The Watchman FLX versus Novel Oral Anticoagulation for Embolic Protection in the Management of Patients with Non-Valvular Atrial Fibrillation (CHAMPION-AF) trial compared left atrial appendage (LAA) closure using the Watchman FLX device with non-vitamin K antagonist oral anticoagulants (NOACs) in patients with non-valvular atrial fibrillation eligible for long-term anticoagulation. LAA closure demonstrated non-inferiority for the composite endpoint of cardiovascular death, stroke, or systemic embolism and reduced non-procedure-related bleeding. However, interpretation is limited by a permissive non-inferiority margin, reliance on a composite endpoint, exclusion of procedural bleeding from the primary safety outcome, and a numerical excess of ischaemic strokes. Overall, CHAMPION-AF represents a shift in risk profile rather than therapeutic equivalence, supporting LAA closure in selected patients rather than as a routine first-line alternative to NOAC therapy.
Persistent air leak and prolonged pleural drainage are common causes of delayed discharge following thoracic surgery, leading to increased hospital stay. This increases healthcare costs, blocks bed availability, and increases the risk of hospital-acquired infections. Outpatient chest drain management (OPCDM) has been used as a strategy to reduce length of stay, but its use has traditionally been limited to selected patients with low air leaks and stable lung expansion. To assess the feasibility and safety (defined as successful outpatient completion without readmission or major intervention) of a structured OPCDM protocol using digital drainage devices and remote monitoring, and to describe the incidence of complications and to estimate the institutional economic impact of the protocol. This retrospective, single-center study included 167 consecutive patients discharged with an intercostal drain (88
Chylothorax is a significant complication following congenital heart surgery in children, with a reported incidence of 4 to 9
Intraoperative tracheobronchial injury (TBI) during esophagectomy is rare potentially life-threatening condition. Among 941 esophagectomies performed at a tertiary cancer center over 14 years, the incidence of intraoperative TBI was 0.85
Comentale et al. provide a timely meta-analysis comparing anticoagulant and antiplatelet strategies after coronary endarterectomy. Their conclusion that dual antiplatelet therapy may reduce short-term myocardial infarction is clinically relevant, but several methodological issues deserve further consideration. In particular, exposure misclassification, heterogeneous myocardial infarction definitions, limited integration of bleeding outcomes, and insufficient procedural granularity may affect interpretation. Future studies should evaluate time-dependent antithrombotic exposure, standardised ischaemic and bleeding endpoints, and patient- and procedure-level modifiers to develop individualised postoperative regimens.
Ectopic thyroid tissue is an uncommon developmental anomaly arising from aberrant embryological migration of the thyroid gland. Although most ectopic thyroid tissue occurs along the thyroglossal tract, mediastinal localization is exceedingly rare, accounting for less than 1
Cardiac myxomas are neoplasms with an incidence of 0.03
Adult presentation of congenital heart disease (CHD) may occasionally reveal unexpected anatomical findings despite extensive knowledge of congenital cardiac anomalies. We report a case demonstrating an unusual anatomical variant characterized by an intramural course of the right pulmonary artery (RPA) with severe ostial stenosis, associated with double outlet right ventricle (DORV) and absent pulmonary valve. A 39-year-old man with a diagnosis of DORV and pulmonary stenosis presented with exertional dyspnea (New York Heart Association (NYHA) class II), mild cyanosis, and hoarseness of voice of several years’ duration. Further evaluation revealed markedly dilated left pulmonary artery (LPA) with prominent left hilar shadow, relatively small RPA and absent pulmonary valve. During intracardiac repair, in addition to the absent pulmonary valve, the RPA origin was just above the pulmonary annulus with severe ostial stenosis (3 mm) and an intramural course within the main pulmonary artery (MPA). The intramural segment was unroofed throughout its course, enlarging the lumen to accommodate a #13 Hegar dilator. The unroofed margins were muscular. Intracardiac repair was completed and the pulmonary valve was replaced with a 23-mm Flomero bioprosthetic valve. The postoperative course was uneventful and the patient was discharged on the fifth postoperative day. We report a unique case of DORV with absent pulmonary valve associated with a stenotic supra-annular origin of the RPA and an intramural course within the MPA. The anomaly was not detected on preoperative imaging and was diagnosed intraoperatively. Surgical unroofing of the intramural segment resulted in satisfactory enlargement of the RPA with an excellent early outcome. Awareness of this rare anatomical variant may facilitate recognition and appropriate surgical management.
We report a rare case of anomalous systemic arterial supply to the basal segment of the left lung (ABLL) coexisting with large-vessel giant cell arteritis (LV-GCA) in a 73-year-old woman. 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT) demonstrated inflammatory involvement of both the aorta and the anomalous artery. To reduce vascular and perioperative risks, immunosuppressive therapy was initiated first, resulting in improvement in clinical and radiological findings. This case highlights the importance of controlling active vasculitis before definitive surgical treatment.
Cardiac myxomas are the most common primary benign tumors of the heart, with the majority occurring in the left atrium. They are typically composed of gelatinous connective tissue, but rare cases exhibit unusual histological features, including glandular differentiation, which can mimic malignant neoplasms and pose diagnostic challenges. While these tumors are benign, rare cases of tumor embolism to the brain have been reported. Surgical resection remains the treatment of choice, with excellent long-term outcomes in most cases. A 27-year-old woman presented with progressive palpitations, shortness of breath, chest pain, and cough. Transthoracic echocardiography revealed a large, mobile mass in the left atrium. Surgical excision was performed, revealing a gelatinous tumor with areas of glandular differentiation. Immunohistochemical analysis confirmed the epithelial origin of the glandular structures, with a diagnosis of cardiac myxoma with glandular differentiation. Cardiac myxomas with glandular differentiation are rare but important entities that require careful histological and immunohistochemical evaluation to avoid misdiagnosis as primary or metastatic adenocarcinoma. Patients should be monitored for recurrence and potential embolic complications.
Aortic stenosis (AS) is a prevalent and high-mortality valve disease. Transcatheter aortic valve replacement (TAVR) is a minimally invasive treatment with outcomes often better than surgery, requiring a multidisciplinary team. This study analyzes outcomes and trends from a high-volume TAVR program in an urban, low-income setting since 2017 to guide future practices. Medical records of patients that underwent TAVR were analyzed retrospectively from 2018 to 2023, dividing them into two cohorts to analyze trends in operative details, complications, length of stay (LOS), and readmission/mortality rates. The learning curve (LC) was assessed by operative time. Risk-adjusted cumulative sum (RA-CUSUM) analysis identified the transition point at case 76, dividing the cohort into early LC phase group (n = 76) and post-LC phase group (n = 190). Median operative time decreased from 106 to 80 minutes. After adjustment, operative time was 14
