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Risks posed by SARS-CoV-2 to be able to Us softball bats during winter fieldwork.
Understand the limitations of the modeling of survival data, especially as pertains to the Cox proportional hazards model.An introduction to model-free estimates of survival, namely, the restricted mean survival time/restricted mean lost time.Use R (The R Foundation for Statistical Computing, Austria) or STATA® (The STATACorp, College Station, TX, USA) to perform analyses and obtain these parameters from a dataset.
The online version contains supplementary material available at 10.1007/s12055-021-01167-4.
The online version contains supplementary material available at 10.1007/s12055-021-01167-4.Peri-procedural myocardial infarction (PMI) is an important outcome measure in several trials. JAK inhibitors in development However, there is no consensus regarding the definition of PMI. There is significant variability in terms of biomarkers used, the threshold values, the requirement for additional supporting evidence, and even the duration until which PMI can be said to occur. This lack of clarity leads to inappropriate comparisons between trials. Besides, the outcome of a trial and the inferences drawn are completely altered by using a different definition. Thus, there is a pressing need to formulate a uniform definition for PMI in future studies.Dr. O.P. Yadava, CEO & Chief Cardiac Surgeon, National Heart Institute, New Delhi, India and Editor-in-Chief, Indian Journal of Thoracic and Cardiovascular Surgery in conversation with Dr. Adrian J Levine, Consultant Cardiac Surgeon, University Hospital of the North Midlands, UK.
The online version contains supplementary material available at 10.1007/s12055-021-01221-1.
The online version contains supplementary material available at 10.1007/s12055-021-01221-1.A case of left atrial myxoma, diagnosed on echocardiography in the emergency department, was referred for open heart surgical intervention. On reviewing chest X-ray, right lung, lower lobe whiteout was noted which instigated the need to perform a computed tomography (CT) chest. On CT chest, a heterogenously hypodense mass was seen along the posterior and inferior aspect of the right hemithorax. It had ill-defined planes with left atrium and extension into the left atrium through the right inferior pulmonary vein. On the basis of imaging, the etiology was sarcomatous/malignant vascular mass of pulmonary origin and unnecessary open-heart surgery was averted. The patient was transferred to the oncology department for further management.Left atrial clots are occasionally seen in patients with long-standing atrial fibrillation who come for valve surgery. Once identified on echocardiogram, intraoperative identification and retrieval of the clot are essential in order to prevent the possibly devastating complication of embolism and stroke.
The online version contains supplementary material available at 10.1007/s12055-021-01154-9.
The online version contains supplementary material available at 10.1007/s12055-021-01154-9.In the context of collateral circulation of the heart, the role of extra-cardiac collateral arteries has been thought to be negligible. We present a case in which such collateral vessel acted as a rescue, subsequent to a failed revascularisation attempt. With surgeons nowadays considering 'less is more' in terms of grafting in coronary artery bypass grafting (CABG), and more evidence arising in favour of medical therapy, we need to re-assess the role of these collateral vessels in the coronary circulation.A case of a 46-year-old woman with disease relapse and surgical intervention with a transverse rectus abdominalis muscle flap (TRAM) of the chest wall is reported. Long-term survival (64 months) following aggressive surgery was succeeded.A 46-year-old male presented with breathlessness for a few months. He had been operated twice for liver hydatid cysts and once for right pulmonary hydatid cysts at other hospitals. Now he was found to have one hydatid cyst in the upper lobe of the left lung and multiple hydatid cysts adjoining left heart border. On computed tomography (CT) scan chest and echocardiography, it was difficult to ascertain whether these cysts were pulmonary or intrapericardial. Left ventricular ejection fraction (LVEF) was 25%. Enzyme-linked immunosorbent assay (ELISA) was positive for hydatid. Left posterolateral thoracotomy revealed dead hydatid cyst in upper lobe of the lung that was removed. Infected mother hydatid cyst was encountered inside pericardial sac. Scores of daughter hydatid cysts, varying in size from 1 to 30 mm, were scooped out intact from the pericardial cavity. There was significant improvement in cardiac activity, once the tamponade effect of hydatid cyst was removed. Pericardium was about 1 cm thick with lot of purulent and necrotic slough. To prevent future constrictive pericarditis, subtotal pericardiectomy was done. Intrapericardial hydatid cyst should be kept in mind whenever it obscures the heart border and patient has features of cardiac tamponade. Early surgical intervention may be required in these cases.Transcatheter aortic valve implantation has emerged as a therapeutic option for patients with symptomatic severe aortic stenosis who are inoperable, or at very high risk of open-heart surgery. Recently, we encountered a patient with aortic stenosis and Larsen syndrome, who had short stature, obesity, kyphoscoliosis, multiple musculoskeletal deformities, and severe restrictive lung disease. An open-heart surgery in such a patient involves substantial peri-operative risk. A successful transcaval aortic valve implantation was done under general anesthesia.We report two cases of patients with carcinoid heart disease affecting all four valves. All four of the valves showed signs of regurgitation and were replaced using biological valves. Left-sided involvement is uncommon (5-10%), but can occur in the absence of an intracardiac shunt. Quadruple valve replacement in symptomatic patients can result in functional improvement with acceptable risks.Hydatid disease is a parasitic infection caused by the tapeworm Echinococcus. It has a worldwide distribution, but it is endemic in certain geographic locations. Hydatid disease can involve any body organ. Cardiac echinococcosis is a rare but potentially very serious complication of hydatid disease. This paper presents a case report of a myocardial hydatid cyst, which was totally excised without the aid of cardiopulmonary bypass. The patient was admitted to the hospital with non-specific symptoms and complaint of atypical chest pain together with palpitations. Transthoracic echocardiography with color Doppler imaging and computerized tomography with contrast were done for diagnosis and for deciding the strategy of operation. With the aid of intraoperative transesophageal echocardiography and controlled fluid evacuation, curative excision was performed after confirming that there is no communication with the cardiac chambers. The patient recovered well and postoperative anti-helminthic therapy was instituted. The patient continues to do well after 4 years of follow-up.
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