• The management of thoracic inlet syndrome associated with Hurler's syndrome: a novel surgical technique.

      Ahsan, Rauf M; Early, Sarah A; O'Meara, Anne; Nolke, Lars; Department of Cardiothoracic Surgery, Our Lady's Children's Hospital, Crumlin,, Dublin 12, Ireland. (2012-02-01)
      A 21-year-old male developed significant swelling of his tongue after a respiratory arrest. The patient had a history of Hurler's syndrome. Magnetic resonance imaging (MRI) angiogram delineated that the swelling was due to compression of his internal jugular veins at the level of the first rib, resulting in thoracic inlet obstruction. The standard surgical treatment of thoracic inlet obstruction was not suitable in this patient's case due to his short thick neck and his characteristic Hurler's syndrome body habitus. Therefore, a novel surgical strategy was used to decompress his head and neck vessels. The manubrium was widened using an iliac crest bone graft, stabilised using internal fixation plates and reconstructed with a pectoral muscle flap.
    • Occlusive ascending aorta and arch atheroma treated with deep hypothermic circulatory arrest and thromboendarterectomy.

      O' Sullivan, Katie E; Early, Sarah A; Lawler, Leo; Hurley, John; Department of Cardiothoracic Surgery, Mater Misericordiae University Hospital, Dublin, Ireland. (2013-12)
      We describe an uncommon presentation of severely advanced aortic atherosclerosis in a 48-year old man with a history of hypertension and heavy smoking. Initial presentation with upper limb ischaemia led to the diagnosis of an aortic arch atheroma occluding 90% of the aortic lumen, managed with deep hypothermic circulatory arrest and aortic thromboendarterectomy. To our knowledge, this is the first reported case of atherosclerotic plaque resulting in aortic occlusion and requiring emergent operative intervention.