothorax and chronic empyema resulting from a foreign body retained for 17 years. Can Med Assoc J 1962 Aug;87:349–51.
http://dx.doi.org/10.1016/j.hlc.2014.12.109
Robert B. Xu, MBBS , Mart Nadal, MD, Kate E. Drummond, FANZCA, Michael Worthington, FRACS, Craig Jurisevic, FRACS
Intrapericardial bronchogenic duplication cyst
D’Arcy Sutherland Cardiothoracic Surgical Unit Royal Adelaide Hospital * Corresponding author.
The Prince Charles Hospital, Chermside, Australia * Corresponding author.
Introduction: Pyopneumothorax secondary to foreign bodies is a rare occurrence, with only four cases listed in the literature [1–4]. Where details were available regarding the management of the these cases, thoracic surgical intervention was carried out successfully [1,4]. We describe the first documented case, to our knowledge, of a pyopneumothorax secondary to a foreign body in Australia. Methods: Retrospective analysis of case data including pre-operative, intra-operative and post-operative, including laboratory and radiological investigations was performed. A systematic review of the literature was also conducted through PubMed, Embase and Cochrane library, focusing on pyopneumothoraces secondary to foreign bodies. Search of
Lawrence Nair, Yasangi Ranawaka *, Rishendran Naidoo
Bronchogenic cysts arise from an abnormal budding of the ventral diverticulum of the foregut or the tracheobronchial tree, during embryogenesis. Intrapericardial cysts are rare, accounting for 27% of bronchogenic cysts. In this case report, we present a young woman with a symptomatic intrapericardial bronchogenic cyst compressing the superior vena cava. The cyst was resected via median sternotomy, alleviating the patients’ preoperative symptoms. Case: A 40-year old female was referred to the Thoracic Surgery out-patients with the diagnosis of a mediastinal mass. She had undergone an elective haemorrhoidectomy 2 weeks prior to her presentation, with her postoperative progress complicated by intermittent episodes of dyspnoea. Gradual worsening of the dyspnoea, associated with atypical
