ResearchPad - cardiac https://www.researchpad.co Default RSS Feed en-us © 2020 Newgen KnowledgeWorks <![CDATA[Is transjugular insertion of a temporary pacemaker a safe and effective approach?]]> https://www.researchpad.co/article/elastic_article_13814 Temporary pacemakers (TPMs) are usually inserted in an emergency situation. However, there are few reports available regarding which route of access is best or what the most preferred approach is currently in tertiary hospitals. This study aimed to compare procedure times, complication rates, and indications for temporary pacing between the transjugular and transfemoral approaches to TPM placement. We analyzed consecutive patients who underwent TPM placement. Indications; procedure times; and rates of complications including localized infection, any bleeding, and pacing wire repositioning rates were analyzed. A total of 732 patients (361 treated via the transjugular approach and 371 treated via the transfemoral approach) were included. Complete atrioventricular block was the most common cause of TPM placement in both groups, but sick sinus syndrome was especially common in the transjugular approach group. Separately, procedure time was significantly shorter in the transjugular approach group (9.0 ± 8.0 minutes vs. 11.9 ± 9.7 minutes; P < 0.001). Overall complication rates were not significantly different between the two groups, and longer duration of temporary pacing was a risk factor for repositioning. The risk of reposition was significantly increased when the temporary pacing was continued more than 5 days and 3 days in the transjugular approach group and the transfemoral approach group, respectively. The transjugular approach should be considered if the TPM is required for more than 3 days.

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<![CDATA[Aging-associated sinus arrest and sick sinus syndrome in adult zebrafish]]> https://www.researchpad.co/article/elastic_article_13853 Because of its powerful genetics, the adult zebrafish has been increasingly used for studying cardiovascular diseases. Considering its heart rate of ~100 beats per minute at ambient temperature, which is very close to human, we assessed the use of this vertebrate animal for modeling heart rhythm disorders such as sinus arrest (SA) and sick sinus syndrome (SSS). We firstly optimized a protocol to measure electrocardiogram in adult zebrafish. We determined the location of the probes, implemented an open-chest microsurgery procedure, measured the effects of temperature, and determined appropriate anesthesia dose and time. We then proposed an PP interval of more than 1.5 seconds as an arbitrary criterion to define an SA episode in an adult fish at ambient temperature, based on comparison between the current definition of an SA episode in humans and our studies of candidate SA episodes in aged wild-type fish and Tg(SCN5A-D1275N) fish (a fish model for inherited SSS). With this criterion, a subpopulation of about 5% wild-type fish can be considered to have SA episodes, and this percentage significantly increases to about 25% in 3-year-old fish. In response to atropine, this subpopulation has both common SSS phenotypic traits that are shared with the Tg(SCN5A-D1275N) model, such as bradycardia; and unique SSS phenotypic traits, such as increased QRS/P ratio and chronotropic incompetence. In summary, this study defined baseline SA and SSS in adult zebrafish and underscored use of the zebrafish as an alternative model to study aging-associated SSS.

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<![CDATA[Commentary: Selective His-Bundle Pacing May Preserve Intrinsic Repolarization as Well as Depolarization]]> https://www.researchpad.co/article/elastic_article_13253 <![CDATA[Atherosclerotic spontaneous coronary artery dissection (A-SCAD) in a patient with COVID-19: case report and possible mechanisms]]> https://www.researchpad.co/article/elastic_article_12474 Spontaneous coronary artery dissection (SCAD) may be atherosclerotic (A-SCAD) or non-atherosclerotic (NA-SCAD) in origin. Contemporary usage of the term ‘SCAD’ is typically synonymous with NA-SCAD. COVID-19 could induce a vascular inflammation localized in the coronary adventitia and periadventitial fat and contribute to the development of an A-SCAD of a vulnerable plaque in a susceptible patient.Case summaryIn this report we describe a case of a COVID-19 patient with past cardiac history of CAD who was admitted for acute coronary syndrome (ACS). Coronary angiography demonstrated the culprit lesion in the proximal LAD that presented with a very complex and unusual morphology, indicative of an A-SCAD. The diagnosis of A-SCAD was supported by the presence of a mild stenosis in the same coronary segment in the last angiogram performed 3 years previously. He was successfully treated by PCI, had a favourable course of the COVID-19 with no symptoms of pneumonia, and was discharged from the hospital after two negative tests for SARS-CoV-2.DiscussionA higher index of suspicion of A-SCAD is needed in patients with suspected or confirmed COVID-19 presenting with ACS. The proposed approach with ‘thrombolysis first’ for treating STEMI patients with suspected or confirmed COVID-19 infection could be unsafe in the case of underlying A-SCAD. ]]> <![CDATA[Right Ventricular Perforation Presenting as Tingling of the Left Breast]]> https://www.researchpad.co/article/elastic_article_10714 Pacemaker lead-associated cardiac perforation is a rare phenomenon. Lead perforations can be acute, subacute, or chronic following lead placement. Symptoms are typically nonspecific and depend on the location of the displaced lead. Diagnostic workup requires interrogation of the pacemaker and imaging studies. Management of lead displacement is dependent on multiple risk factors such as age, gender, corticosteroid use, and anticoagulation therapy.

A 74-year-old female with a history of myosin light chain kinase (MYLK) 2 hypertrophic cardiomyopathy, Sjogren’s syndrome, Raynaud’s disease, and sick sinus syndrome was evaluated for an abnormal finding on pacemaker interrogation. The patient’s only symptom was tingling of her left breast. Imaging studies confirmed pacemaker lead perforation. Right ventricle perforation due to a pacemaker lead displacement can cause severe complications. Early identification and treatment by physicians can reduce the risk of mortality.

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<![CDATA[The Effect of Preoperative Hematocrit Level on Early Outcomes After Coronary Artery Bypass Surgery]]> https://www.researchpad.co/article/elastic_article_10537 Introduction: Low hematocrit level is a hematological problem that is frequently encountered in the preoperative evaluation of patients undergoing coronary artery bypass grafting (CABG) surgery. The aim of this study was to investigate the effect of preoperative hematocrit level on the first 30-day outcomes in patients undergoing CABG surgery.

Methods: Ninety-four patients undergoing isolated CABG were included in the study. The patients were divided into two groups as patients with preoperative low hematocrit levels (<36%) in Group 1 and patients with preoperative normal hematocrit levels (≥36%) in Group 2.

Results: Forty-six patients in Group 1 (mean age: 63.6 ± 7.9 years) and 48 patients in Group 2 (mean age: 56.5 ± 8.8 years) were enrolled. European System for Cardiac Operative Risk Evaluation (EuroSCORE) scoring was statistically significantly higher in Group 1 (p = 0.011). In the postoperative period, the amount of drainage, transfusion of blood, and blood products were significantly higher in Group 1 (p < 0.001). The mortality rate of Group 1 was statistically higher in the first 30 days postoperatively (p = 0.020).

Conclusion: Low preoperative hematocrit levels are associated with increased mortality after CABG surgery. We suggest that patients’ preoperative hematocrit levels must be added to the risk scoring systems as an assessment parameter.

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<![CDATA[The Effectiveness of Endovenous Radiofrequency Ablation Application in Varicose Vein Diseases of the Lower Extremity]]> https://www.researchpad.co/article/elastic_article_9382 We aimed to determine the outcome, complications, and quality of life effects of radiofrequency ablation (RFA) in the treatment of superficial venous insufficiency.

A total of 134 extremities from 100 patients were evaluated in this retrospective study performed at the Cardiovascular Surgery Department of Atatürk University Faculty of Medicine. Treatment success was determined by occlusion. The clinical, etiologic, anatomic, and pathophysiologic (CEAP) and venous clinical severity score (VCSS) scores of patients were assessed pre- and postoperatively to evaluate clinical outcome and quality of life. The pain was assessed with the Wong-Baker score. Complications and their frequency were assessed and recorded.

Treatment success, as measured by occlusion rate, was 99% percent. Prior to treatment, the CEAP clinical score was C2 (81.0%), while after treatment, it was C0 (54.0%) (p<0.001). The pretreatment median VCSS score was 5 (min-max: 1-9) while the post-treatment median was 1 (min-max: 1-3) (p<0.001). The mean pain score was 1.34; only one patient reported a score of 6 while the minimum score was 1. A total of 15 complications occurred; only one was a major complication (deep vein thrombosis or DVT) while the remaining 14 were minor complications.

While longstanding surgical treatments still provide significant success, the RFA technique not only surpasses them in success rate but also in terms of pain, complications, and better patient satisfaction. The results of our study indicate that RFA is an effective and safe option for the treatment of superficial venous insufficiency.

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<![CDATA[Right ventricular pressure overload directly affects left ventricular torsion mechanics in patients with precapillary pulmonary hypertension]]> https://www.researchpad.co/article/elastic_article_8470 This study examined the impact of septal flattening on left ventricular (LV) torsion in patients with precapillary pulmonary hypertension (PH). Fifty-two patients with proven precapillary PH and 13 healthy controls were included. Ventricular function was assessed including 4D-measurements, tissue velocity imaging, and speckle tracking analysis. Increased eccentricity index (1.39 vs. 1.08, p<0.001), systolic pulmonary artery pressure (64 vs. 29mmHg, p<0.001) and right ventricular Tei index (0.55 vs. 0.28, p = 0.007), and reduced tricuspid annular plane systolic excursion (19.0 vs. 26.5mm, p<0.001) were detected in PH patients as compared to controls. With increasing eccentricity of left ventricle, LV torsion was both decreased and delayed. Torsion rate paralleled this pattern of change during systole, but not during diastole. In conclusion, right ventricular pressure overload directly affects LV torsion mechanics. The echocardiographic methodology applied provides novel insights in the interrelation of right- and left ventricular function.

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<![CDATA[Development and validation of a questionnaire to assess healthcare personnel competence in cardiac arrest and resuscitation in pregnancy]]> https://www.researchpad.co/article/elastic_article_7826 Cardiac arrest is rare in pregnancy, and up-to date competence can be difficult to assess and maintain. The objective of this study was to develop and validate a questionnaire to assess healthcare personnel experiences, self-assessed competence and perception of role and resposibility related to cardiac arrest and cardio-pulmonary resuscitation (CPR) in pregnancyMethodsThe study had a cross-sectional design, developing and validating a questionnaire: the Competence in cardiac arrest and CPR in pregnancy (ComCA-P). Development and validation of the ComCA-P was conducted in three stages: 1) Literature review and expert group panel inputs, 2) a pilot study and 3) a cross-sectional questionnaire study. In stage one, the ComCA-P was developed over several iterations between the researchers, including inputs from an expert group panel consisting of highly competent professionals (n = 11). In stage two, the questionnaire was piloted in a group of healthcare personnel with relevant competence (n = 16). The ComCA-P was then used in a baseline study including healthcare personnel potentially involved in CPR in pregnancy (n = 527) in six hospital wards. Based on these data, internal consistency, intra-class correlations, and confirmatory factor analysis were utilized to validate the questionnaire.ResultsThe expert group and pilot study participants evaluated the appropriateness, relevance and accuracy to be high. Formulation of the items was considered appropriate, with no difficulties identified related to content- or face validity. Cronbach’s alpha was 0.8 on the thematic area self-assessment, and 0.73 on the theoretical knowledge area of the ComCA-P. On both the self-assessed competence items and the teoretical knowledge items, Kaiser-Meyer-Olkin was 0.8. Moreover, the Bertletts’ test of sphericity was greater than the critical value for chi-square, and significant (p < .0001).ConclusionsFindings indicate that the ComCA-P is a valid questionnaire that can be used to assess healthcare personnel competence in cardiac arrest and resuscitation in pregnancy. ]]> <![CDATA[Ion currents, action potentials, and noradrenergic responses in rat pulmonary vein and left atrial cardiomyocytes]]> https://www.researchpad.co/article/elastic_article_7931 Effects of noradrenaline on action potential (AP) repolarisation in PV cardiomyocytes. A Representative AP recording from a PV cardiomyocyte in control solution and in the presence of 1 μM noradrenaline (NA). B Representative AP recording from another PV cardiomyocyte in control solution and in the presence of 1 μM NA showing lack of AP prolongation. C Before‐and‐after plot of APD30 in PV cardiomyocytes in control solution and after superfusion with 1 μM NA. D Noradrenaline‐induced fold‐changes in APD30 in LA and PV cardiomyocytes.

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<![CDATA[Model based estimation of QT intervals in non-invasive fetal ECG signals]]> https://www.researchpad.co/article/elastic_article_7659 The end timing of T waves in fetal electrocardiogram (fECG) is important for the evaluation of ST and QT intervals which are vital markers to assess cardiac repolarization patterns. Monitoring malignant fetal arrhythmias in utero is fundamental to care in congenital heart anomalies preventing perinatal death. Currently, reliable detection of end of T waves is possible only by using fetal scalp ECG (fsECG) and fetal magnetocardiography (fMCG). fMCG is expensive and less accessible and fsECG is an invasive technique available only during intrapartum period. Another safer and affordable alternative is the non-invasive fECG (nfECG) which can provide similar assessment provided by fsECG and fMECG but with less accuracy (not beat by beat). Detection of T waves using nfECG is challenging because of their low amplitudes and high noise. In this study, a novel model-based method that estimates the end of T waves in nfECG signals is proposed. The repolarization phase has been modeled as the discharging phase of a capacitor. To test the model, fECG signals were collected from 58 pregnant women (age: (34 ± 6) years old) bearing normal and abnormal fetuses with gestational age (GA) 20-41 weeks. QT and QTc intervals have been calculated to test the level of agreement between the model-based and reference values (fsECG and Doppler Ultrasound (DUS) signals) in normal subjects. The results of the test showed high agreement between model-based and reference values (difference < 5%), which implies that the proposed model could be an alternative method to detect the end of T waves in nfECG signals.

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<![CDATA[Valvular imaging in the era of feature‐tracking: A slice‐following cardiac MR sequence to measure mitral flow]]> https://www.researchpad.co/article/elastic_article_7097 In mitral valve dysfunction, noninvasive measurement of transmitral blood flow is an important clinical examination. Flow imaging of the mitral valve, however, is challenging, since it moves in and out of the image plane during the cardiac cycle.PurposeTo more accurately measure mitral flow, a slice‐following MRI phase contrast sequence is proposed. This study aimed to implement such a sequence, validate its slice‐following functionality in a phantom and healthy subjects, and test its feasibility in patients with mitral valve dysfunction.Study TypeProspective.Phantom and SubjectsThe slice‐following functionality was validated in a cone‐shaped phantom by measuring the depicted slice radius. Sixteen healthy subjects and 10 mitral valve dysfunction patients were enrolled at two sites.Field Strength/Sequence1.5T and 3T gradient echo cine phase contrast.AssessmentA single breath‐hold retrospectively gated sequence using offline feature‐tracking of the mitral valve was developed. Valve displacements were measured and imported to the scanner, allowing the slice position to change dynamically based on the cardiac phase. Mitral valve imaging was performed with slice‐following and static imaging planes. Validation was performed by comparing mitral stroke volume with planimetric and aortic stroke volume.Statistical TestsMeasurements were compared using linear regression, Pearson's R, parametric paired t‐tests, Bland–Altman analysis, and intraclass correlation coefficient (ICC).ResultsPhantom experiments confirmed accurate slice displacements. Slice‐following was feasible in all subjects, yielding physiologically accurate mitral flow patterns. In healthy subjects, mitral and aortic stroke volumes agreed, with ICC = 0.72 and 0.90 for static and slice‐following planes; with bias ±1 SDs 23.2 ± 13.2 mls and 8.4 ± 10.8 mls, respectively. Agreement with planimetry was stronger, with ICC = 0.84 and 0.96; bias ±1 SDs 13.7 ± 13.7 mls and –2.0 ± 8.8 mls for static and slice‐following planes, respectively.Data ConclusionSlice‐following outperformed the conventional sequence and improved the accuracy of transmitral flow, which is important for assessment of diastolic function and mitral regurgitation. Level of Evidence: 2 Technical Efficacy: Stage 2J. Magn. Reson. Imaging 2020;51:1412–1421. ]]> <![CDATA[Trends, Outcomes, and Predictors of Sepsis and Severe Sepsis in Patients with Left Ventricular Assist Devices]]> https://www.researchpad.co/article/N124d80dc-f8ee-4875-88ec-d3253d207960 Left ventricular assist device (LVAD) is used in end-stage heart failure that is refractory to medical treatment. However, there is a paucity of data looking at the rates of sepsis and severe sepsis (SSS). Therefore, this study was conceived with the purpose of analyzing the SSS burden and outcomes associated with LVAD implantation. The national inpatient sample database was queried from 2010 to 2014 using ICD-9 procedure code for LVAD use among patients 18 years or older and 2359 patients were identified. During the five-year study period, the average incidence of SSS was 11.8% and it was noted that cases with SSS were associated with an increased likelihood of mortality, greater length of hospital stay (LOS), and higher hospital-related charges (p < .001) compared to controls. Controlling for age, sex, and LOS, hierarchical multivariate logistic regression revealed that significant predictors of SSS were acute kidney injury [Adjusted odd’s ratio (AOR) = 2.75, 95% CI = 1.87, 4.14)], mechanical ventilation (AOR = 2.34, 95% CI = 1.70, 3.23), venous thromboembolism (AOR = 1.76, 95% CI = 1.12, 2.75), gastrointestinal bleed (AOR = 1.77, 95% CI = 1.12, 2.76), chronic obstructive pulmonary disease (COPD) (AOR = 0.55, 95% CI = 0.40, 0.77), acute myocardial infarction (AOR = 0.54, 95% CI = 0.36, 0.80) and mild liver disease (AOR = 2.18, 95% CI = 1.55, 3.06). The rate of incidence of sepsis has remained constant and is often associated with a worse clinical outcome. This provides a basis to identify high-risk groups and helps argue for earlier detection of such patients and better patient selection so as to reduce infectious complications.

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<![CDATA[The Management Dilemma: Concomitant Acute Hip Fracture and Severe Asymptomatic Aortic Stenosis]]> https://www.researchpad.co/article/N09170aaa-4d97-4c6e-b5cc-b1ec753cf36a Acute hip fractures (AHF) are common in elderly patients. A combination of age-related osteoporosis and increased fall risk makes this population group most susceptible to different fractures including acute fracture of the hip. AHF is a disabling condition that warrants immediate attention. It has a huge impact on the already compromised baseline functional status of elderly patients rendering them more susceptible to different morbidities and even mortality. Similarly, age-related degeneration of the aortic valve with resulting calcification also makes elderly patients prone to aortic stenosis (AS). Severe asymptomatic AS when diagnosed in these patients with AHF in the perioperative period makes the management options very challenging. Severity of AS usually translates into worse postoperative outcomes. The management rationale of concomitant presence of these two conditions is unclear. There is a lack of clear-cut recommendations and societal guidelines in such scenario. 

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<![CDATA[Successful Treatment of Cardiac Tamponade due to Rupture of the Heart Performing an Open-chest Pericardiotomy]]> https://www.researchpad.co/article/N25be801d-6cb0-4736-ba3c-d2fbb6c69c59

A 78-year-old woman with mild dementia was found unconscious by her family. She was transported by an ambulance to our emergency room (ER). Initially, she was comatose and in a state of shock. The echocardiographic findings suggested cardiac tamponade by hematoma. Computed tomography also showed tamponade without aortic dissection. After imaging, she went into cardiac arrest, was returned to the ER, and tracheal intubation and left thoracotomy for pericardiotomy were performed. A return of spontaneous circulation was obtained by following this procedure. Bleeding from a rupture of the left cardiac free wall was confirmed, and the rupture was closed with TachoSil®. After closing the thoracotomy, electrocardiography revealed ST elevation in the precordial leads. Subsequently, placement of an indwelling intra-aortic balloon pump and coronary angiography (CAG) were performed. CAG showed an occlusion of the anterior interventricular branch and circumflex branch of the left coronary artery. She underwent conservative therapy in a coronary care unit. Finally, after obtaining hemodynamic stability and baseline mental status, she was transferred to another medical facility.

We herein report a rare case involving the successful treatment of cardiac tamponade due to rupture of the heart performing an open-chest pericardiotomy and additionally discuss the key points for obtaining a favorable outcome.

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<![CDATA[Damage Control Management for Thoracic Trauma with Cardiac Arrest Complicated by Emphysematous Gastritis and Cystitis]]> https://www.researchpad.co/article/N55ff3b20-a67e-4067-a9d7-06b86110be40

A 78-year-old man was found unconscious after sliding from a rock. His history included hypertension, atrial fibrillation and cerebral infarction requiring warfarin. On arrival, he received six units of blood type O transfusion and vitamin K in an emergency room (ER) due to hemorrhagic shock. His systolic blood pressure temporarily increased to 100 mmHg, and he underwent traumatic pan scan revealing occipital fracture, cerebral contusion, and cervical and multiple left rib fractures with left-dominant bilateral hemothorax. He re-entered a shock state after the examination and underwent transfusion again, but he then entered cardiac arrest. He underwent damage control surgery in the ER and obtained spontaneous circulation. The postoperative course was eventful, but he eventually obtained a survival outcome. Damage control surgery may be beneficial, even in cases of severe thoracic blunt trauma; however, postoperative infections may cause severe problems.

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<![CDATA[Persistent Left Superior Vena Cava Suggested by an Unusual Central Venous Pressure Waveform]]> https://www.researchpad.co/article/N6b3cfb11-3de6-4980-a247-0184df8c438d

Background  A persistent left superior vena cava (PLSVC) is the most common congenital anomaly of the thoracic venous return.

Case Description  During atrial septal defect repair, a pulmonary artery (PA) catheter was placed via the left internal jugular vein. Although placement of the PA catheter in the main PA was confirmed by transesophageal echocardiography, the central venous pressure (CVP) waveform was abnormal. Intraoperatively, the PA catheter was seen exiting the coronary sinus with the CVP port within the coronary sinus.

Conclusions  The diagnosis of PLSVC is discussed and the differential diagnosis of the abnormal “ventricular” pattern of the CVP waveform is reviewed.

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<![CDATA[Contrast enhanced computed tomography findings of persistent truncus arteriosus; A rare congenital heart disease]]> https://www.researchpad.co/article/N45fb28d5-fcc9-4e58-ac04-3582187bce5d

Persistent Truncus Arteriosus is a cyanotic congenital heart anomaly in which a single trunk supplies both the pulmonary and systemic circulation, instead of a separate aorta and a pulmonary trunk. It is usually classified as a conotruncal anomaly. Due to parallel fetal circulation, truncus arteriosus does not cause any haemodynamic problem in utero. However it is a major problem postnatally and, if left untreated, approximately 80% of infants die within the first year. Diagnosis should be made early by radiologists and cardiologists due to fatal illness. We found it valuable to present a case of truncus arteriosus with computerized tomography findings because of its rare occurrence.

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<![CDATA[The Right Anterior Thoracotomy Approach to Resect a Cardiac Papillary Fibroelastoma of the Aortic Valve]]> https://www.researchpad.co/article/N0de1fe1b-a5ba-4795-aeb9-63eaaf203957

A cardiac papillary fibroelastoma (CPFE) is reported to be the second most common cardiac neoplasm after myxoma cordis. CPFEs are histologically benign, frequently asymptomatic, but highly thrombogenic, which could lead to systemic and peripheral embolization. We present a case of a 68-year-old-patient, with a history of angioosteohypertrophy syndrome, who presented at our emergency department (ED) with symptoms of transient ischemic attacks. A thorough investigation, including echocardiography, revealed a neoplasm on the left coronary cusp (LCC) of the aortic valve. The neoplasm was resected via a valve-sparing shave via the right anterior thoracotomy (RAT). The pathological assessment confirmed it to be CPFE. CPFE is a rare but treatable cause of thromboembolism. The removal of CPFEs has classically been performed through a full median sternotomy. We like to present the first case of a valve-sparing removal of a CPFE on the aortic valve through a RAT approach.

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<![CDATA[Laparoscopic Hiatal Hernia Repair in Patients with an Intrathoracic Pancreas: Case Series and a Review of Literature]]> https://www.researchpad.co/article/N9ea31ad9-0002-43c0-ad51-b266407d311e

Transhiatal herniation of the pancreas is rare with only 17 cases reported in 25 years. Presentation of pancreatic herniation is diverse. In the majority of cases, the pancreatic herniation is found incidentally on CT-scans made for evaluating complaints related to a large or giant hiatal hernia. We present a literature review and case series of three patients with symptomatic type IV hiatal hernia with incidental, asymptomatic pancreatic herniation. All cases were managed laparoscopically with robotic assistance.

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