Intravenous heparin therapy is used in the management of angina and myocardial infarct with increasing frequency in recent years. Those patients who have been on heparin therapy for several days may exhibit resistance to heparin given before cardiopulmonary bypass. This article is available only as a PDF. Please click on...

Total thymectomy is the established surgical therapeutic method for generalised myasthenia gravis. Several approaches are used for the surgical removal of the thymus and these include the transcervical approach, partial sternotomy, median sternotomy and a combination of the transsternal and transcervical approaches. This article is available only as a PDF....

In the past, cardiac patients in this institution were ventilated postoperatively for a prolonged period, frequently overnight. Since 1997 some of our cardiac anaesthetists have, whenever possible, adopted the practice of early extubation after cardiac surgery to improve the patient’s level of comfort and to allow an early return...

Children with complex congenital heart disease and a functional single ventricle may not be ideal candidates for a Fontan procedure. A staged approach to Fontan’s operation has been undertaken in an effort to reduce the volume load of a single ventricle as early as possible and to minimise the...

Despite the recent developments of minimally invasive surgery, most cardiac surgery procedures still include ischaemic cardioplegic arrest and cardiopulmonary bypass. For decades the efforts of many researchers aimed at improvement of cardioplegic solutions to minimise ischaemic injury of the myocardium. This article is available only as a PDF. Please click...

Tumours of the chest wall are uncommon and are usually sarcomatous in nature. Primitive neuroectodermal tumours (PNETs) are rare and are thought to arise from neuroepithelial cells, possibly derived from the peripheral intercostal nerves. They could also arise from the neural crest cells, which have migrated alongside the peripheral...

Atrial septal defect (ASD) forms the commonest grown up congenital heart diseases seen in cardiac surgical practice. Repair of this has become so safe that the emphasis now is on cosmetic outcome. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

The association between congenital complete heart block (CHB) and maternal autoimmune disorders has been described for many years. Maternal systemic lupus erythematosus (SLE) is the commonest of these disorders, and a leading cause of heart block in newborns. This article is available only as a PDF. Please click on “Download...

Congestive heart failure (CHF) is a leading cause of cardiovascular morbidity and mortality. This syndrome tends to run a chronic course with a wide spectrum of compensatory physiological and neurohormonal mechanisms that may be maladaptive in the terminal phase of the illness. This article is available only as a PDF....

The management of aortoiliac occlusive disease has been evolving in the past few decades. Surgical options include aortofemoral bypass, endarterectomy, extraanatomical bypass and endovascular intervention. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Paroxysmal supraventricular tachycardia (SVT) is well-recognised as one of the commonest rhythm disorders in children. There may be few symptoms, but many experience palpitations, or some other less specific complaints such as nausea, pallor and sweatiness. This article is available only as a PDF. Please click on “Download PDF” on...

Despite intensive therapeutic efforts, both the incidence and mortality of gastrointestinal complications after cardiac surgery employing cardiopulmonary bypass (CPB) have not decreased during the last two decades. Gastric bleeding, ischaemic bowel disease, gallbladder disease, and pancreatitis are reportedly the most common complications. This article is available only as a PDF....

Minimally invasive techniques are increasingly being used in cardiac surgery. In particular, coronary artery bypass grafting (CABG) and mitral valve surgery are now often done using a limited approach to the heart. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Cardiac and pericardial lipomas are very rare tumours. They remain asymptomatic for a long time and produce symptoms, if at all, by the virtue of their size. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Diaphragmatic rupture is a recognised consequence of high-velocity blunt trauma to the abdomen and chest and also has been reported in 0% to 5% of thoracoabdominal trauma patients. The diagnosis is often difficult and delay in diagnosis is implicated in increased morbidity and mortality. This article is available only as...

Fourteen years ago, an editorial in the Annals announced the coming of age of cardiology in Singapore. Among the issues raised in that editorial were the impact of changing demographics and disease patterns, the importance of optimising resources, and the need for structured training and sub-specialisation. This article is available...

The use of deep hypothermic circulatory arrest (DHCA) as a method of cerebral protection during aortic surgery was first described in 1975. Its use is based on 2 fundamental concepts. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Compared to in-hospital patients, patients treated in an intensive care unit (ICU) have the highest risk of contracting an infection. The risk correlates well with underlying and accompanying diseases and invasive monitoring. This article is available only as a PDF. Please click on “Download PDF” on top to view the...

Pulmonary artery catheter is widely used in cardiovascular surgical practice. Various complications of the Swan-Ganz catheter during insertion, its long-term placement, or removal are well known since its introduction. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Nasal breathing is critical in infants and children; for example, neonatal choanal atresia often leads to respiratory distress and may require urgent intervention in the newborn nursery. Later, during development in the first years of life, abnormal nasal breathing has important consequences for facial growth. This article is available only...

Pulmonary hernia is a rare and uncommon clinical entity that has been defined as a protrusion of pleural membranes or lung parenchyma through the defect in the thoracic enclosure. According to aetiology, pulmonary hernias can be congenital (due to rib or intercostal hypoplasia or agenesis) or acquired (traumatic, pathological...

Radiofrequency ablation (RFA) intended to produce complete thermal necrosis of unresectable primary or secondary hepatic malignancies have gained widespread availability and acceptance over the past 5 years. This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Percutaneous coronary intervention (PCI) is the preferred therapy strategy for revascularisation in the case of an acute coronary syndrome (ACS) or acute myocardial infarction (AMI). This article is available only as a PDF. Please click on “Download PDF” on top to view the full article.

Dear Editor, Reoperation for mitral valve re-replacement in patients with patent coronary bypass grafts can be a formidable task in the elderly. We report a patient that was successfully treated using a novel minimally invasive approach via the apex of the left ventricle. This article is available only as a PDF....

Although coronary angiography has been used as the “gold standard” imaging technique for the diagnosis of coronary artery disease, it is essentially a lumenogram that offers no information on the functional significance of a coronary lesion. It is difficult to define the haemodynamic significance of a stenosis from the...

  Atrial fibrillation (AF) is the most common and severe cardiac arrhythmia. It affects 0.4% to 1% of the general population, and the prevalence of AF,1 which increases with age, is 8% in people aged over 80. About three-quarters of the cases are non-valvular AF. The risk for stroke in...

Paravalvular leaks (PVLs) are not uncommon after surgical valve replacement. The need for re-operation for clinically significant leaks is between 1 and 3%. Percutaneous PVL closure has become increasingly performed and is an alternative to surgery.1 PVLs occur more frequently after transcatheter aortic valve implantation (TAVI), as the transcatheter...