Case Description

A 10-month-old infant presented with a hard chest wall mass, palpable at the level of the left fourth rib, and was found to have a bifid left fourth rib on chest radiography (Fig. 1). This was later confirmed using 3-dimensional chest computed tomography reconstruction (Fig. 2), which also ruled out any other masses in the chest wall or in the pleural or pericardial spaces.

Fig. 1 Chest radiograph showing a bifid left fourth rib.
Citation: Texas Heart Institute Journal 50, 1; 10.14503/THIJ-22-7975

Fig. 2 Three-dimensional computed tomography reconstruction of the chest showing an isolated bifid left fourth rib.
Citation: Texas Heart Institute Journal 50, 1; 10.14503/THIJ-22-7975

Comment

Bifid rib is

Abstract

Surgical approaches for mitral valve exploration vary, with the preferred approach being via the interatrial groove. Data on whether the interatrial groove approach can be used for mitral valve surgery in patients with a previously implanted Amplatzer septal occluder (ASO) (St Jude Medical, an Abbott company) are extremely limited. The authors performed mitral valve surgery using the transatrial septal approach on 2 patients following explantation of an ASO, which significantly impedes the interatrial groove approach. Concomitant surgical procedures with mitral valve replacement, removal of the ASO, and closure of an atrial septal defect with a patch significantly prolonged the cross-clamp and cardiopulmonary bypass durations, which is the reason for intraoperative low cardiac output syndrome. An intra-aortic balloon pump and venoarterial extra-corporeal membrane oxygenation were used in these 2 patients because of low cardiac output syndrome. When planning mitral valve surgery in patients with a previously implanted ASO, the device precludes the interatrial groove approach and can produce an unpredictable clinical scenario.

Abbreviations and Acronyms

CAD: coronary artery disease
LVNC: left ventricular noncompaction

Case Report

A 51-year-old man without cardiac risk factors was referred to the hospital after a complete left bundle block was discovered on an electrocardiogram; he had a 6-month history of fatigue and mild exertional dyspnea. Transthoracic echocardiogram showed a spongiform appearance of the left ventricle, with prominent hypertrabeculations in lateral and apical walls (Fig. 1A and B). The left ventricle was dilated and hypokinetic (diastolic diameter, 70 mm; ejection fraction, 25%).

Fig. 1 Transthoracic echocardiography shows a dilated left ventricle with spongiform appearance and prominent hypertrabeculations

Citation: Texas Heart Institute Journal 50, 1; 10.14503/THIJ-21-7595

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Abstract

Blunt traumatic injuries to the brachiocephalic artery require surgical management. The operative technique used depends on the location of the injury, the patient's hemodynamic stability, and the surgeon's experience. Perfusion strategy can facilitate vascular control of the aortic arch and branch vessels. This report presents an urgent repair of a proximal posterior blunt traumatic brachiocephalic artery injury under circulatory arrest, with an excellent outcome.

Abstract

This report involves a young woman with isolated cardiac paraganglioma that was diagnosed using ⁶⁸Gallium-labeled [1,4,7,10-tetraazacyclododecane-1,4,7,10-tetraacetic acid]-1-NaI3-octreotide positron emission tomographic scintigraphy. For the preoperative evaluation, multimodality imaging accurately described the anatomic location of the tumor and its relationship with the surrounding tissues. The patient underwent successful surgical resection of the tumor along with right coronary artery bypass grafting. The 2-month follow-up scintigraphy was normal. Next-generation sequencing evaluation revealed a novel germline mutation for the succinate dehydrogenase subunit B gene.