Month: August 2026

ANZ J Surg. 2026 Jul 6. doi: 10.1111/ans.70833. Online ahead of print.

ABSTRACT

BACKGROUND: Bovine pericardium (BP) is increasingly utilised in complex surgical reconstruction because of its favourable biological and mechanical properties. Although widely used in cardiovascular surgery, its role in general surgery remains less well characterised.

METHODS: A narrative review was conducted to synthesise available evidence regarding the biological properties, preparation methods, tissue integration and clinical applications of BP in general surgery.

RESULTS: BP demonstrates favourable tensile strength, low antigenicity, and reliable biocompatibility. Available evidence, largely from observational studies and small case series, supports its use across a variety of general and subspecialty surgical settings including vena cava and portal vein reconstruction, diaphragmatic hernia repair, abdominal wall reconstruction, and arteriovenous fistula formation. Compared with synthetic grafts, BP may offer advantages in contaminated or infected fields, although comparative data is limited. Tissue integration varies according to preparation technique, with decellularised grafts demonstrating improved cellular infiltration and reduced calcification. Novel applications, including reconstructing the empty pelvis after exenteration, are emerging.

CONCLUSION: BP is a durable and individually adaptable biomaterial with expanding applications in general surgery. Its favourable handling characteristics and biological integration make it a valuable adjunct in complex reconstructions, although further studies are required to better define its long-term outcomes and comparative effectiveness.

PMID:42409595 | DOI:10.1111/ans.70833

ANZ J Surg. 2026 Jul 6. doi: 10.1111/ans.70833. Online ahead of print.

ABSTRACT

BACKGROUND: Bovine pericardium (BP) is increasingly utilised in complex surgical reconstruction because of its favourable biological and mechanical properties. Although widely used in cardiovascular surgery, its role in general surgery remains less well characterised.

METHODS: A narrative review was conducted to synthesise available evidence regarding the biological properties, preparation methods, tissue integration and clinical applications of BP in general surgery.

RESULTS: BP demonstrates favourable tensile strength, low antigenicity, and reliable biocompatibility. Available evidence, largely from observational studies and small case series, supports its use across a variety of general and subspecialty surgical settings including vena cava and portal vein reconstruction, diaphragmatic hernia repair, abdominal wall reconstruction, and arteriovenous fistula formation. Compared with synthetic grafts, BP may offer advantages in contaminated or infected fields, although comparative data is limited. Tissue integration varies according to preparation technique, with decellularised grafts demonstrating improved cellular infiltration and reduced calcification. Novel applications, including reconstructing the empty pelvis after exenteration, are emerging.

CONCLUSION: BP is a durable and individually adaptable biomaterial with expanding applications in general surgery. Its favourable handling characteristics and biological integration make it a valuable adjunct in complex reconstructions, although further studies are required to better define its long-term outcomes and comparative effectiveness.

PMID:42409595 | DOI:10.1111/ans.70833

J Cardiothorac Surg. 2026 Jul 19. doi: 10.1186/s13019-026-04610-y. Online ahead of print.

ABSTRACT

Aberrant right subclavian artery (ARSA) is the most common anomaly of the aortic arch and is usually asymptomatic. In a minority of patients, ARSA may cause dysphagia due to esophageal compression (dysphagia lusoria). The coexistence of symptomatic ARSA and severe aortic stenosis requiring surgical treatment is extremely rare, and the optimal management strategy remains unclear. A 43-year-old woman presenting with acute decompensated heart failure was diagnosed with severe aortic stenosis and concomitant dysphagia lusoria. Following medical stabilization in the intensive care unit, she underwent a single-stage total correction. To minimize surgical trauma and avoid multiple incisions, a conventional median sternotomy was slightly extended into the right supraclavicular region, serving as a single unified incision. Through this approach, transposition of the ARSA to the right common carotid artery was performed first, followed by mechanical aortic valve replacement with bovine pericardial patch repair of a focal annular defect secondary to decalcification and primary closure of a patent foramen ovale. Postoperatively, valve hemodynamics improved markedly, and dysphagia resolved completely, leading to a significant recovery of the patient’s nutritional status. This case demonstrates that a single-stage, single-incision approach is a highly effective and viable strategy, providing valuable clinical insight into the management of these combined rare pathologies.

PMID:42472844 | DOI:10.1186/s13019-026-04610-y

Plast Aesthet Nurs (Phila). 2026 Jul-Sep 01;46(3):147-152. doi: 10.1097/PSN.0000000000000673.

ABSTRACT

The increasing number of younger patients requiring cardiac implantable electronic devices (CIEDs) necessitates not only survival but also a preserved quality of life. Aesthetic considerations for CIED placement-particularly in the context of the female breast-are increasingly important, yet current guidelines lack standardized recommendations for ideal generator pocket positioning, especially in the presence of breast implants. We report the first use of bovine pericardium mesh to reposition a migrated, protruding subcutaneous CIED in a patient with prior breast implant reconstruction, who presented with breast contour distortion. Generator pocket repositioning was performed using an acellular biological matrix (ABM) to anchor the device securely against the prepectoral fascia, effectively preventing future dislodgement. The patient achieved excellent breast symmetry and a smooth transition between the anterior chest wall and the superolateral mammary pole. Postoperative ultrasonography confirmed successful compartmentalization of the periprosthetic space, matrix, and device. Durable device positioning was maintained at 12-month follow-up. This case demonstrates that reinforcement and repositioning of subcutaneous CIEDs using ABM in patients with breast implants offers multiple advantages including minimized tissue disruption; stable positioning along the chest wall; isolation of the periprosthetic space; and aesthetic outcomes comparable to those achieved with deeper device placement.

PMID:42390052 | DOI:10.1097/PSN.0000000000000673

Plast Aesthet Nurs (Phila). 2026 Jul-Sep 01;46(3):147-152. doi: 10.1097/PSN.0000000000000673.

ABSTRACT

The increasing number of younger patients requiring cardiac implantable electronic devices (CIEDs) necessitates not only survival but also a preserved quality of life. Aesthetic considerations for CIED placement-particularly in the context of the female breast-are increasingly important, yet current guidelines lack standardized recommendations for ideal generator pocket positioning, especially in the presence of breast implants. We report the first use of bovine pericardium mesh to reposition a migrated, protruding subcutaneous CIED in a patient with prior breast implant reconstruction, who presented with breast contour distortion. Generator pocket repositioning was performed using an acellular biological matrix (ABM) to anchor the device securely against the prepectoral fascia, effectively preventing future dislodgement. The patient achieved excellent breast symmetry and a smooth transition between the anterior chest wall and the superolateral mammary pole. Postoperative ultrasonography confirmed successful compartmentalization of the periprosthetic space, matrix, and device. Durable device positioning was maintained at 12-month follow-up. This case demonstrates that reinforcement and repositioning of subcutaneous CIEDs using ABM in patients with breast implants offers multiple advantages including minimized tissue disruption; stable positioning along the chest wall; isolation of the periprosthetic space; and aesthetic outcomes comparable to those achieved with deeper device placement.

PMID:42390052 | DOI:10.1097/PSN.0000000000000673

Plast Aesthet Nurs (Phila). 2026 Jul-Sep 01;46(3):147-152. doi: 10.1097/PSN.0000000000000673.

ABSTRACT

The increasing number of younger patients requiring cardiac implantable electronic devices (CIEDs) necessitates not only survival but also a preserved quality of life. Aesthetic considerations for CIED placement-particularly in the context of the female breast-are increasingly important, yet current guidelines lack standardized recommendations for ideal generator pocket positioning, especially in the presence of breast implants. We report the first use of bovine pericardium mesh to reposition a migrated, protruding subcutaneous CIED in a patient with prior breast implant reconstruction, who presented with breast contour distortion. Generator pocket repositioning was performed using an acellular biological matrix (ABM) to anchor the device securely against the prepectoral fascia, effectively preventing future dislodgement. The patient achieved excellent breast symmetry and a smooth transition between the anterior chest wall and the superolateral mammary pole. Postoperative ultrasonography confirmed successful compartmentalization of the periprosthetic space, matrix, and device. Durable device positioning was maintained at 12-month follow-up. This case demonstrates that reinforcement and repositioning of subcutaneous CIEDs using ABM in patients with breast implants offers multiple advantages including minimized tissue disruption; stable positioning along the chest wall; isolation of the periprosthetic space; and aesthetic outcomes comparable to those achieved with deeper device placement.

PMID:42390052 | DOI:10.1097/PSN.0000000000000673

BMC Surg. 2026 Jun 30. doi: 10.1186/s12893-026-03680-y. Online ahead of print.

ABSTRACT

BACKGROUND: Double aortic arch (DAA) is a rare congenital aortic arch anomaly that is usually identified in infancy because of symptoms related to a vascular ring. Acute type A intramural hematoma (IMH) with a focal intimal tear in an adult with DAA is extremely rare, and no consensus has been established regarding emergency management.

CASE PRESENTATION: Seventy-three year-old woman presented with burning pain in the throat and suprasternal notch and was initially suspected of having acute coronary syndrome. Computed tomography angiography (CTA) of the whole aorta and supra-aortic vessels demonstrated a double aortic arch, with the right common carotid artery and right subclavian artery originating from the right arch and the left common carotid artery and left subclavian artery originating from the left arch. After preoperative evaluation, emergency surgery was performed through a median sternotomy. Intraoperatively, a focal intimal tear approximately 2 cm in length was identified in the ascending aorta. Given the complex branching anatomy of the double aortic arch, right femoral artery cannulation was used to establish cardiopulmonary bypass in order to minimize invasive manipulation of the arch. Resection of the diseased ascending aorta and graft replacement were performed, and the potential false lumen at the aortic root was obliterated using the adventitial inversion technique. The prosthetic graft was wrapped with bovine pericardium, and the double aortic arch was not addressed during the same operation. The patient experienced recurrent perioperative hypoxemia and was extubated 17 h after surgery following respiratory support, lung-protective management, and anti-inflammatory treatment. She was discharged on postoperative day 12. Approximately 1 month later, she was readmitted with chest pain, and CTA revealed a newly developed dissection in the proximal right aortic arch. The family declined reoperation, and the patient was subsequently lost to follow-up.

CONCLUSIONS: In patients with DAA complicated by acute type A IMH with a focal intimal tear, limited ascending aortic replacement in the emergency setting may reduce surgical trauma; however, it may leave a high-risk residual arch segment and increase the risk of clamp-related injury or insufficient resection margins. Perioperative airway compression caused by the vascular ring should be assessed using imaging, and one-stage or staged reconstruction should be planned according to the patient’s condition. Strict postoperative blood pressure control and close follow-up are essential to reduce the risk of recurrence.

PMID:42380909 | DOI:10.1186/s12893-026-03680-y

BMC Surg. 2026 Jun 30. doi: 10.1186/s12893-026-03680-y. Online ahead of print.

ABSTRACT

BACKGROUND: Double aortic arch (DAA) is a rare congenital aortic arch anomaly that is usually identified in infancy because of symptoms related to a vascular ring. Acute type A intramural hematoma (IMH) with a focal intimal tear in an adult with DAA is extremely rare, and no consensus has been established regarding emergency management.

CASE PRESENTATION: Seventy-three year-old woman presented with burning pain in the throat and suprasternal notch and was initially suspected of having acute coronary syndrome. Computed tomography angiography (CTA) of the whole aorta and supra-aortic vessels demonstrated a double aortic arch, with the right common carotid artery and right subclavian artery originating from the right arch and the left common carotid artery and left subclavian artery originating from the left arch. After preoperative evaluation, emergency surgery was performed through a median sternotomy. Intraoperatively, a focal intimal tear approximately 2 cm in length was identified in the ascending aorta. Given the complex branching anatomy of the double aortic arch, right femoral artery cannulation was used to establish cardiopulmonary bypass in order to minimize invasive manipulation of the arch. Resection of the diseased ascending aorta and graft replacement were performed, and the potential false lumen at the aortic root was obliterated using the adventitial inversion technique. The prosthetic graft was wrapped with bovine pericardium, and the double aortic arch was not addressed during the same operation. The patient experienced recurrent perioperative hypoxemia and was extubated 17 h after surgery following respiratory support, lung-protective management, and anti-inflammatory treatment. She was discharged on postoperative day 12. Approximately 1 month later, she was readmitted with chest pain, and CTA revealed a newly developed dissection in the proximal right aortic arch. The family declined reoperation, and the patient was subsequently lost to follow-up.

CONCLUSIONS: In patients with DAA complicated by acute type A IMH with a focal intimal tear, limited ascending aortic replacement in the emergency setting may reduce surgical trauma; however, it may leave a high-risk residual arch segment and increase the risk of clamp-related injury or insufficient resection margins. Perioperative airway compression caused by the vascular ring should be assessed using imaging, and one-stage or staged reconstruction should be planned according to the patient’s condition. Strict postoperative blood pressure control and close follow-up are essential to reduce the risk of recurrence.

PMID:42380909 | DOI:10.1186/s12893-026-03680-y

Open Vet J. 2025 Dec;15(12):6805-6808. doi: 10.5455/OVJ.2025.v15.i12.59. Epub 2025 Dec 31.

ABSTRACT

BACKGROUND: Ectopia cordis (EC) is a rare congenital condition in which the heart is partially or completely displaced outside the thoracic cavity. This abnormality is most commonly recognized in humans but has also been observed in dogs, cats, cattle, pigs, and goats. However, it has not been documented in camelids.

CASE DESCRIPTION: This case report describes the case of a neonatal camel calf born in rural Wad Ashana, North Kordofan, Sudan, who presented with EC. The heart was located in its pericardium outside the thoracic cavity, at the most ventral aspect of the cervical region. The heart exhibited a normal morphology and a normal heartbeat. Despite the absence of any additional malformations, the calf died 2 days after delivery.

CONCLUSION: This case is the first documented instance of EC in camels from Sudan and offers important information for veterinary literature on congenital anomalies.

PMID:42376508 | PMC:PMC13313918 | DOI:10.5455/OVJ.2025.v15.i12.59

Cureus. 2026 May 19;18(5):e109183. doi: 10.7759/cureus.109183. eCollection 2026 May.

ABSTRACT

Atrial septal defects (ASDs) are among the most common forms of congenital heart disease diagnosed in adulthood. Ostium secundum defects represent the majority of cases and may remain clinically silent for decades. Delayed diagnosis can lead to progressive right-sided cardiac chamber dilation, pulmonary hypertension, arrhythmias, and heart failure. The choice between percutaneous and surgical closure depends on anatomical characteristics such as defect size and the adequacy of surrounding septal rims. We report the case of a 49-year-old woman with hypertension, type 2 diabetes mellitus, and hyperlipidemia who presented with one week of substernal chest pain, palpitations, and progressive dyspnea on exertion consistent with New York Heart Association (NYHA) functional class III limitation. Physical examination revealed a holosystolic murmur best heard along the tricuspid area with inspiratory accentuation. Transthoracic echocardiography identified a large secundum ASD measuring 35 mm × 22 mm with elevated pulmonary artery systolic pressure and right-sided chamber dilation. Transesophageal echocardiography confirmed a large defect with minimal aortic rim and limited atrioventricular valve rim, precluding percutaneous closure. Cardiac catheterization demonstrated bidirectional shunting with a Qp/Qs ratio of 2.65 and normal pulmonary vascular resistance. The patient subsequently underwent successful surgical ASD closure using a bovine pericardial patch. Her postoperative course was uncomplicated, with complete resolution of symptoms and normalization of pulmonary artery pressures on follow-up echocardiography six months later. This case highlights the potential for large ASDs to remain undiagnosed until adulthood, when progressive right-sided cardiac remodeling leads to symptomatic disease. Early detection through timely echocardiographic evaluation is critical to facilitate timely intervention and may expand eligibility for less invasive percutaneous repair. Prompt recognition and closure of hemodynamically significant ASDs can prevent irreversible cardiopulmonary complications and significantly improve long-term outcomes.

PMID:42326254 | PMC:PMC13277483 | DOI:10.7759/cureus.109183