Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Dec 2008
Case ReportsBuilt-in defect of a biological pericardial aortic prosthesis?
We report a case on an early complication of a biological pericardial tissue valve in the aortic position that required emergency replacement. One of the three leaflets of the valve was stuck open in a fixed-open position and would not unfold in diastole. This resulted in severe aortic insufficiency, diagnosed by standard postoperatory echocardiography and confirmed in the operating room.
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Interact Cardiovasc Thorac Surg · Dec 2008
Comparative StudyIs blood versus crystalloid cardioplegia relevant? Significantly improved protection may require new cardioplegic concepts!
The predominant method of myocardial protection during cardiac surgery is hyperkalaemic cardioplegia, inducing depolarised arrest. Since its development in the 1970s, the only real change has been to alter the vehicle to blood. Although blood cardioplegia was shown to be 'superior' to crystalloid cardioplegia, this advantage is marginal and might explain the continuous use of crystalloid cardioplegia by some surgeons. To achieve significant improvements in cardioplegic protection, more radical and conceptual changes in the solution, such as those potentially achieved by 'polarised' arrest, should be explored.
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Interact Cardiovasc Thorac Surg · Dec 2008
Case ReportsConsequences of incomplete repair of acute type A aortic dissection.
During emergency repair of acute Stanford type A aortic dissections, surgical compromises in the form of incomplete arch replacement are made due to the unstable condition of the patient and safety issues of the performing team. We report a case of delayed reoperation after previous incomplete surgery for acute type A aortic dissection in a young patient with Marfan's syndrome. ⋯ After a good progress during the first days after surgery, the patient died due to a ruptured thoraco-abdominal aneurysm on the fifth postoperative day. Extensive surgical reconstruction including aortic arch replacement should be considered in patients with Marfan's syndrome who present with aortic dissections type A to avoid unnecessary reoperations and their complications.
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Interact Cardiovasc Thorac Surg · Dec 2008
Case ReportsPost-esophagectomy chylous leakage from a duplicated left-sided thoracic duct ligated successfully with left-sided video-assisted thoracoscopic surgery.
Three months after esophagectomy for esophageal cancer, a 58-year-old man presented with fluid trapped in his upper mediastinum due to chylous leakage from a duplicated left-sided thoracic duct that remained after excision of the main thoracic duct. Classical lymphangiography using lipiodol confirmed the presence of duplicated thoracic ducts. ⋯ Anatomic variations of the thoracic duct can result in chylous leakage after thoracic surgery. Even if the patient has anomaly of the thoracic duct, classical lymphangiography is useful for detecting locations of the thoracic duct precisely, allowing for certain ligation of the duct with video-assisted thoracoscopic surgery.
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Interact Cardiovasc Thorac Surg · Dec 2008
Case ReportsLeft ventricular pseudoaneurysm after pericardiocentesis.
We present the case of a patient with recurrent episodes of pericardial effusion and fever. During approximately one month, the patient was treated with double pericardiocentesis for cardiac tamponade and the last of them was interrupted for the suspect of left ventricular puncture due to aspiration of arterial blood from the needle used for pericardiocentesis. Considering the suspect of infective pleuro-pericarditis and patient's symptoms, a surgical drainage of the pericardial effusion was performed via right thoracotomy. ⋯ Exclusion of the LV pseudoaneurysm was performed using a Prolene 0 running suture on two strips of bovine pericardium, avoiding ECC use. The patient was discharged on the 7th postoperative day. Iatrogenic pseudoaneurysm caused by pericardiocentesis represents a very rare complication and it should be prevented by identifying the high-risk patients.