Type I endoleak after endovascular abdominal repair is associated with a high risk of aneurysm expansion and rupture. Though type I endoleak can frequently be managed with endovascular techniques, in this report we describe a patient whose endoleak was refractory to multiple attempts at endovascular repair. The patient ultimately underwent a novel minimally invasive surgical repair with placement of an aortic wrap around the infrarenal aortic neck, successfully abolishing the endoleak.

West Nile virus is a mosquito-borne RNA Flavivirus infection transmitted to humans and other vertebrates, mainly by the Culex species of mosquito. Since the mid-1990s, the frequency and apparent clinical severity of West Nile virus outbreaks have increased. We report the case of a patient who developed West Nile virus encephalitis shortly after undergoing cardiac transplantation. Clinicians should be aware of the possibility of West Nile virus infection in transplant recipients and in patients receiving blood transfusions. (c) 2005 by the International Society for Heart and Lung Transplantation.

The treatment of patients who have cardiac tumors can be challenging, because these tumors occur infrequently and in variable locations, and surgical resection is often technically difficult. We report the cases of 2 patients, each of whom underwent successful surgical excision of large melanomas that had metastasized to the right cardiac ventricle. Although the presence of widespread disease and a limited life expectancy usually prevent surgical therapy for patients who have metastatic cardiac tumors, removal of such masses greatly facilitated subsequent medical management of these 2 patients and improved their quality of life.

Interrupted aortic arch is a rare congenital malformation of the aortic arch that occurs in 3 per million live births. Defined as a loss of luminal continuity between the ascending and descending portions of the aorta, this anomaly entails a very poor prognosis without surgical treatment. To our knowledge, the world medical literature contains only 12 reports of isolated interrupted aortic arch diagnosed in adults. Nine of these patients underwent successful surgical repair, but 1 died during the early postoperative period. We describe a 10th successful surgical repair, which involved a 42-year-old woman who had an asymptomatic type B interrupted aortic arch (characterized by interruption between the left subclavian and left carotid arteries). We performed a single-stage extra-anatomic repair by placing a 16-mm extra-anatomic Dacron graft between the ascending and descending portions of the thoracic aorta and by interposing a 7-mm extra-anatomic Dacron graft between the 16-mm graft and the left subclavian artery. The patient recovered uneventfully and continued to do well 6 months later.