Aorta-right atrial tunnel is rare. We report a case of aorta-right atrial tunnel in which the right coronary artery arose from the tunnel. Successful surgical treatment was performed.

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Centrifugal pumps are nonocclusive pumps that offer centrifugal blood pumping known as the constrained force vortex principle.Of 2405 open heart procedures, 370 (15.4%) were performed with a centrifugal pump (CP). In the rest of the cases extracorporeal circulation (ECC) was established with conventional roller pump (RP). The operations performed with a CP were: 34 reoperations, 11 ascending aortic aneurysms + coronary artery bypass graft (CABG), 47 multivalve replacements, 125 CABG + left ventricular aneurysmectomies, and 153 CABGs alone. This prospective study consisted of two groups, each group including 50 patients undergoing CABG surgery. In group I ECC was established with a CP and in group II with a conventional RR The two selected groups of patients were considered to be similar in terms of clinical, hemodynamic, and angiographic data. Hemodynamic study concerned flow rate, systemic vascular resistance (SVR), and urinary output. No difference was found between the CP and RP hemodynamically. Nevertheless, the alteration of the flow rate in response to variation of SVR is accepted as an advantage.As for hemolytic effect during ECC of CP compared with RP: Plasma free hemoglobin, hemotocrit, platelet count, platelet factor 4, and fibrinogen levels, were investigated. These parameters revealed that there was significant hemolysis and trauma to the blood components in the RP group when compared with the CR (p < 0.05, p < 0.01). at NORTH CAROLINA STATE UNIV on March 15, 2015 ves.sagepub.com Downloaded from 124There was no significant difference in psychoneurologic complications, but behavioral and sensory disorders were encountered sevenfold more in the RP group. This might be due to spoliation of the tubing set or to microair embolism.Compared with the conventional RP the CP proved to have no hemodynamic advantage. The effects on blood components showed significant trauma to the RP group. Postoperative drainage verified this observation (p < 0.05).In this study the CP appears to be superior to the RP especially in complicated and prolonged ECC.

Varicose veins, associated with great saphenous vein (GSV) incompetence, are traditionally treated with conventional surgery. In recent years, minimally invasive alternatives to surgical treatment such as the endovenous laser ablation (EVLA) and radiofrequency (RF) ablation have been developed with promising results. Residual varicose veins following EVLA, regress untouched, or phlebectomy or foam sclerotherapy can be concomitantly performed. The aim of the present study was to investigate the safety and efficacy of EVLA with different levels of laser energy in patients with varicose veins secondary to saphenous vein reflux. From February 2006 to August 2011, 740 EVLA, usually with concomitant miniphlebectomies, were performed in 552 patients. A total of 665 GSV, 53 small saphenous veins (SSV), and 22 both GSV and SSV were treated with EVLA under duplex USG. At 84 patients, bilateral intervention is made. In addition, miniphlebectomy was performed in 540 patients. A duplex ultrasound (US) is performed to patients preoccupying chronic venous insufficiency (with visible varicose veins, ankle edema, skin changes, or ulcer). Saphenous vein incompetence was diagnosed with saphenofemoral, saphenopopliteal, or truncal vein reflux in response to manual compression and release with patient standing. The procedures were performed under local anesthesia with light sedation or spinal anesthesia. Endovenous 980-nm diode laser source was used at a continuous mode. The mean energy applied per length of GSV during the treatment was 77.5 ± 17.0 J (range 60-100 J/cm). An US evaluation was performed at first week of the procedure. Follow-up evaluation and duplex US scanning were performed at 1 and 6 months, and at 1 and 2 years to assess treatment efficacy and adverse reactions. Average follow-up period was 32 ± 4 months (3-55 months). There were one patient with infection and two patients with thrombus extension into the femoral vein after EVLA. Overall occlusion rate was 95%. No post-procedural deep venous thrombosis or pulmonary embolism occurred. Laser energy, less than 80 J/cm, was significantly associated with increased recanalization of saphenous vein, among the other energy levels. EVLA seems a good alternative to surgery by the application of energy of not less than 80 J/cm. It is both safe and effective. It is a well-tolerated procedure with rare and relatively minor complications.

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These findings suggested that PTX may be an effective agent in reducing the haemolysis during CPB.