Interrupted aortic arch (IAA) is rare congenital cardiac defect defined as a complete loss of luminal and anatomical continuity between ascending and descending segments of the aorta. Usually it is detected in the perinatal period or during the first hours or days of infancy. If not treated surgically, it usually is lethal. Nevertheless, diagnosis can be made in adults but is a very rare entity. Extremely few cases in adults are reported in the pertinent medical literature. We present an asymptomatic 62-year-old patient who was found to have IAA after examination for hypertension. The patient underwent a successful anatomical repair, with an uneventful postoperative course, and follow-up examinations reveal regression of hypertension and excellent health condition.

The use of opioid analgesics to control pain after median sternotomy in cardiac surgical patients is worldwide accepted and established. However, opioids have a wide range of possible side effects, concerning prolonged extubation time, gastrointestinal tract dyskinesia and urinary tract disorders mostly retention. All these may lead to a prolonged ICU stay or overall hospitalization time increase.Objective: To determine whether a continuous subcutaneous regional anesthetic infusion delivered directly to the sternotomy site would result in decreased levels of postoperative pain and opioid requirements in cardiac surgical patients undergoing median sternotomy. Method:The continuous subcutaneous infusion (OnQ Painbuster system) was applied in 37 patients. 3 patients were exempted due to prolonged ICU stay. 29 patients underwent CABG, 5 had AVR, 1 MVR and modified Maze, 1 patient had a 3-valve repair due to endocarditis and another one had reconstruction of the left ventricle. Requirements of opioid analgesics were recorded for 96 hours after operation. Pain was assessed using the visual analog scale and the total postoperative hospital length of stay was also measured. Results:The postoperative pain was significantly diminished (0 -3 at VAS). The mean postoperative length of stay was 5,8 days, rather improved compared to the average stay of 6,7 days. Conclusion:Continuous subcutaneous infusion of ropivacaine directly at the median sternotomy significantly diminishes postoperative pain and the need for opioid analgesic use. Moreover, it seems to reduce overall postoperative length of stay for all cardiac surgical patients.

Gastrointesinal stromal tumors (GISTs) are the most common mesenchymal neoplasms of the gastrointestinal tract and they show differentiation towards interstitial cells of Cajal (ICC). Herein, we describe a case of a 60-year-old man presenting with symptoms mimicking adenomatous hyperplasia of the prostate that was subjected to repeated transurethral prostatectomies. Histologic and immunohistochemical examination showed a neoplastic process with characteristics consistent with GIST. Imaging studies confirmed a rectal origin of the tumor. Review of the literature revealed 20 cases of GISTs occurring in the prostate gland, either diagnosed as either primary GISTs or, more commonly, as rectal neoplasms extending to this organ. We add our case in this short list, emphasizing on the importance of inclusion of GISTs in the differential diagnosis of every spindle cell lesion encountered in the prostate.

Background: Temporary epicardial pacing wires are routinely used during cardiac surgery; they are dependable in controlling postoperative arrhythmias and are associated with low morbitity.

Key Clinical MessageLead perforation is a life‐threatening rare complication of pacemaker or defibrillator lead implantation. Clinical examination, electrocardiogram, device interrogation, echocardiography, chest x‐ray, and chest computed tomography scan can help in the diagnosis. Clinicians should be aware because early diagnosis and treatment are the cornerstones for achieving a better outcome.