Fotios A Mitropoulos

The involvement of the aortic arch in thoracic aortic aneurysms (TAA), or acute aortic dissections (AAD), represents a challenging clinical entity, mandating a meticulous surgical plan, tailored to each individual case. The advent of endovascular techniques and the introduction of modern arch protheses have led to the implementation of the frozen e...

Sodium-glucose cotransporters 2 (SGLT2) are high-capacity, low-affinity transporters, expressed mainly in the early portion of the proximal renal tube, mediating up to 90% of renal glucose uptake, while SGLT1 receptors are found mainly in the small intestine, facilitating glucose absorption. SGLT2 inhibitors (SGLT2i) originally emerged as agents fo...

Non-A non-B aortic dissection (AAD) is an infrequently documented condition, comprising of only a small proportion of all AADs. The unique anatomy of the aortic arch and the failure of the existing classifications to adequately define individuals with non-A non-B AAD, have led to an ongoing controversy around the topic. It seems that the clinical p...

Mitral annular disjunction (MAD) is a structural abnormality defined by a distinct separation of the mitral valve annulus—left atrial wall continuum and the basal aspect of the posterolateral left ventricle. This anomaly is often observed in patients with myxomatous mitral valve prolapse. Importantly, MAD has been strongly associated with serious v...

Background Surgical treatment of prosthetic valve endocarditis (PVE) with destruction of the aortic root and aortomitral continuity is demanding even in experienced hands. Case presentation Herein, we describe a case of a 71-year-old female patient who presented with PVE that was further complicated by a fistulous abscess cavity. The patient under...

Background: Balloon aortic valvuloplasty (BAV) is a well-established treatment modality for congenital aortic valve stenosis. Aim: To evaluate the role of rapid right ventricular pacing (RRVP) in balloon stabilization during BAV on aortic regurgitation (AR) in pediatric patients. Methods: A systematic review of the MEDLINE, Cochrane Library, a...

Background: Type 2 diabetes mellitus (DM) is associated with a considerable risk of cardiovascular and renal disease, including heart failure. Sodium-glucose cotransporter 2 (SGLT2) inhibitors have demonstrated unprecedented cardiorenal protective effects in large scale clinical trials of patients with or without diabetes and either established ca...

Objective: Rapid right ventricular pacing during balloon aortic valvuloplasty is commonly used to achieve balloon stability in children and adults. There is no consensus for the use of the technique in neonates and infants. We sought to review our institutional experience with rapid right ventricular pacing-assisted balloon aortic valvuloplasty ac...

Anomalous aortic origin of a coronary artery is a congenital abnormality of the origin or course of a coronary artery that arises from the aorta. The surgical treatment of this anomaly is highly variable and controversial and is achieved by implementing elaborate techniques of anatomic repair or by simple coronary artery bypass grafting. This revie...

Discrete fibromembranous subaortic stenosis is a common type of subaortic stenosis causing clinically significant left ventricular outflow obstruction. Surgery for discrete subaortic stenosis is most often performed through a typical midline sternotomy. Herein, we present our experience with an adult patient who underwent a right mini-thoracotomy f...

Purpose of review: Aberrant subclavian artery (ASCA) represents one of the most common congenital vascular anomalies of the aortic arch. The majority of ASCAs are associated with an aneurysm which occurs at their origin from the descending thoracic aorta, namely, the Kommerell's diverticulum. In this review, we discuss recent data with regards to...

Levoatriocardinal vein (LACV) is a rare congenital anomaly of the systemic veins. We describe the case of a 43-year-old patient who presented with a transient ischemic attack episode, desaturation, and ventricular arrhythmias. Transesophageal echocardiography diagnosed a patent foramen ovale, and magnetic resonance imaging revealed 2 small myocardi...

Introduction: Development of pulmonary insufficiency in patients with surgically corrected tetralogy of Fallot (TOF) may lead to severe right heart failure with serious consequences. We herein present our experience with pulmonary valve replacement (PVR) in these patients. Methods: From 2005-2013, 99 consecutive patients (71 males/28 females, mean...

Transposition of the great arteries occurs rarely in patients with mirror image dextrocardia and situs inversus, while the combination with severe coarctation of the descending aorta (CoA) makes the anatomy even more unusual. Therefore, it is not surprising that a case with such unusual and complicated anatomy presents unique problems when a primar...

Aorto-ventricular tunnel is a rare congenital malformation, and aorto-right ventricular tunnel (ARVT) is an even less common entity. Here, we report the case of a 3-month-old female who underwent successful surgical closure of ARVT. The origin of the right coronary artery was proximal to the ostium of the tunnel.

Key Clinical Message A middle‐aged woman with a history of resected colorectal cancer and receiving chemotherapy presented with a right atrial mass and the provisional diagnosis of myxoma supported by echocardiography, computed tomography, and magnetic resonance imaging. Successful surgical removal revealed organized thrombus instead. Atrial thromb...

Management in patients with coexisting coronary artery disease and lung carcinoma is usually a two-stage operation, with the cardiac surgery procedure followed by pulmonary resection at a later time. Delayed tumor resection on the other hand may be detrimental. Off-pump coronary artery bypass grafting could facilitate concomitant lung resection at...

A 9-year-old girl with a giant tumor of the right lung and an isolated metastasis of the left lower lobe underwent combined pneumonectomy and metastasectomy through means of a right thoracotomy. Her postoperative course was uneventful. The operative approach of a tumor of this scale and the concurrent contralateral metastasectomy are described and...

A coronary artery fistula was surgically ligated in a 38-year-old woman via a left anterior mini-thoracotomy without the use of cardiopulmonary bypass. In selected cases, this surgical approach can provide an excellent surgical exposure for coronary artery fistula ligation. It also offers an excellent cosmetic result and shorter hospital stay.

Thoracic incisions are the portals of choice for accessing thoracic organs. There are instances, however, that more than one incision are required at the same or a later stage, in order to access other, thoracic or extrathoracic, organs for more complicated procedures. Then again, a single thoracic incision may offer more than adequate access to ex...

Cardiac myxoma is the most common primary cardiac tumour in adulthood and may present in the context of Carney's complex. A 32-year-old male with a history of repaired tetralogy of Fallot in childhood was admitted with severe pulmonary valve regurgitation and a mobile mass in the right ventricle. The patient underwent pulmonary valve replacement an...

The case is presented of a previously healthy infant with a known asymptomatic bicuspid aortic valve who developed fungal endocarditis. The patient underwent aortic root replacement with a pulmonary autograft (Ross procedure). Cultured operative material revealed Aspergillus infection. The patient had an excellent recovery and remained well one yea...

Numerous technical modifications and various complications of the Senning procedure have been described in the literature. We describe the excellent clinical status and anatomic result of a 33-year-old patient who underwent a modified Senning operation using the left atrial appendage for reconstruction more than 30 years prior to presentation.

Supravalvar aortic stenosis (SVAS) in patients with Williams' syndrome is often accompanied by coronary, pulmonary, and even myocardial lesions and therefore associated with increased perioperative morbidity and mortality. Extracorporeal membrane oxygenation (ECMO) provides reliable short-term mechanical circulatory support to patients, especially...

Oxidised regenerated cellulose is a commonly used haemostatic agent in surgery which, in rare cases, has been held responsible for severe complications. A 6-year-old girl developed flaccid paraplegia following the excision of a large thoracic ganglioneuroblastoma. Magnetic resonance imaging revealed spinal cord compression at the T10-11 level and t...

We present a case report of a nine-year-old asymptomatic girl with a large cystic lesion of the left hemithorax, occupying almost 80% of the left hemithorax, first believed to be a parasitic cyst that was operated and proved to be of parietal pericardial origin. Mediastinal cysts and pericardial cysts in particular are mostly discovered accidentall...

Experimental right heart bypass operations have influenced the evolution of current application of the Fontan procedure. In this review, we summarize the evolution and progress of the experimental Fontan operation (FO) and discuss the questions raised so far. The evolution and progress of the experimental FO is analyzed in this review by collecting...

Occlusive coronary artery disease coexisting with Buerger's disease has rarely been reported. Potential difficulties regarding diagnostic workup and therapeutic management in this group of patients are discussed through this case report. We present an interesting case of a 52-year-old patient suffering from Buerger's disease, with a history of gene...

In patients with corrected tetralogy of Fallot (TOF), progressive right ventricular volume overload from longstanding regurgitation of the pulmonary valve, results in severe late complications. The presence of additional major clinical conditions may aggravate the clinical status in these patients. We describe the case of a patient with coexistence...

Histological changes of the lungs were studied after the establishment of a modified total cavopulmonary connection (TCPC) without the use of cardiopulmonary bypass (CPB) or other means of temporary bypass on a swine model. 8 open chest-anesthetized pigs Landrace x Large White pigs (mean weight 43kg, mean age 4.5 months) underwent TCPC by the use o...

p>Mechanical and biological prostheses are valid options when aortic valve replacement is necessary. The Ross procedure is also an alternative solution, especially for young patients. We describe the case of a young patient with congenital aortic stenosis and bicuspid aortic valve who presented with dyspnea on exertion. An open commissurotomy was...

We present the interesting case of a 15-year old boy with a monophasic synovial sarcoma (MSS) of the mediastinum, which was infiltrating the right heart chambers and the inferior vena cava (IVC). A radical excision was performed, with extensive reconstruction of the heart, under deep hypothermic circulatory arrest. Radical surgical excision is cons...

We describe the case of a 67-year-old man who was referred for the management of severe mitral valve regurgitation and coronary artery disease. Further workup revealed a descending thoracic aorta aneurysm. He underwent mitral valve replacement with coronary artery bypass surgery and, at a second stage, endovascular stent graft repair of the descend...

We describe a woman with tetralogy of Fallot and pulmonary atresia, with a history of four previous cardiac operations, who decided to bear her own children. Under interdisciplinary counselling and the appropriate medical care, she underwent a successful vaginal delivery and had a healthy baby.

We are reporting the successful surgical treatment of a 23-year-old female with a giant right coronary artery to coronary sinus fistula. This woman had complaints of chest pain and dyspnea on exertion for few months. Transthoracic echocardiography (TTE) showed a large tortuous right coronary artery and a dilated coronary sinus. Preoperative multi-d...

The combination of anomalous left coronary artery origin from the pulmonary artery and an accessory pathway has not been reported previously in the medical literature. In medicine, the coexistence of two clinical causes can lead to the same clinical findings, and this can make the researcher's attempt to distinguish between the two of them and, hen...

Congenital coronary artery fistula is an extremely rare anomaly that may involve any of the coronary arteries and any of the cardiac chambers. We report the case of a 14-year-old female patient with a symptomatic congenital coronary fistula starting from the left main coronary artery and draining to the coronary sinus. The patient underwent surgica...

We present the case of a 42-year-old man with mitral valve prolapse (MVP) and infective endocarditis. He was referred to our hospital by his family physician for the evaluation of a cardiac murmur. A detailed medical history revealed that he had been feeling fatigue with occasional episodes of slight fever during the last two months. Echocardiograp...

The feasibility and the hemodynamic outcome of Fontan circulation, without the use of cardiopulmonary bypass, were studied on a beating heart of an adolescent pig model, using a modified total cavopulmonary connection. Eight open-chest anesthetized pigs underwent a successful total cavopulmonary connection with the use of an appropriate Y-shaped Da...

Anomalous origin of a pulmonary artery from the ascending aorta (AORPA) is a rare congenital cardiac malformation that needs prompt surgical repair; otherwise it is associated with poor prognosis. We describe 3 cases of AORPA that successfully underwent complete surgical correction without extracorporeal circulation.

We describe the case of a man, with a history of a cadaveric renal transplantation two years earlier, who developed symptomatic triple coronary-vessel disease. He underwent a triple coronary artery bypass graft operation and his postoperative course was uneventful. We discuss the distinct problems and operative precautions regarding this particular...

Truncal valve insufficiency is a significant risk factor for post-operative mortality following repair of truncus arteriosus. The surgical management of dysplastic and insufficient truncal valves remains an operative challenge. We report the cases of two infants with type 2 truncus arteriosus and severely dysplastic and insufficient quadricuspid tr...

We present an alternative treatment employing a hybrid approach used in 3 patients with congenital heart disease. The goal was to provide optimal therapy by minimizing the potentially harmful effects of methods that accompany conventional surgical procedures. Two patients aged 4 and 6 months underwent beating-heart closure of a muscular ventricular...

Sarcoidosis is a systemic disease which affects many organs, including the heart. Cardiac sarcoidosis has a reported incidence of about 25 % and carries a poor prognosis. It can occur in the form of conduction abnormalities, pericardial and valvular heart disease, congestive heart failure, arrhythmias and sudden cardiac death. The diagnosis of card...

Background: Several agents have been recently approved for treatment of serious infections due to GPC. Comparative data is needed to define the utility of these agents. This study compared outcomes associated with daptomycin (DAP), linezolid (LZD), vancomycin (VA), and oxacillin (OX) when used to treat complicated skin and skin structure infections...

Background: MDR Acinetobacter baumannii (Ab) have emerged as important nosocomial pathogens. Meropenem (M), a carbapenem with activity against Ab, is often combined with other antibiotics to treat complicated MDR infections. This study characterized the extent of kill over 24 hours by M alone and in combination with colistin sulfate (C) against thr...

Pulmonary artery reconstruction remains a challenging clinical problem. We sought to evaluate the use of intraoperative stenting in conjunction with open heart surgical repairs. We retrospectively analyzed data from 22 patients between 1998 and 2003 who underwent intraoperative pulmonary artery stenting. The mean age was 9.3 years (range, 9 months...

Historically, oral cephalosporins represent one of the most widely used and safest classes of antimicrobials available. Typical adverse events have included nausea, vomiting, diarrhea, and hypersensitivity reactions. Other more serious events such as pseudomembranous colitis, although infrequent, may occur. The exact type and incidence of adverse e...

We report a patient with congenitally corrected transposition of the great arteries, dextrocardia in congestive heart failure, with severe tricuspid regurgitation; a large ventricular septal defect, and giant left atrium. The patient underwent a two-ventricle repair with physiologic correction and had an excellent postoperative outcome.

Aortic aneurysm formation is a well-documented complication in patients with coarctation of the aorta, whether untreated or treated. Patients not undergoing surgical or interventional treatment may develop aneurysms of the ascending aorta, possibly involving the aortic arch. This is prob- ably the manifestation of inherent aortic wall abnor- maliti...

Using an in vitro pharmacodynamic model, a multidrug-resistant strain of Acinetobacter baumannii was exposed to colistin methanesulfonate alone and in combination with ceftazidime. Pre- and postexposure colistin sulfate MICs were determined. A single daily dose of colistin methanesulfonate combined with continuous-infusion ceftazidime prevented reg...

A 10-day-old infant was diagnosed with aorto-left ventricular tunnel. An alternative surgical approach is described. This technique may minimize the risk of aortic valve injury.

We report a 71-year-old man with severe mitral valve regurgitation in end stage heart failure intractable to medical treatment. He underwent mitral valve repair, coronary artery bypass grafting and tricuspid annuloplasty, and his postoperative course was uneventful with significant improvement of his symptoms. Mitral valve repair should be consider...

We describe the case of a young man who underwent anatomical correction of Tetralogy of Fallot in childhood. The patient developed severe pulmonary valve regurgitation, moderate tricuspid regurgitation and dilation of the right heart chambers. He underwent a redo sternotomy, replacement of the pulmonary valve and tricuspid annuloplasty with beating...

We report a case of a 43-year-old man with dilated cardiomyopathy and intractable ventricular tachycardias who did not respond to percutaneous implantable cardioverter defibrillator therapy and required implantation of epicardial patches. An apical suctioning device was used to retract the apex of the heart outside the mediastinal domain. The devic...

Extranodal marginal zone B-cell lymphomas of mucosa associated lymphoid tissue (MALT) are indolent lymphomas with specific clinical and pathologic features. MALT lymphomas can arise from any extranodal site. Non-gastrointestinal (non-GI) MALT lymphomas are rarer (<1% of NHL) and have been described in various sites (salivary glands, orbit, lung, sk...

Antibiotic resistance in Streptococcus pneumoniae is not only increasing with penicillin but also with other antimicrobial classes including the macrolides, tetracyclines and sulfonamides. This trend with antibiotic resistance has highlighted the need for the further development of new anti-infectives for the treatment of pneumococcal infections, p...

Expansion of potential donor pool may be facilitated by using cardiac allografts with long ischemic time. Early graft failure and potential relation to transplant coronary artery disease remains a concern. We sought to evaluate outcomes of heart transplantation in recipients of donor allografts with prolonged ischemia time. The study group consiste...

Colleges and universities are increasingly offering at least part and, in many instances their entire curriculum via online learning modalities. Despite this trend, there is inadequate support for the professors responsible for restructuring the courses they have refined over a career in the classroom for delivery via the Web. Teachers who are expe...

Colleges and universities have increasingly migrated towards utilizing the World Wide Web to convey at least a part and, in many cases, their entire curricular offering. Despite this trend, there is inadequate support for the professors responsible for restructuring the courses they have refined over a career in the classroom for delivery via the W...

The number of patients with severe ventricular dysfunction from coronary artery disease is constantly increasing. Although the medical management of these patients with angiotensin-converting enzyme inhibitors and beta-blockers has favorable impact on the morbidity and mortality the overall prognosis is still poor. Historically many of these patien...

Pulmonary involvement in Waldenström’s macroglobulinaemia (WM) occurs in 3–5&percnt; of cases, but lung involvement without bone marrow infiltration is extremely rare. We report 2 patients who presented with bilateral consolidations on chest X-ray and non-specific symptoms and were treated for a long period of time for pulmonary infections until th...

Pulmonary involvement in Waldenström's macroglobulinaemia (WM) occurs in 3-5% of cases, but lung involvement without bone marrow infiltration is extremely rare. We report 2 patients who presented with bilateral consolidations on chest X-ray and non-specific symptoms and were treated for a long period of time for pulmonary infections until the diagn...

To report a case of trovafloxacin-associated leukopenia, which occurred in a trauma patient shortly after administration and resolved following discontinuation of the drug. A 79-year-old white man was admitted to Yale New Haven Hospital after sustaining partial amputation of his right lower leg by an industrial lawn mower. After successful resuscit...

In view of the dual role that DNA topoisomerase IIa (TopoIIa) plays as a cell proliferation marker and as a possible indicator of chemosensitivity, we investigated its expression in non-Hodgkin's lymphomas (NHL) in relation to conventional clinicopathological parameters, cell proliferation (as defined by Ki67 immunoreactivity), response to therapy...

Primary non-Hodgkin lymphoma of the gallbladder is a very rare location of extranodal non-Hodgkin lymphomas. A patient with a primary non-Hodgkin lymphoma of the gallbladder is reported and in addition, the English literature is reviewed. Clinical presentation, diagnostic evaluation, histopathologic findings, treatment modalities and prognosis of p...

Objective. This study was undertaken to determine changes of aortic function during the progression of experimentally induced atherosclerosis. Methods. Forty-four white male New Zealand rabbits were divided into 4 groups. In Group I (n = 15), animals were fed a regular diet whereas in Groups II (n = 5), III (n = 10), and IV (n = 14), animals were f...

Disorders of urachal origin are rarely encountered in adults. Traditional treatment consists of a classic laparotomy and total excision of the urachal structure. We report a case of laparoscopic urachal sinus removal that was performed synchronously with laparoscopic cholecystectomy and ovarian cyst excision. We confirm that the laparoscopic techni...