The authors report a case of tracheo-innominate artery fistula secondary to tracheal perforation in an 18-year-old patient who is tetraplegic following cervical trauma. The patient had a very long tracheal stenosis, secondary to tracheostomy, which was managed by laser resection and a Gianturco stent. One of the anterior struts of the stent had eroded the trachea and the posterior wall of the innominate artery. Surgical management consisted of arterial resection, a longitudinal tracheal split incision to withdraw the stent and placement of a Montgomery T-tube. The patient has no respiratory discomfort 7 months after surgery.
Meningeal hemangiopericytoma is an uncommon and aggressive malignancy that, in contrast to meningiomas, shows a high propensity for local recurrence and the development of late extraneural metastases. The results of chemotherapy in advanced hemangiopericytoma have been disappointing, and they have been particularly poor in cases located in the meninges. We report a case of a heavily pretreated metastatic meningeal hemangiopericytoma in which fourth-line chemotherapy with trabectedin, a marine-derived antineoplastic agent effective in treating advanced soft tissue sarcomas, resulted in clinical benefit.
terns depend on anatomical severity, degree of right-to-left atrial shunt, and age at presentation. 4, 5 Long-term outcome is usually good for patients who survive the neonatal period and for those with no symptoms following the first years of life. 3 Therefore, many patients will develop symptoms and surgical treatment may be necessary. Current surgical criteria according to European or US guidelines include: (1) presence of symptoms or worsening functional class; (2) cyanosis (oxygen saturation <90%); (3) paradoxical embolism; (4) progressive cardiomegaly on chest X-ray; and (5) progressive RV dilation or RV systolic dysfunction. 6 Other authors recommend surgical repair in patients with more than moderate TR in the presence of symptoms (New York Heart Association [NYHA] class >II or arrhythmias) or worsening exercise capacity. 7 Optimal timing for surgical management in this patient subset remains controversial. Badiu et al found that NYHA functional class >II and cardiothoracic index >0.6 are important prognostic factors associated with long-term mortal-E bstein's anomaly (EA) accounts for <1% of all congenital heart disease. There is general consensus that EA affects not only the tricuspid valve but also the whole right ventricle (RV). This results in a particular type of right-sided cardiomyopathy. 1 The characteristic features of this anomaly are: (1) predominant septal and inferior tricuspid leaflet attachment to the underlying myocardium due to failure of delamination; (2) anterior and apical rotational displacement of the functional annulus; (3) dilation of the "atrialized" portion of the RV with variable degrees of hypertrophy and wall thinning; (4) redundancy, fenestration and tethering of the anterior leaflet; (5) dilation of the right atrioventricular junction (the true tricuspid annulus); and (6) variable degree of ventricular myocardial dysplasia and dysfunction. 1-3These anatomical and functional abnormalities cause important tricuspid regurgitation (TR) in many patients that contributes to right chamber dilation and atrial or ventricular arrhythmias. Hemodynamics and clinical pat-
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