24^th International Conference on Cardiovascular and Thoracic Surgery 2018-06-06 June 06-07, 2018 Osaka, Japan

Venous aneurysms are rare causes of a neck mass. Aneurysm of External Jugular Vein (EJV) is very rare. Surgery is the treatment of choice .Aneurysm of the External Jugular Vein is a very rare clinical entity . The etiology is congenital or acquired . Acquired causes include trauma , tumor , iatrogenic trauma, thoracic outlet syndrome. Imaging techniques include Ultrasonography, Doppler ; rarely Angiography is required . We report a case of EJV aneurysm in a 45 year old lady who presented with history of swelling in the right side of the neck of one year duration and pain of two months duration . She had noticed increase in size of the swelling during coughing and speaking. There was no preceding history of local trauma. Clinical examination showed a 3 cm diameter,soft, non- compressible swelling in the right supraclavicular region. The swelling increased in size on coughing, Valsalva maneuver and speaking. There was no thrill or bruit. Ultrasonography and Doppler study of the area showed an eccentric, well defined, swelling measuring 30 x 13 x 25mm seen arising from the distal part of the right EJV with blood swirling in the swelling. The communication with the EJV was 3mm . CT Angiography confirmed a 30 x 17mm saccular aneurysm of right EJV at C6-C7 level,abutting the right sternocleidomastoid . The aneurysm was excised and the wall of the ETV was reconstructed with a Dacon patch . Post - operative Doppler study did not reveal any flow abnormality in the right EJV. Antiplatelet agent ( Clopidogrel 75 mg once daily ) was continued for six months. Patient is doing fine. Aneurysms of the cervical venous system are rare due to the low pressure in the veins. The Internal jugular vein is rarely involved. EJV aneurysms are extremely rare. The etiology is congenital fragility of the venous wall or acquired. Acquired causes are trauma, tumor, thoracic outlet syndrome, iatrogenic trauma . The aneurysm could be saccular or fusiform. Venous colour Doppler is a useful imaging technique. Computerised Tomagraphy Angiography is the gold standard imaging technique. Surgical excision is the treatment of choice for fear of risk of thrombosis, rupture and for cosmetic reasons .

Lale Hakami has her expertise in pediatric cardiac surgery in infants and newborn. She is a German-board-certified cardiac surgeon with a subspecialization in pediatric cardiac surgery. From 2006-2008, she was the junior consultant of the Congenital Heart Surgery at the University Hospital Erlangen/Germany. From 2008-2009, she was Research Fellowship at the Children's Hospital Boston/USA. From 2009 to 2011 she was director of pediatric cardiac surgery in Mainz/Germany. From 2011-2014 she was senior consultant in children heart center in Linz/Austria. From 2014 she is senior consultant at the University Hospital Munich/Germany and University Lecture of Pediatric Cardiac Surgery at Ludwig-Maximilians-University Munich/Germany (LMU). Her particular experience is in single ventricle physiology and heart transplantation in infants and newborn.

Objectives: The impact of the ventricular morphology in patients, who underwent Fontan procedure on midterm and late outcomes are subjects of controversial discussions in the literature worldwide. The aim of this study was to compare the postoperative outcomes between single left ventricle and single right ventricle morphology referring to the ventricular function and the need of feasible chronic heart failure therapy. Methods: Fontan palliation was performed by 168 Patients with a single ventricle morphology (median age 2.6 years, median weight 12.4 kg, female n=68, 40.2%; male n=101, 59.8%). We aimed to report our results on our hospital in a retrospective and descriptive analysis from 2003 to 2012. Group I: 116 hypoplastic left heart syndrome (HLHS), Group II: hypoplastic right ventricle n=35. We compared the patients by their heart disease in two groups of ventricular morphology. The echocardiogram study of single ventricle function and the necessity of chronic heart failure treatment were compared straight after Fontan procedure and after six, twelve, sixty, 120 and 156 months. Results: Patients with right ventricular morphology had a significant higher need of chronic heart failure therapy pre-Fontan (p=0) and after six (p< 002), twelve (p< 0.04) and sixty months (p< 0.004). Straight after the Fontan procedure and after 10 and 13 years we could not find a significant difference. In group I was performed after Fontan 13 cardiovascular interventions and 8 cardiac reoperations while in group II was reoperations required just in 2 cases. The echocardiogram study of single ventricle function showed no significantly higher occurrence of decreased ventricular function in the groups. One Patient died in group II died 13 years after Fontan operation because of cardiogenic shock. Conclusion: The midterm and late outcome of patients with single left or single right ventricle at our hospital is comparable good and these are comparable with international results. Our results showed that patients with single right ventricle morphology have an increased need of chronic heart failure therapy.

Introduction: Coronary artery bypass graft surgery is a successful operation in cardiac patients, but these patients experience stressful conditions after surgery. The most important asking of these patients is providing feel comfortable. Comfort is one of important goals of nursing cares, which is used for provide it`s from various methods. Foot reflective massage is one of the effective treatments on patient`s comfort. Accordingly, considering to importance of comfort in patients undergoing coronary artery bypass grafting, this study was designed with determine of effect of reflective massage on comfort in patients undergoing coronary artery bypass grafting. Method: In this clinical trial study, 70 patients undergoing the coronary artery bypass graft were selected to convenience sampling method and were assigned in two groups of test and control by blocking-permutational method. Data gathering tools included demographic information questionnaire and HCQ questionnaire, which were completed in two stages, 24 hours after surgery, before massage and the 6th day after massage. In this study, data were analyzed by SPSS software version 23. Results: The mean score of comfort before intervention in the test group was 104.11 ± 9.05 which was increased to 111.30 ± 7.58 after intervention and in the control group before intervention was 105.14 ± 10.38 which was increased to 110.64 ± 7.05 in the 6th day. Comparison of mean score of comfort in both groups was significant before and after intervention (P <0.05). But, the comparison of mean score of comfort in the two groups before and after the intervention was not significant (P> 0.05). Also, mean of changes in comfort score were not significant in two groups (P> 0.05), and the mean score of comfort was not significant According to gender, age and education (P> 0.05). Conclusion: The present study is reported a significant increase of comfort in the 6th day in both groups. On the other hand, increased of comfort in the control group, desired level of nursing cares indicated in providing of comfort for patients in open heart surgery unit. But, considering to lack meaningful in comparison of the results in two groups is suggesting the restoration, strengthening and revision in interventions of affecting on comfort and conducting of training courses for nurses of the intensive care unit. Keywords: Comfort, Reflective massage, Coronary artery bypass grafting

Lymphangioma circumscriptum is a misnomer because this is not a true tumor --- it is a malformation of the superficial lymphatics . Treatment is by surgical excision or laser therapy.Lymphangioma circumscriptum is caused by congenital or acquired blockage of the lymphatics resulting in backup of lymph into multiple small vesicles , giving a frogspawn appearance. Common sites are axilla, abdomen, extremities and mouth. We report a 40 year old lady presented with history of swelling in the right forearm of 2 years duration. The swelling had steadily been increasing in size with associated pain of 1 month duration . There was no preceding history of local trauma .Clinical examination revealed a non- tender , non -compressible, ovoid swelling in the flexor aspect of right forearm ,10cm by 5 cm in size with diffuse border. Ultrasonography suggested a subcutaneous Hemangioma.Contrast MRI displayed an ill -defined , heterogeneously enhancing subcutaneous lesion suggestive of subcutaneous Hemangioma .Complete excision was done using right brachial block . Histopathological examination revealed a cystic lymphangioma . Post –operative Ultrasonography confirmed the absence of any residual lesion . Patient is doing well at 6 months follow up. Lymphangiomas are malformations of the lymphatics . They can be localized or generalized, congenital or acquired. The classical types are (a) Lymphangioma simplex (b) Lymphangioma circumscriptum (c) cavernous Lymphangioma (d) cystic Lymphangioma. The term Lymphangioma circumscriptum was coined by Morris et al in 1889. The pathogenesis was first described by Whimster in 1976 . Acquired causes of obstruction of lymphatics are (i) Tuberculosis (ii) Filariasis (iii) Lymphogranuloma venereum (iv) Local radiotherapy (v) lymph node malignancy –primary or secondary . The potential complications are (a) cellulitis (b) hemorrhage (c) secondary infection and rarely (d) squamous cell carcinoma (e) Dabska tumor- papillary intralymphatic hemangioendothelioma. Surgical excision is regarded as the most definitive treatment ,giving the highest chance of cure with a recurrence rate of 17% to 23% . The palliative modalities include Sclerotherapy using hypertonic saline , Electrocautery ,Electrofulguration ,Laser and light based device ablation. Diode laser with radiofrequency current devices have replaced electrocautery as these are more versatile due to their various therapeutic waveforms .

Objective: To determine the efficacy and safety of immediate, pre-emptive platelet transfusion in patients undergoing coronary artery bypass graft surgery(CABG). Background: Excessive postoperative bleeding is associated with increased mortality and morbidity. Some surgeons at the Hammersmith Hospital (HH) intraoperatively transfuse platelets to manage bleeding, however the effect upon postoperative blood loss is unknown. Methods: The use of intraoperative platelet transfusion (IPT) was assessed in a retrospective cohort study of all urgent in-patients who underwent CABG surgery at the HH between August 2012 and November 2014. Endpoints to determine the efficacy included: chest tube output, transfusions; namely red blood cells, platelets and fresh frozen plasma, and the reoperation rate. Safety endpoints included: the duration of intubation, non-invasive ventilation, ITU and hospital stay and adverse events. Results: Of 165 patients included in the study, 72 did not receive IPT whilst 93 did. Baseline characteristics were largely comparable; including possible confounding factors such as the number of patients administered clopidogrel prior to surgery (p=>0.05), and the drug washout period for both aspirin (p=>0.05), and clopidogrel (p=>0.05). Intraoperative variables were also comparable. IPT did not reduce postoperative blood loss, blood product transfusion or the reoperation rate. Furthermore, IPT had no effect upon the duration of intubation, non-invasive ventilation, ITU or hospital stay, or adverse outcomes. Conclusion: The use of IPT in urgent in-patients undergoing CABG surgery does not reduce postoperative blood loss, the need for blood product transfusion or reoperation rate, however it is a safe intervention and does not worsen patient prognosis.