BackgroundDespite decreasing sheath diameter, access site bleeding and vascular complications are still a major concern in transfemoral aortic valve implantation (TAVI), and may increase morbidity and even increase mortality. The aim was to compare safety of arterial closure in transfemoral TAVI with two different principles, pre-suture with ProGlide and collagen plug closure with Manta.ResultsSeventy-six patients treated with ProGlide and 75 with Manta were analysed. The endpoints were 1: access site vascular complications and 2: non-planned vascular or endovascular surgery at the puncture site. Complications occurred in 2 (2.7%) ProGlide and in 8 (10.7%) Manta cases, p = 0.047. During the learning phase there were no significant differences. In the established phase there was one event (2%) in the ProGlide group, compared to 6 endpoints (12.0%), p = 0.047, in the Manta group.Unplanned surgery or intervention was seen in two (2.7%) ProGlide and in 7 (9.3%) Manta patients, p = ns. There were no significant differences during the learning phase. In established use, endpoints occurred more frequently in patients treated with the Manta device (12%), than in patients treated with the ProGlide (2%), p = 0.047.ConclusionThe ProGlide presuture closure device was associated with significantly lower rates of vascular complications and lower rates of surgery and interventions compared to the collagen plug Manta system.Trial registrationThe data were collected from Internal quality control registry on treatment of patients with valvular heart disease with or without coronary artery disease, No 2014/17280, Oslo University Hospital, Ullevål.

Objectives: Due to the pathological effects of endothelin-1 (ET-1) on cardiomyocytes and the extracellular matrix, ET-1 levels may impact on the prognosis of aortic stenosis (AS) patients operated with aortic valve replacement (AVR). We examined ET-1 levels in AS patients throughout the whole AVR process, thus exposing potential therapeutic windows of opportunity. Methods: Plasma ET-1 levels were measured before and 2 days, 6 and 12 months after AVR in 22 patients with AS. Myocardial ET-1 was measured in biopsies from 7 patients undergoing AVR. Peroperatively, plasma ET-1 was analyzed in the coronary sinus and radial artery before aortic cross-clamp and at 5 and 20 min of reperfusion, in a second group of 30 patients. Results: Circulating ET-1 levels were transiently increased 2.6-fold 2 days following AVR. Myocardial ET-1 protein was 2.1-fold higher in patients with AS compared to controls. Plasma levels of ET-1 correlated to echocardiographic markers of diastolic dysfunction postoperatively. There was no increase in plasma ET-1 during early reperfusion, but veno-arterial differences indicated potential cardiac ET-1 extraction. Conclusions: Plasma ET-1 increases 2 days following AVR and myocardial ET-1 protein levels are increased in patients with AS before AVR. Peroperatively, no plasma ET-1 augmentation or release from the heart was observed in AS patients.

Conservative treatment, consisting of respiratory assistance and pain control, is still the treatment of choice in the vast majority of patients with multiple rib fractures. In selected patients, operative fixation of fractured ribs within 72 h postinjury may lead to better outcome. More randomized control trials are needed to further determine who benefits from surgical fixation of rib fractures.

Introduction: Pleural endometriosis is a rare condition. Spontaneous, recurring pneumothorax occurring during menstruation, referred to as catamenial pneumothorax, is associated with pleural endometriosis. A multidisciplinary approach is needed for a successful result. Material and methods: During the last five years (2005–2010), we have treated six patients with menstruation related pneumothorax at Oslo University Hospital. The surgical treatment was performed by the thoracic surgery department but the medical follow-up was carried out by the gynecological and pulmonary medicine departments. Results: We report three of the patients treated. All three patients were premenopausal, aged 19–36, and had recurring, menstruation related, spontaneous pneumothorax, predominantly on the right side. The condition was treated by various surgical approaches, including chest tube drainage, video assisted thoracic surgery, chemical pleurodeses and thoracotomy. Conclusions: Spontaneous, recurring pneumothorax in women with no previous history of endometriosis can be the first manifestation of pleural endometriosis. The disorder requires surgical intervention, but early diagnosis and postoperative hormonal therapy are just as important for a successful outcome.

Plasma levels of GDF-15 were significantly elevated after 5 and 20 minutes of myocardial reperfusion during AVR. Plasma levels of IL-18 were elevated after 20 minutes, but only when using crystalloid cardioplegia.

We report for the first time that plasma IL-18 and IL-18BP are differentially regulated after AVR for AS with an early increase in IL-18BP postoperatively followed by a later peak in IL-18 at 12 months. Given the known effects of these mediators on myocardial remodeling and function, they might play a role in the reverse and remodeling process associated with AVR.

Avdeling for radiologi og nukleaermedisin Oslo universitetssykehus, Ullevål Johan Wang er lege i spesialisering i radiologi. Forfa eren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. Thoraxkirurgisk avdeling Oslo universitetssykehus, Ullevål og Institu for klinisk medisin Universitetet i Oslo Peter Majak er ph.d., spesialist i torakskirurgi, overlege og førsteamanuensis. Forfa eren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. Thoraxkirurgisk avdeling Oslo universitetssykehus, Ullevål Per Reidar Woldbaek er dr.med., spesialist i torakskirurgi og overlege. Forfa eren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter. Avdeling for radiologi og nukleaermedisin Oslo universitetssykehus, Ullevål Eirik Madsen er spesialist i radiologi og overlege. Forfa eren har fylt ut ICMJE-skjemaet og oppgir ingen interessekonflikter.