This study aims to evaluate the association between target vessel size and graft patency in the right IMA–right coronary territory anastomosis. A total of 402 patients who underwent CABG between 2005 and 2016 using the right IMA Y-graft to the posterolateral branch or posterior descending artery were enrolled. Preoperative coronary angiography was utilized to measure the size of the target coronary arteries in the right territory. Follow-up angiography and computed tomography at 6 to 12 months were used to determine graft patency. Thirty patients (7.5%) were found to have occluded graft. Larger target vessel size was associated with lower risk of graft occlusion (OR: 0.18, 95% CI:0.05–0.62, P = .007). The receiver operating characteristic (ROC) curve showed that the cutoff-value of 1.93 mm was found to have the maximum sum of sensitivity and specificity for graft patency (Area under the curve (AUC): 0.65, P = .01). Excluding patients with right coronary artery total occlusion, the discriminative performance of target vessel size became more prominent (AUC: 0.76, P < .01), with same cutoff value. In the setting of bilateral IMA composite grafting, the patency of right IMA to right coronary territory was influenced by the size of the target coronary artery. The influence of target coronary artery size was prominent in non-total occlusion patients. Careful selection of a target anastomosis site is recommended.

Ectopia Cordis is a congenital anomaly in which the heart is located abnormally outside the thoracic cavity. Aetiology of this defect is still unclear with the incidence rate of 8:1,000,000 live births. Clinical manifestations usually present as severe sepsis respiratory distress due to heart failure as a result of an intrinsic abnormality of the heart which makes the management more challenging. Five days-old female newborn was referred to our hospital by a local doctor with "beating lump" outside her chest. The diagnosis of complete thoracic ectopia cordis was made by clinical examination, chest x-ray, and echocardiography. The Echo showed complete AV canal, ASD, mild pulmonary stenosis, and atrioventricular valve regurgitation. Palliative surgery was then undertaken with the initial goal to limit exposure and prevent further infection. The heart is covered with bovine pericardium sutured along the edge of the chest wall defect. Ectopia cordis is rare and has a poor prognosis especially thoracic and cervical types. Definitive surgery, to replace the heart to the thoracic cavity, is difficult to perform because of the hypoplastic thoracic cavity. Attempt to do palliative surgery, such as covering the heart with either skin flap or other material, becomes the choice of treatment in this case although there is no evidence reported of adulthood survivors.Ektopia Cordis adalah anomali kongenital di mana jantung terletak tidak normal di luar rongga toraks. Etiologi cacat ini masih belum jelas dengan tingkat kejadian 8: 1.000.000 kelahiran hidup. Manifestasi klinis biasanya timbul sebagai gangguan pernapasan sepsis berat akibat gagal jantung akibat kelainan intrinsik jantung yang membuat penatalaksanaan lebih menantang. Bayi perempuan yang baru berusia lima hari dirujuk ke rumah sakit kami oleh dokter setempat dengan "benjolan" di luar dadanya. Diagnosis dari ectopia cordis toraks lengkap dibuat dengan pemeriksaan klinis, rontgen dada, dan ekokardiografi. Echo menunjukkan saluran AV lengkap, ASD, stenosis paru ringan, dan regurgitasi katup atrioventrikular. Operasi paliatif kemudian dilakukan dengan tujuan awal untuk membatasi pajanan dan mencegah infeksi lebih lanjut. Jantung ditutup dengan pericardium bovine yang dijahit di sepanjang tepi dinding dada yang cacat. Cordic ectopia merupakan kasus yang jarang dan memiliki prognosis yang buruk terutama tipe toraks dan serviks. Pembedahan definitif, untuk menggantikan jantung ke rongga toraks, sulit dilakukan karena rongga toraks hipoplastik. Mencoba melakukan pembedahan paliatif, seperti menutupi jantung dengan lipatan kulit atau bahan lain, menjadi pilihan perawatan dalam kasus ini meskipun tidak ada bukti yang dilaporkan tentang orang dewasa yang selamat.

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Introduction: Iatrogenic pseudoaneurysm (PSA) in hemodialysis vascular access puncture site is the most common complication in a patient with ERSD, which needs urgent surgical intervention. This research explained the patients’ characteristics with pseudoaneurysm in vascular access that underwent surgical intervention immediately. Methods: Retrospectively, it reported cases of pseudoaneurysm that underwent immediate surgical intervention in an operating theatre in the emergency department of RS Dr. Soetomo Surabaya. Result: Twenty-one patients, whose age range from 26-to 64 years old (mean 46.57 + 12.14 years), have undergone immediate surgical and vascular intervention in an operating theater in the emergency department of RS Dr. Soetomo from 2017 until March 2021. The site of pseudoaneurysm varies from cubiti (90.4%), with signs and symptoms of impending rupture (57.1%), rupture (28.6%), and infected pseudoaneurysm (14.3%). Surgical management such as arterial repair was conducted in 90.4% of cases, and two patients (9.6%) unfortunately underwent takedown AVF. It was found from all 21 cases that nine cases didn’t have vascular access as recommended, leading to repetitive puncture in the same puncture site. Conclusion: Iatrogenic Pseudoaneurysm in ESRD patients on regular hemodialysis is the most common complication that has been treated. The medical staff’s knowledge about recognition and prevention is a crucial factor in controlling this complication

Background Healthcare workers are still the front liners in health care services, and have major roles during the COVID-19 pandemic. In a resource-limited country like Indonesia, it is necessary to provide safe screening and management both for patients and healthcare workers to minimize the transmission. We report our experience in the cardiac surgery department on how to provide safe management during the COVID-19 pandemic. Methods A retrospective observational study was performed in a single-tertiary-center cardiac surgery department in Surabaya and included all patients who underwent cardiac surgery during the first year of the COVID-19 pandemic. We also collected the patients from a 1-year period before the pandemic as the comparison data. Analysis of the patient characteristics, operative data, and postoperative outcome, was performed. This study also provides our experience in changes of admission in the cardiac surgery preoperative system that can be utilized for others. Results A total of 179 patients were admitted to and had cardiac surgery. Of these, 3.80% ( n = 7) were COVID-19 confirmed by a real-time polymerase chain reaction. Five patients were delayed to have cardiac surgery with no mortality or morbidity reported in these patients. During the period after changes of admission procedural in cardiac surgery patients, there were no healthcare workers infected by COVID-19 by patient transmission in our center (0%). Conclusion Our study reported a systematic screening and that possible delay in cardiac surgery appears to be feasible and safe, both for patients and for healthcare workers during the COVID-19 pandemic.