Category: General

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

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

Indian J Thorac Cardiovasc Surg. 2026 Jul;42(7):892-896. doi: 10.1007/s12055-026-02183-y. Epub 2026 Feb 19.

ABSTRACT

Cardiac transplantation in situs inversus with dextrocardia is rare and surgically complex, owing to the reconstruction of systemic and pulmonary venous pathways. We present a 21-year-old male diagnosed with complex cyanotic congenital heart disease with situs inversus, dextrocardia, mixed total anomalous pulmonary venous connection (TAPVC), and good ventricular function with single ventricle physiology. He underwent left superior vena cava (LSVC) to left pulmonary artery (LPA) bidirectional (BD) Glenn shunt, with mixed TAPVC repair at 3 years of age. At the age of 21 years, he developed severe restrictive myocardial dysfunction and was not suitable for Fontan completion surgery. Hence, he was considered for orthotopic cardiac transplantation. The donor pericardium and donor heart were harvested with the full length of the superior vena cava (SVC) and the innominate vein. The ascending aorta and the aortic arch were harvested to the maximum possible length. After recipient cardiectomy and taking down the Glenn shunt, the recipient’s right atrium (RA) was constructed into a composite tunnel by suturing the retained right atrial cuff posteriorly with bovine pericardium anteriorly. The donor inferior vena cava (IVC) was anastomosed to this tunnel. The donor right SVC was anastomosed to the recipient LSVC using the donor aortic homograft as an interposition graft. The native pulmonary artery (PA) confluence was anastomosed to the donor PA using donor pericardium to augment the anterior and lateral parts of the conduit, followed by aortic anastomosis. Post-procedure, the patient performed well with acceptable hemodynamics, and the heart occupied a mesocardial position.

PMID:42367276 | PMC:PMC13304018 | DOI:10.1007/s12055-026-02183-y

Indian J Thorac Cardiovasc Surg. 2026 Jul;42(7):892-896. doi: 10.1007/s12055-026-02183-y. Epub 2026 Feb 19.

ABSTRACT

Cardiac transplantation in situs inversus with dextrocardia is rare and surgically complex, owing to the reconstruction of systemic and pulmonary venous pathways. We present a 21-year-old male diagnosed with complex cyanotic congenital heart disease with situs inversus, dextrocardia, mixed total anomalous pulmonary venous connection (TAPVC), and good ventricular function with single ventricle physiology. He underwent left superior vena cava (LSVC) to left pulmonary artery (LPA) bidirectional (BD) Glenn shunt, with mixed TAPVC repair at 3 years of age. At the age of 21 years, he developed severe restrictive myocardial dysfunction and was not suitable for Fontan completion surgery. Hence, he was considered for orthotopic cardiac transplantation. The donor pericardium and donor heart were harvested with the full length of the superior vena cava (SVC) and the innominate vein. The ascending aorta and the aortic arch were harvested to the maximum possible length. After recipient cardiectomy and taking down the Glenn shunt, the recipient’s right atrium (RA) was constructed into a composite tunnel by suturing the retained right atrial cuff posteriorly with bovine pericardium anteriorly. The donor inferior vena cava (IVC) was anastomosed to this tunnel. The donor right SVC was anastomosed to the recipient LSVC using the donor aortic homograft as an interposition graft. The native pulmonary artery (PA) confluence was anastomosed to the donor PA using donor pericardium to augment the anterior and lateral parts of the conduit, followed by aortic anastomosis. Post-procedure, the patient performed well with acceptable hemodynamics, and the heart occupied a mesocardial position.

PMID:42367276 | PMC:PMC13304018 | DOI:10.1007/s12055-026-02183-y