A retroesophageal right subclavian artery (lusoria) is unusual for the surgeon, yet common regarding pathological findings (0.5-2%). Complications arising from it are rare (dysphagia). We report a case of traumatic descending aortic tear originating from a lusoria. The patient had experienced chest trauma due to a skiing accident. CT scan revealed an intramural haematoma of the proximal descending aorta. As a coincidence finding, a retroesophageal right subclavian artery was diagnosed. The patient was first treated conservatively. After an initial period--of stable patient conditions--repeated CT scan revealed a haematoma enlargement and surgery was scheduled: A localized aortic tear was suspected through CT scan, yet no aortic tear or flap was visible. During a two-staged surgical procedure, transpositioning of the lusoria into the right common carotid artery was performed, followed by replacement of the distal aortic arch during a second session using a single-branched Dacron tube graft. The left subclavian artery was then reinserted into the side-branched graft after reuptake of extracorporeal circulation. Extracorporeal circulation was applied via the femoral vessels and circulatory arrest in combination with deep hypothermia. After surgery, the patient was stable, having no signs of neurocognitive dysfunction or dysphagia.

The indication for coronary bypass surgery in the elderly has been dramatically expanded in recent years. The results, however, are often contradictory. 1,538 consecutive patients undergoing cardiac surgery were divided into two groups by their age at the time of operation: younger than 75 years (n = 1,480) and 75 years and older (n = 58). These groups were compared with regard to influencing factors of early and late mortality, morbidity, and quality of life. Preoperatively, the clinical condition of the group greater than or equal to 75 years was significantly worse than the condition of the group less than 75 years (NYHA IV: greater than or equal to 75 years: 63.8%; less than 75 years: 31.9%). Cerebrovascular diseases occurred more often in the patients greater than or equal to 75 years (stroke or transient ischemic attack: greater than or equal to 75 years: 8.6%; less than 75 years: 2.3%). The necessity of carotid reconstruction prior to coronary surgery was significantly higher in the patients greater than or equal to 75 years: (greater than or equal to 75 years: 5.2%; less than 75 years: 1.5%). Diabetes mellitus could be observed in 19.0% of the patients greater than or equal to 75 years and in 10.1% of the patients less than 75 years. The preoperative ejection fraction was similar in both groups. Cardiopulmonary bypass time and crossclamping time of the aorta did not differ significantly. Both groups received approximately the same number of distal coronary anastomoses. Rethoracotomy due to hemorrhage had been observed more often in the older group (greater than or equal to 75 years: 8.6%; less than 75 years: 4.5%).(ABSTRACT TRUNCATED AT 250 WORDS)

The long-term results of cardiac surgery in 212 consecutive octogenarians (116 men, 96 women) were reviewed retrospectively. Preoperative functional status, Euroscore, and the incidences of hypertension and chronic obstructive pulmonary disease were similar in both sexes. Women had more diabetes mellitus (45% versus 25%; p < 0.05) but less renal dysfunction (16% versus 29%; p < 0.05). Men required emergency procedures more frequently (p < 0.05). Women underwent complete revascularization more often and had more arterial grafts. Hospital mortality was similar (11.5% in women versus 12.9% in men), but women had more complications (76% versus 64%), longer convalescence (24.3 versus 18.5 days), fewer psychiatric disorders (14% versus 23%) and less heart block (9% versus 19%). Men had a slightly better outcome in terms of functional class and Euroqol score during follow-up of up to 114 months. Median survival was longer in women (3.15 versus 2.96 years) but 1-, 3-, and 5-year survival rates and late deaths were similar. Outcomes appear to be equitable for both sexes among octogenarians.

Feeding tubes are commonly used in neonatal intensive care units, and their abnormal position seen on radiographs may indicate underlying serious problems. We recently cared for two infants who presented with clinical deterioration. An abnormally placed feeding tube seen on the chest radiograph revealed underlying serious conditions. The first case was an infant 29 weeks of age who presented with right-sided pneumothorax after birth. By history and a right-side-displaced orogastric (OG) tube, iatrogenic esophageal perforation was diagnosed. The second case was a 16-day-old infant who presented with recurrent vomiting. An OG tube extending into a cystic mass at the right cardiophrenic angle resulted in diagnosis of a herniated stomach with organoaxial-type volvulus, which required surgical repair. Both cases recovered uneventfully. As illustrated in these two rare cases, feeding tube position is not only important for feeding practice, but it also has diagnostic implications in newborn infants.