Cardiac Compression Research Articles

High incidence of dyspnoea and pulmonary aspiration in giant hiatus hernia: a previously unrecognised cause of dyspnoea.

Dyspnoea is common in patients with giant paraoesophageal hernia (PEH). Pulmonary aspiration has not previously been recognised as a significant contributory factor. Aspiration pneumonia in association with both gastro-oesophageal reflux disease (GORD) and PEH has a high mortality rate. There is debate about routine anti-reflux measures with surgical repair. Reflux aspiration has been examined in a consecutive cohort using scintigraphic scanning and symptoms. Reflux aspiration scintigraphy (RASP) results and symptoms were evaluated in consecutive patients with PEH managed in our service between January 2012 and March 2017. PEH was diagnosed in 96 patients. Preoperative reflux pulmonary scanning was performed in 70 patients: 54 were female (77.1%) and the mean age was 68years (range 49-85). Dyspnoea was the most common symptom (77.1%), and a symptomatic history of aspiration was seen in 18 patients (25.7%). Clinical aspiration was confirmed by RASP in 13 of these cases. Silent RASP aspiration occurred in a further 27 patients without clinical symptoms. RASP was negative in five patients with clinical symptoms of aspiration. No aspiration by either criterion was present in 27 patients. Dysphagia was negatively related to aspiration on RASP (p<0.01), whereas dyspnoea was not (p=0.857). GORD, dyspnoea and silent pulmonary aspiration are frequent occurrences in the presence of giant PEH. Subjective aspiration was the most specific and positive predictor of pulmonary aspiration. Dyspnoea in PEH patients may be caused by pulmonary aspiration, cardiac compression and gas trapping. The high rate of pulmonary aspiration in PEH patients may support anti-reflux repair.

The CorInnova Implantable Cardiac Assist System for Direct Cardiac Compression.

The CorInnova cardiac compression device (CorInnova, Inc., Houston, TX, USA) is designed to provide direct biventricular support, increase cardiac output, and improve ventricular unloading in patients with heart failure. Placed within the pericardium and surrounding both ventricles, the device has two concentric sets of thin-film polyurethane chambers: (1) inner (epicardial) saline-filled chambers that conform intimately to the epicardial surface, eradicating any gaps in the interface between the device and the heart; and (2) outer air-filled chambers cycled to provide epicardial compression during systole and negative epicardial pressure during diastole, consistent with physiological cardiac contraction and relaxation. A superelastic, collapsible Nitinol frame gives the device structure, enables minimally invasive self-deployment, and enhances diastolic filling. Preclinical testing has been extremely promising, with improvements in cardiac output and other cardiac parameters in animal heart failure models. This potentially transformative technology is moving rapidly toward first-in-human use. The CorInnova device may provide an effective device-based solution for patients with heart failure who currently have few or limited mechanical cardiac support options, including patients with biventricular cardiac failure, those with right heart failure, those who are older, and those who are of smaller size. It can be removed easily and requires minimal maintenance. An important, unique feature of this technology is that it provides mechanical cardiac assistance without blood contact or need for anticoagulation. The CorInnova device may be particularly important for those patients who have contraindications to anticoagulation due to allergy, neurological bleeds, or preexisting hemorrhage. No other mechanical circulatory support device addresses these underserved heart-failure populations.

PNEUMOPERICARDIUM: UNEXPECTED FINDING IN A BLUNT THORACIC TRAUMA

TYPE: Late Breaking Abstract TOPIC: Critical Care INTRODUCTION: Pneumopericardium is a rare finding. We present a clinical case of a pneumopericardium due to blunt thoracic trauma and its management. CASE PRESENTATION: A 22-year male admitted to the Emergency Department after a high energy car crash with blunt thoracic and abdominal trauma presented with severe hypotension and tachycardia. Thoracic x-ray showed a left pneumothorax and a chest tube was inserted. FAST ultrasound was positive on the Morrison space, prompting immediate surgical intervention, during which a right chest tube was inserted due to suspicion of right pneumothorax. After surgery, the patient remained in circulatory shock, warranting high doses of vasoactive drugs. A CT scan was performed, depicting a 15 mm pneumopericardium (Figure 1). ECG had a low voltage tracing, a mild elevation of cardiac biomarkers was noted and echocardiography showed preserved biventricular systolic function, a 10 mm inferior vena cava and no signs of cardiac compression, thus making tension pneumopericardium an unlikely diagnosis. The right chest drain was hypothesized as potential cause of the pneumopericardium. An urgent consultation with cardiac surgery was requested and low pressure suction was initiated in the ICU. Pneumopericardium dimensions improved over time, with no evidence of pericardial air on day three. DISCUSSION: Although its etiology remained unclear, close monitoring for signs of cardiac suffering throughout ICU stay and a conservative approach led to clinical resolution. CONCLUSIONS: This case highlights the need for a multidisciplinary approach when managing specific thoracic pathology in the ICU setting. DISCLOSURE: No significant relationships. KEYWORD: pneumopericardium

P297 PERICARDIAL EFFUSION WITHOUT HEMODYNAMIC INSTABILITY: WHEN AND TO WHOM THE PERICARDIOCENTESIS?

Abstract Cardiac tamponade is traditionally considered a clinical diagnosis, but there are pre–tamponating effusions that occur without signs of cardiogenic shock, and in these situations it can be complex to determine when and which patient treat with pericardiocentesis. The clinical case concerns a 90–year–old woman who comes to the emergency room for exertional dyspnea. Upon arrival blood pressure was 150/90 mmhg, heart rate 70 bpm. On chest x–ray, enlargement of the cardiac silhouette was evident (Fig 1). The echocardiogram showed a circumferential pericardial effusion of 2 centimeters with signs of right cardiac chambers compression (Fig 2). Hospitalized in ICU, the clinical situation was complicated by the onset of atrial fibrillation with a high ventricular response (Fig 3) and immediate cardiogenic shock (BP 70/40 mmHg, tachypnea, altered mental status). We proceed with emergency electrical cardioversion, effective in restoring sinus rhythm with almost immediate arrhythmic recurrence; therefore we perform a pericardiocentesis, with regression of the shock status after aspiration of a few cc of serum–haematic pericardial fluid (total 750 cc); spontaneous restoration of sinus rhythm after the procedure. Neoplastic problems were excluded, IgM positivity for influenza A and B on blood tests. The patient presented no further complication, was discharged at home, in sinus rhythm, with negative follow–up so far. This clinical case focuses the question of the indication and timing of pericardiocentesis. We managed a pericardial effusion with ultrasound signs of compression of the right sections, but in the absence of clinical signs of cardiogenic shock / Beck‘s triad. Given the clinical evolution, should we have perform the pericardiocentesis as soon as the patient arrived, in conditions of hemodynamic stability? Interesting are the score index proposed by Halpern et al. and an ESC position statement that serves to identify patients to undergo urgent pericardiocentesis based not only on clinical factors, but also on imaging evaluation. The total score of our case would have been indicative for an immediate pericardiocentesis. In our opinion, the formulation of a triage system for patients with pericardial effusion and hemodynamic stability that can be routinely implemented in clinical practice would be extremely useful.

Pediatric Advanced Life Support in a Neonatal Context.

Pediatric Advanced Life Support in a Neonatal Context.

Fetal thoracic teratomas: mediastinal or pericardial?

Mediastinal and pericardial teratomas have overlapping imaging features that may make accurate prenatal diagnosis challenging. To identify prenatal imaging features that may aid in distinguishing between mediastinal and pericardial teratomas. Prenatally diagnosed pericardial and mediastinal teratomas evaluated at our fetal center from 1995 to 2020 were included in this Institutional Review Board-approved study. Lesion volume was calculated using prospectively reported ultrasound (US) measurements and the formula of a prolate ellipsoid, which was then normalized to head circumference. Prenatal US and magnetic resonance imaging (MRI) studies were anonymized with two fetal imagers reviewing the US studies and two different fetal imagers reviewing the MRI studies. These experienced reviewers scored location of the mass in the craniocaudal axis and in the transverse axis. MRI reviewers also scored the presence of inferior cardiaccompression by the lesion and whether there was identifiable thymic tissue. Reviewer disagreements were resolved by consensus review. Eleven pericardial teratomas and 10 mediastinal teratomas were identified. All cases underwent detailed fetal anatomic US and fetal echocardiogram and 10/11 (91%) pericardial teratomas and 8/10 (80%) mediastinal teratomas underwent fetal MRI. Median volume was higher for mediastinal teratomas compared to pericardial teratomas (42.5mL [interquartile range (IQR) 15.9 - 67.2mL] vs. 8.1mL [IQR 7.7 - 27.7mL], P=0.01) and median volume/head circumference was also statistically higher in mediastinal teratomas (1.33 [IQR 0.78 - 2.61] vs. 0.43 [IQR 0.38 - 1.10], P=0.01). Logistic regression analysis demonstrated a statistical difference between teratoma types with respect to location in the craniocaudal axis by both modalities with mediastinal teratomas more commonly located in the upper and upper-middle thorax compared to pericardial teratomas, which were more commonly found in the middle thorax (US, P=0.03; MRI, P=0.04). Logistic regression analysis also demonstrated a statistical difference between teratoma types with respect to position along the transverse axis by both modalities with mediastinal teratomas more commonly located midline or left paramedian and pericardial teratomas more often right paramedian in location (US, P&lt;0.01; MRI, P=0.02). Inferior cardiac compression observed by MRI was associated more commonly with mediastinal teratomas compared to pericardial teratomas (87.5% [7/8] vs. 10% [1/10], P&lt;0.01). Identifiable thymus by MRI was more commonly observed in cases of pericardial teratomas, however, this difference was not statistically significant (P=0.32). Mediastinal teratomas are associated with larger lesion size and inferior cardiac compression when compared to pericardial teratomas. These features combined with lesion location in the craniocaudal and transverse axes may allow for more accurate prenatal diagnosis and optimal perinatal and surgical management.

A Large Hiatal Hernia Causing Cardiac Compression and Leading to Arrhythmias

A Large Hiatal Hernia Causing Cardiac Compression and Leading to Arrhythmias

Direct Cardiac Compression Devices to Augment Heart Biomechanics and Function.

The treatment of end-stage heart failure has evolved substantially with advances in medical treatment, cardiac transplantation, and mechanical circulatory support (MCS) devices such as left ventricular assist devices and total artificial hearts. However, current MCS devices are inherently blood contacting and can lead to potential complications including pump thrombosis, hemorrhage, stroke, and hemolysis. Attempts to address these issues and avoid blood contact led to the concept of compressing the failing heart from the epicardial surface and the design of direct cardiac compression (DCC) devices. We review the fundamental concepts related to DCC, present the foundational devices and recent devices in the research and commercialization stages, and discuss the milestones required for clinical translation and adoption of this technology.

Abdominal compartment syndrome: an often overlooked cause of acute kidney injury.

Abdominal compartment syndrome (ACS) is defined as any organ dysfunction caused by intra-abdominal hypertension (IAH), referred as intra-abdominal pressure (IAP) ≥ 12mm Hg according to the World Society of Abdominal Compartment Syndrome. Abdominal compartment syndrome develops in most cases when IAP rises above 20mmHg. Abdominal compartment syndrome, while being a treatable and even preventable condition if detected early in the stageofintra-abdominal hypertension, is associated with high rates of morbidity and mortality if diagnosis is delayed: therefore, early detection is essential. Acute kidney injury (AKI) is a common comorbidity, affecting approximately one in every five hospitalized patients, with a higher incidence in surgical patients. AKI in response to intra-abdominal hypertension develops as a result of a decline in cardiac output and compression of the renal vasculature and renal parenchyma. In spite of the high incidence of intra-abdominal hypertension, especially in surgical patients, its potential role in the pathophysiology of AKI has been investigated in very few clinical studies and is commonly overlooked in clinical practice despite being potentially treatable and reversible. Aim of the present review is to illustrate the current evidence on the pathophysiology, diagnosis and therapy of intra-abdominal hypertension and abdominal compartment syndrome in the context of AKI.

Cardiac Tamponade Totalis: Unique Phenomenon of Biventricular Tamponade After LVAD Implant

<h3>Introduction</h3> Cardiac tamponade results in obstructive shock due to cardiac chamber compression and impaired cardiac output. This commonly involves the RV due to its lower pressure. We report the first case of biventricular tamponade in a patient with a LVAD. <h3>Case Report</h3> A 30 yr old female (ht 4'7", wt 32 kg, BSA 1.13 m²) with inotrope dependent non-ischemic cardiomyopathy presented for heart transplant evaluation. Right heart catheterization on milrinone 0.375 mcg/kg/min was notable for RA 32 mmHg, PA 51/30 (37) mmHg, PCWP 34 mmHg, CI 1.2 L/min/m², PVR 1.8 Wood units. She was listed for cardiac transplant as her vessels were too small for percutaneous peripheral short term mechanical circulatory support. She decompensated needing VA-ECMO and then HeartWare LVAD implantation (speed 2300 RPM). 7 days post operatively, low flow alarms occurred with hypotension requiring escalating doses of ino-pressors. Echocardiography revealed a large circumferential pericardial effusion resulting in biventricular collapse (Figure A). Emergent surgical drainage was performed with 500 ml blood removal, resulting in re-expansion of both ventricles (Figure B). <h3>Summary</h3> To our knowledge this is the first report of biventricular cardiac tamponade, or as we have termed it, tamponade totalis. In the presence of a pericardial effusion, continuous LV unloading via a LVAD can cause the LV pressure to be lower than the pericardial pressure. Coupled with reduced RV preload from post-operative bleeding, this results in biventricular compression and tamponade. A combination of patient (size, anticoagulation, surgical approach) and pump (RPM) related factors likely lead to the development of tamponade totalis. Diagnosis of tamponade in a patient with a continuous flow LVAD is challenging due to similarities in presentation of right heart failure and atypical signs. Unique clues suggestive of tamponade in patients with a LVAD are respiratory variation of the pulsatilitiy index waveform and pulseless paradoxus. Imaging is key to diagnosis.

Pulmonary hypertensive crisis in children with pulmonary arterial hypertension undergoing cardiac catheterization.

Pediatric patients with pulmonary arterial hypertension (PAH) are considered to be at risk for pulmonary hypertensive crisis (PHC) or even death during right heart catheterization (RHC). This retrospective study was designed to identify the risks and clinical characteristics associated with PHC in pediatric PAH patients. We included 163 consecutive procedures from 147 pediatric patients diagnosed with PAH who underwent diagnostic RHC in Beijing Anzhen Hospital between January 2007 and December 2020. The average patient age was 9.0 ± 4.7 years and 84 (51.5%) were females. Before RHC, over 20% of patients were in New York Heart Association (NYHA) class III–IV. Sedation or general intravenous anesthesia was used in 103 procedures (63.2%), with spontaneous breathing in 93.2%. PHC occurred in 19 patients (11.7%), 5 (3.1%) required cardiac compression, and 1 died (0.6%). Compared to patients without PHC, those who experienced PHC were more likely to be in NYHA class III–IV (p = 0.012) before RHC, require sedation (p = 0.011), had echocardiographic indices of higher peak tricuspid regurgitation velocity (p = 0.018), and right ventricle (RV) to left ventricle (LV) ratio (p < 0.001). Multivariate logistic regression for PHC identified the need for sedation and a higher RV/LV ratio as independent predictors. In conclusion, the risk of RHC remains significant in children with PAH, particularly in those with severe RV dilation who require sedation during cardiac catheterization. Comprehensive evaluation, close monitoring, and appropriate treatment before and during the procedure are essential for reducing mortality.

Meta-Analysis of the Factors Influencing the Restoration of Spontaneous Circulation After Cardiopulmonary Resuscitation

ObjectiveThis study aimed to systematically evaluate the factors influencing the restoration of spontaneous circulation (ROSC) after cardiopulmonary arrest (CA).MethodsRelevant papers on the factors influencing the ROSC in patients with CA were retrieved from PubMed, Embase, Cochrane Library, China Biology Medicine disk, China National Knowledge Infrastructure, Wanfang, and VIP databases. After screening, data extraction, and quality evaluation of the papers, a meta-analysis was carried out.ResultsA total of 36 papers, involving a total sample size of 2,305 cases, were included. The meta-analysis revealed that the location and time of onset of CA, the type of cardiac rhythm at first monitoring, the start time of cardiopulmonary resuscitation (CPR), the use of electric defibrillation, and the cumulative dose of adrenaline all significantly impacted the ROSC (p < 0.05) and may have affected its success rate. The pH value at CA onset, combined use of adrenaline and vasopressin, CPR duration, mechanical cardiac compression use, and whether CA was caused by heart disease had no significant effect on ROSC.ConclusionThe location and time of onset of CA, the cardiac rhythm at first monitoring, the start time of CPR, the use of electric defibrillation, and the cumulative dose of adrenaline significantly impacted the ROSC.

Full recovery after prolonged resuscitation in a pediatric patient due to fulminant myocarditis: a case report with three-year follow-up

BackgroundFulminant myocarditis (FM) is a common life-threatening disease in pediatric patients, which can result in sudden cardiac arrest (CA). Whether prolonged cardiopulmonary resuscitation (CPR) is beneficial to FM induced CA is unknown.Case presentationWe reported the case of an 8-year-old child with FM. At 14:49 of the day after admission, the ECG monitoring indicated ventricular flutter. The patient was immediately given continuous external cardiac compression. Electric cardioversion (energy 30J) and electric defibrillation (energy 50 J, 100 J, 100 J) were given. Continuous chest compression was conducted until extracorporeal membrane oxygenation (ECMO) successfully placed at 19:30 P.M. The total duration of CPR was 291 min. Nine days later, the ECMO was removed; and 29 days later, the patient was discharged from hospital. In the three years of follow-up, the boy showed a full recovery without neurological sequela. At present, his daily activities have returned to normal and his academic performance at school is excellent.ConclusionsProlonged CPR can be used in FM induced in-hospital CA in pediatric patients, especially during preparation for ECMO after the failure of standard resuscitation measures.

Stab wound or artefact of resuscitation?

Cardiopulmonary resuscitation (CPR) is the quintessential response to cardiac arrest and chest compression has remained its primary element. Chest compressions are often associated with resuscitative artefacts, which are often encountered in our forensic pathology setting. Occasionally, some of these artefacts can resemble and be misinterpreted for accidental or homicidal injuries. We present a case of one such resuscitative artefact caused by an automated mechanical chest compression device, which was initially mistaken by the police to be a ‘stab wound’.

Central congenital diaphragmatic hernia with cardiac compression in a neonate

Congenital diaphragmatic hernias (CDH) occur when the diaphragm fails to close during normal fetal development. The most common subtypes are Bochdalek and Morgagni hernias. There are a variety of presentations from asymptomatic to severe cardiopulmonary compromise present at birth. Presented is a case of a six-day-old neonate with a postero-central diaphragmatic hernia with herniated liver causing right atrial compression and right-to-left shunting across the patient's patent foramen ovale (PFO). The hernia was repaired with a laparoscopic patch technique.

The relationship between body mass index with quality of CPR compression in Nursing Students

&lt;p&gt;&lt;strong&gt;Background: &lt;/strong&gt;Coronary Heart Disease is one of the diseases that causes the most deaths in Indonesia. One of the causes of death from coronary heart disease is cardiac arrest. One of the help that can be given is CPR (Cardiopulmonary Resuscitation). CPR can be performed by ordinary people or trained personnel. The phenomenon that often occurs is that when compression is performed, students are often not optimal in providing compression in terms of compression depth. The impact of poor quality CPR can cause death, economic, psychological, social, and length of treatment.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Objectives: &lt;/strong&gt;This study aims to determine the relationship between Body Mass Index (BMI) and the Quality of Cardiac and Lung Resuscitation Compression in Nursing Students.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Method: &lt;/strong&gt;This study uses a descriptive analytic research, with an observational method using a cross sectional design using a total sampling of 46 respondents.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Result: &lt;/strong&gt;Based on the results of Fisher's Exact test, p-value &amp;lt; (0.001 &amp;lt; 0.05) was obtained so that there was a relationship between student BMI and quality into compression. The quality of nurses' chest compressions in performing chest compressions is lacking, even though some nurses have had cardiopulmonary resuscitation training. Someone who has a high and low BMI in the hospital, it was found that when doing chest compressions the patient gets tired quickly, a high BMI is difficult to do chest compressions when getting into bed.&lt;strong&gt;&lt;/strong&gt;&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusion: &lt;/strong&gt;Body Mass Index can improve the quality of student compression in cardiopulmonary resuscitation. BMI indirectly plays an important role in the performance of nurses in order to provide optimal cardiopulmonary resuscitation.&lt;/p&gt;

Ретроспективный анализ результатов диагностики и лечения врожденной диафрагмальной грыжи плода, по данным перинатального консилиума

Study Objective: Analysis of the detection of congenital diaphragmatic hernia (CDH) in the fetus at the antenatal stage and perinatal outcomes of newborns with CDH in the Russian Federation in a sample of women who applied to the perinatal consultation of the National Medical Research Center for Obstetrics, Gynecology and Perinatology named after academician V.I. Kulakov. Study Design: Retrospective study. Materials and Methods. The study included 235 cases of CDH in fetuses and newborns were selected by the federal perinatal consultation of the National Medical Research Center for Obstetrics, Gynecology and Perinatology named after academician V.I. Kulakov. The following were retrospectively analyzed: medical and social characteristics of pregnant women, results of ultrasound and MRI examination of fetuses, delivery features and perinatal outcomes. Study Results. The number of women with fetal CDH in the perinatal consultation of the Center continues to grow every year. In 3/4 of the treated patients, fetal CDH was detected in the 2nd trimester of pregnancy, which exceeds the European level of detection. But against this background, an extremely low level of invasive prenatal diagnosis was noted. Detection using ultrasound and MRI of liver infection in the chest, including a group with a prognosis of high neonatal survival of 2.2–4 times. The perinatal mortality rate with CDH in the Centers detection is 43.4%. The most common method of delivery is the natural birth. The optimal term of delivery with the least increase in postnatal loss should be considered the period of 38–39 weeks of pregnancy. Forecast of survival of newborns. At the same time, the Apgar score does not have statistical indicators of differences in surviving and deceased newborns, regardless of the method of delivery, which is associated with a violation of child development. Conclusion. The level of detection of CDH and perinatal mortality of newborns is similar to the data of foreign perinatal centers that provide assistance to mothers and their newborns. Increasing the survival rate of newborns with CDH is possible with the development and implementation of an integrated system for diagnosing the severity of CDH, as this will open up the possibility of a personalized approach to the treatment of CDH. Keywords: congenital diaphragmatic hernia, perinatal mortality, perinatal consultation, pulmonary hypoplasia, cardiac compression.

Atrial Fibrillation and Ventricular Tachycardia Associated with External Cardiac Compression from Bochdalek Hernia

A Bochdalek hernia is a congenital posterior diaphragmatic hernia, usually discovered and repaired during childhood. Although they typically cause gastrointestinal symptoms or respiratory symptoms due to lung compression, cardiac arrhythmias have not been described. We present a case of atrial fibrillation (AF) and ventricular tachycardia (VT) associated with compression from a large recurrent Bochdalek hernia.

Cardiovascular Complications of Large Hiatal Hernias: Expanding the Indications for Robotic Surgical Anatomic and Physiologic Repair: A Review

Background: Historically, the pathophysiology of Hiatal Hernias (HH) has not been fully understood. As a result, the surgical therapy of HH has focused primarily on gastrointestinal symptoms and Gastroesophageal Reflux (GERD). This treatment strategy has been associated with poor relief of symptoms and poor long-term outcomes. In fact, until recently, most patients with HH have been watched and referred for surgery as a last resort. Recent experience has shown that a large (giant) Hiatal Hernia (GHH) is a common problem known to impact adjacent organs such as the hearts and lungs. Those referred for surgical repair often complain of dyspnea, which is erroneously attributed to pulmonary compression or aspiration, but has been shown to be from tamponade caused from compression of the heart by herniated abdominal contents. This article reviews the present understanding of GHH, the cardiac complications which result from GHH, and the most advanced robotic minimally invasive surgical approach to the anatomic and physiologic repair of GHH. Methods: In a prospective cohort study, we evaluated patients undergoing RRHH with at least a 2-year follow-up. All patients undergoing elective (RRHH) were identified preoperatively and enrolled prospectively in this study. Preoperative characteristics, medical comorbidities, and clinical information were all recorded prospectively and recorded into a secure surgical outcomes database. All patients received the previously validated Gastroesophageal Reflux Disease-Health-Related Quality of Life (GERD-HRQL) questionnaire preoperatively and at postoperative time points of 1 month, 1 year, and 2 years. Patients routinely had a barium swallow postoperatively before discharge but did not undergo a barium swallow, an endoscopy, or a CT scan study at the 1-month time point unless indicated by symptoms. At 6 months, 1 year, and yearly intervals thereafter, all patients received an endoscopy study to ascertain the presence of a recurrence, regardless of symptoms. Recurrence was defined as over 2 cm or 10% of the stomach above the diaphragm detected by CT, esophagogram or endoscopy. In addition, an extensive search was conducted using Pub Med in order to extract references to the cardiovascular complications of HH. Results: 423 patients underwent RRHH. With a long-term follow-up, there was a significant decrease in the Median Symptom Severity Score from 42.0 preoperatively, to 3.0 postoperatively. Recurrence was seen in 5 patients (5/423) for a recurrence rate of 1.1%. Conclusion: This experience has been the basis of two important realizations: 1) all patients with GHH have at least some degrees of clinically relevant compression of the inferior vena cava and the left atrium which causes tamponade and cardiogenic dyspnea which completely resolves after successful surgical repair; and 2) primary care providers and gastroenterologists who usually treat patients for GHH repair rarely recognize cardiac compression and tamponade as the cause of the shortness of breath and gradual increase in dyspnea on exertion and progressive fatigability in these patients. This article reviews the present understanding of GHH, the cardiac complications which result from GHH and the most advanced robotic minimally invasive surgical approach to the anatomic and physiologic repair of GHH.

Congenital sternal cleft with ventricular septal defect: A case report of a rare condition

Abstract Sternal cleft is a rare congenital abnormality with an incidence of 2:100,000 live births. It could occur in isolation or along with defects of the abdominal wall, diaphragm, pericardium, and heart. Surgical correction in the neonatal period is required to protect the underlying structures as the risk of cardiac compression at this period is still minimal. We report a case of an 8-day-old term male neonate with congenital superior sternal cleft associated with a ventricular septal defect. He was evaluated and referred to a facility where he could access surgical reconstruction.