Technical Tips for Congenital Heart Operations

      The congenital section of this issue includes a range of technical tips for challenging congenital heart operations. Marshall Jacobs and Jeffrey Jacobs provide a detailed review of the available techniques for repair of muscular ventricular septal defects. These techniques range from direct surgical approaches through the atria or ventricles, to percutaneous or perventricular hybrid approaches. The range of available options is a testament to the difficulty of achieving complete closure of complex defects in the muscular septum. Constantine Mavroudis and Carl Backer provide technical tips for the Ross-Konno procedure, ventricular septal defect closure utilizing tricuspid valve detachment, and coronary unroofing. The location of the annular incision described for the Ross-Konno procedure is a novel contribution. These 2 articles provide excellent tips for a range of challenging operations from experienced surgeons.

      Management of the Complicated Pleural Space

      Management of the complications affecting the pleural space can be a significant issue for thoracic surgeons and their patients. In this issue of Operative Techniques in Thoracic and Cardiovascular Surgery we have three important contributions that examine the options available to help manage the complicated pleural space. Dr. John Mitchell and colleagues from the University of Colorado describe their approach to harvest of thoracic wall muscles for use in the pleural space. Dr. Seth Force from Emory University highlights important technical points in harvesting the omentum to help manage complications associated with postresectional empyemas with or without a bronchial fistula. Finally, Dr. Chad Denlinger from the Medical University of South Carolina provides a superb description of the classic Eloesser flap for drainage of the infected pleural space. Collectively, these three articles offer the reader important technical points on the harvest of thoracic muscle flaps and omentum, as well as performing definitive drainage procedures for the pleural space.

      Thoracoabdominal Aortic Aneurysm Repair: The Gold Standard and the Endovascular Approach. Are We Entering a New Era?

      In this issue of Operative Techniques, we have two manuscripts which describe the conventional open approach and a novel endovascular approach to the repair of thoracoabdominal aortic aneurysms. Drs. Huh, LeMaire, Weldon and Coselli present an excellent treatise on the open repair of the thoracoabdominal aortic aneurysm. This treatise is very well illustrated and provides a clear roadmap to the open repair of the thoracoabdominal aorta. It has stood the test of time in the hands of this experienced group.
      With the advent of endovascular approaches to the thoracic aorta, Soltesz and Greenberg describe their approach to thoracoabdominal aortic aneurysms utilizing endovascular techniques and replacing the aorta with fenestrated and branched stent grafts. These authors include their results in their initial series of patients with these techniques.
      Both manuscripts describe the respective techniques in elegant fashion and are beautifully illustrated. These operations are truly tours de force. While the open techniques have been the gold standard, the less invasive nature of the endovascular approach for these extensive aneurysms will demand continued investigations of these methods.