Objective In recent years, low-dose, short-acting anesthetic agents, which replaced the former high-dose opioid regimens, offer a faster postoperative recovery and decrease the need for mechanical ventilatory support. In this study, the aim was to determine the success rate of fast-track approach in surgical procedures for congenital heart disease. Methods There is some evidence, mostly from retrospective analyses, that fast tracking can be beneficial. Ninety-one cases with moderate complex cardiac malformations were operated with fast-track protocol during cardiothoracic charitable missions. The essential aspects of early extubation in our cohort included selected patients with good preoperative status, good surgical result with hemodynamic stability in low dose of inotropic drugs at the end of bypass, and no active bleeding. In this setting, a careful choice and dosing of anesthetic agents, alongside a good postoperative analgesia are mandatory. Results The authors found that an early extubation (< 4 hours) can be both effective and safe as it reduces intubation and ventilator times without increasing postoperative complications in pediatric congenital heart disease. Conclusion This study supports a wider use of fast-track extubation protocols in pediatric patients submitted for congenital cardiac surgery in developing countries.

AimsWe sought to determine the diagnostic performance, clinical profiles and outcomes of anomalous aortic origin of coronary arteries (AAOCA) using a standardised echocardiographic approach in young adults and athletes.MethodsIn 2015–2019, we screened 5998 outpatients (age 16 years (Q1–Q3: 11, 36)), referred for routine echocardiography, using four specific echocardiographic windows: parasternal short/long axis and apical 4/5-chambers view. Coronary CT confirmed AAOCA. For the performance analysis, 300 coronary-CT scans were available; two independent and double-blinded physicians retrospectively reviewed echocardiographic images.ResultsA total of 47 AAOCA was diagnosed; the overall prevalence was 0.0078%. Over 5 years, we found a significant increment of AAOCA diagnostic rate (P for trend=0.002). Syncope (n=17/47) and palpitations (n=6/47) were prevalent symptoms. All patients suspended sports activity at the diagnosis. Twenty-seven patients underwent surgery, while 20 underwent a conservative medical treatment. All patients are alive at a median follow-up of 3±1.6 years; only surgical repairs restarted their activity. Our method showed better sensitivity than traditional short-axis evaluation: 93% vs 83%, p=0.0030 (AUC 0.96 (95% CI 0.92, 0.99) and AUC 0.89 (95% CI 0.83, 0.95), respectively), with a good interobserver agreement (95%, k=0.83, p<0.001).ConclusionsThe application of a standardised echocardiographic approach for AAOCA detection led to a significantly increased rate of identified anomalies. This approach demonstrated higher sensitivity than the traditional echocardiographic assessment. Implementing this protocol in clinical practice may help improve the AAOCA diagnosis in young adults and athletes.Trial registration numberNCT04224090.

Spontaneous coronary artery dissection is a rare and generally fatal disease. A review of the literature demonstrates that the aetiopathogenesis of the disease is unknown and that the histology is rarely described. It usually occurs in young women during the post-partum period or while taking oral contraceptives. The treatment depends on the clinical presentation and the results of the angiography. We report here a case of spontaneous dissection of the left main stem coronary artery, with extension into the left coronary territory which which occurred in a 43-year-old woman.

In recent years, low-dose, short-acting anesthetic agents, which replaced the former high-dose opioid regimens, offer a faster postoperative recovery and decrease the need for mechanical ventilatory support. In this study, the aim was to determine the success rate of fast-track approach in surgical procedures for congenital heart disease. There is some evidence, mostly from retrospective analyses, that fast tracking can be beneficial. Ninety-one cases with moderate complex cardiac malformations were operated with fast-track protocol during cardiothoracic charitable missions. The essential aspects of early extubation in our cohort included: selected patients with good preoperative status, good surgical result with hemodynamic stability in low dose of inotropic drugs at the end of bypass, no active bleeding. In this setting a carefull choice and dosing of anesthetic agents, alongside a good postoperative analgesia are mandatory. The authors found that an early extubation (< 4 hours) can be both effective and safe as it reduces intubation and ventilator times without increasing post-operative complications in pediatric congenital heart disease. This study supports a wider use of fast-track extubation protocols in paediatric patients submitted for congenital cardiac surgery in developing countries.

HighlightsMyocardial bridge is muscle overlying intramyocardial segment of an epicardial coronary artery.Arrhythmic complications were reported in patients with myocardial bridge.ARCA surgery is recommended in symptomatic patients.

In non-addicted patients, several states, such as permanent pacemakers, can provide the predisposing factors for tricuspid-valve endocarditis. In this report, we present a case of a 66-year-old man with pacemaker lead infection and tricuspid-native-valve endocarditis, related to Staphylococcus hominis, very rare cause of infective endocarditis that carries a high-mortality risk. Surgery was indicated for the patient due to persistent enlarging vegetation on the tricuspid valve, severe tricuspid regurgitation, septic pulmonary emboli and finally uncompensated respiratory and heart failure. Many ingenious methods have been devised to repair the tricuspid valve in patients with infective endocarditis. Valve replacement, however, is hazardous due to the possibility of prosthetic infection, and we choose to repair the native valve. The patient has now been weel for 3 years.

In congenital non-Ebstein anomalies of the tricuspid valve, the septal leaflet is often involved and tethered. We describe a standardized approach to address septal leaflet tethering by concomitant augmentation of the anterior and posterior leaflets.

A pseudoaneurysm of the ventricle is formed when there is rupture of the myocardial wall with the discontinuity being roofed over by the pericardium and mural thrombus or fibrous tissue without myocardial elements. Cardiac pseudoaneurysm is a rare and a potentially life-threatening event. Early prophylactic surgical aneurysmectomy has been the treatment of choice. In this context, we report an unusual case of giant left ventricular pseudoaneurysm, as a result of unknown aetiology, appearing like a pulsatile mass, which was easily seen from the chest wall, in a young female, successfully treated with surgery.