Search

While some have claimed that a median sternotomy is an 'unkind cut,' when this incision is performed, closed, and managed optimally, it can be one of the 'most kind cuts' used for major operations. The median sternotomy is the most commonly used incision for coronary artery bypass surgery, which is the most common operation performed in the United States at the current time. This approach is, of course, used for many other cardiac and thoracic operations, as well. It is, however, also one of the most misunderstood procedures in Surgery. Because it is an incision that even a novice surgical resident can perform, with proper supervision, the subtleties and nuances of not only opening but also of closing sternotomies are not often conveyed optimally to our trainees. In this treatise we will attempt to comprehensively address these subtleties, nuances, and misunderstandings, both for the benefit of our younger learners, but also, and more importantly, for the benefit of our patients., (© 2021 Forum Multimedia Publishing, LLC)

The HeartMate II is an axial-flow left ventricular assist device that is approved for the treatment of advanced heart failure as a bridge to transplant or destination therapy. Despite the success of this device, right ventricular failure remains a persistent problem in most studies. Right ventricular dysfunction is usually defined as the need for right heart mechanical support or the persistent requirement for inotropes to support right heart function beyond 14 days. Over 21 months, 45 patients with end-stage heart disease underwent placement of the HeartMate II at our institution. This continuous cohort of patients underwent a retrospective review to evaluate the incidence of right heart failure. The perioperative survival was 91% with no incidents of mechanical support for the right ventricle and no requirements for inotropes beyond 14 days. This survival was consistent to beyond 1 year at the time of the study, and 18% of patients underwent heart transplant with 100% survival.

Background: A 56-year-old male with a past history of excision of a malignant melanoma from his lip presented with squeezing chest pain. The patient was evaluated and determined to have a tumor of the left ventricle. Excision of such a tumor is indicated to prevent embolization and also to prevent the possibility of outflow tract obstruction., Methods: The patient underwent transesophageal echocardiography and was placed on cardiopulmonary bypass with cold-blood cardioplegia. The ascending aorta was opened and a video-assisted cardioscope was inserted through the aortic valve and used to visualize the tumor. The tumor was resected under direct vision and the aorta was closed., Results: Frozen section analysis revealed the tumor to be a benign hemangioma. The patient had an uneventful recovery with no evidence of ventricular septal defect or embolization., Conclusions: Performing the cardioscopy via the aortotomy helped us to avoid an atriotomy and/or ventriculotomy and enabled us to discern the precise extent of the tumor and rule out concomitant pathology. The use of cardioscopy as an adjunct for excision of intraventricular abnormalities can assist in determining the precise location and size of tumors and in resecting tumors in areas of the heart that might otherwise be difficult to visualize.

Significant hepatotoxicity due to allopurinol seems to be rare. Only 6 such cases have been recorded in the literature. The clinical and histopathologic findings of allopurinol-induced liver injury are variable in the previously reported cases. Described herein is another patient with allopurinol hepatotoxicity. Of interest is the similar histopathology between the present case and the two previously reported cases of allopurinol-induced granulomatous hepatitis; thus this is the third such recorded case. Allopurinol should be suspected when liver abnormalities occur following use of this drug.