The lymphatics of the heart have not generated any broad or sustained interest among clinicians. Few publications on cardiac lymphatics are available, the anatomy is not routinely known and the true role of cardiac lymphatics remains doubtful. One important anatomical concept needing clarification is that of the lymphatic drainage of conduction tissue. The sinoatrial node lymphatic collector and right principal lymphatic trunk are both incorporated into the aortic fat pad of the ascending aorta and are the most frequently damaged lymphatic vessels during cardiac surgery. Thus, preservation of the aortic fat pad and its lymphatic collectors should reduce the incidence of new atrial fibrillation observed in patients after cardiac surgery. This review assesses current knowledge of cardiac lymphatics and shows their possible role in triggering arrhythmias in the postoperative period.

From 1985From to 1999 patients with cor triatriatum underwent surgical correction. Their ages ranged from 3 months to 9 years (mean, 32.5 months). Eight patients were cyanosed; the other 10 presented with congestive heart failure. Recurrent chest infection was observed in 10 cases, and failure to thrive in 7. One patient had isolated cor triatriatum, and 17 had an associated atrial septal defect. Other associated anomalies included patent ductus arteriosus, ventricular septal defect, and partial and total anomalous pulmonary venous connection. Two deaths occurred perioperatively in patients with associated severe heart defects. Follow-up ranged from 1 month to 10 years. No late events occurred among the survivors, and all were in New York Heart Association functional class I. Their most recent echocardiograms showed no residual obstruction or shunt and good development of the left cardiac chambers. Echocardiography is recommended as the diagnostic modality of choice. Cor triatriatum can be corrected surgically with low mortality and good long-term results.

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BackgroundCoronary revascularization surgery does not traditionally employ angiography to assess procedural success. Early graft failure is reported up to 30% in one year (JAMA Nov 2005) may relate to technical errors or conduit problems. We hypothesize that intra-operative assessment of graft by angiography identifies graft defects and may improve the long term graft survival. MethodsWe have developed one of the first hybrid operation room in the USA. In one year period 203 consecutive patients (age:63+/−16, M/F:126/39) underwent coronary revascularization with angiography before decannulation. ResultsOf 436 grafts, 72 angiographic defects were detected in 69 grafts (17% of total grafts). There were 11% conduit defects, 3% anastomotic defects, and 3% target vessel error. Of 72 defects, 25/72 defects required minor revision, 47/72 required either surgical or percutaneous intervention. Intra-operative angiography added an average 20+/−12 minutes to the surgery and 112+/−56 ml contrast. Renal function at 24hours and 48 hours after procedure did not vary significantly between patients who did vs. those did not have revisions. There were no significant differences in cardiopulmonary bypass time, aortic cross clamp time, and length of hospital stay for patients who underwent revision compared to those who did not. Renal function, bleeding complication, transfusion were similar in patients with percutaneous vs. surgical revision. ConclusionsIntraoperative graft angiography performed at the time of CABG identifies graft defects, allowing for immediate surgical or percutaneous revision. Long-term study is in progress to assess whether intra-operative completion angiography decreases the rate of early graft failure. PurposeThis systematic review aims to assess the safety and efficacy of radiofrequency ablation(RFA) for pulmonary malignancies. MethodologySearches for relevant literature on RFA for lung tumours prior to Nov 2006 were performed in six electronic databases. Application of predetermined inclusion and exclusion criteria, quality assessment and data extraction were independently performed for all retrieved studies. Results were synthesized through tabulation and combined with a narrative review. ResultsSixteen relevant studies on lung RFA with more than 10 patients that reported rates of morbidity, mortality, complete tumour ablation, local recurrence or survival were identified for this review. All included studies were level 4 evidence case series with median follow-up periods ranging from 9-24 months. The overall post-procedural morbidity rates ranged from 15-76% and mortality rates ranged from 0-5%. The most common complications were pneumothoraces occurring at 9-61 % of procedures. The rates of complete tumour necrosis achieved by RFA ranged from 38-98% while the rates of local recurrence from previously ablated lesions ranged from 2-38%. The overall median progression free interval ranged from 13 to 26 months. The A12 ANZ J. Surg. 2007; 77 (Suppl. 1) Journal compilation © 2007 The Royal Australian and N...