Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Oct 2009
Case ReportsRight atrium traumatic rupture presenting as chronic tamponade.
Non-penetrating cardiac traumatisms can cause cardiac rupture, myocardial contusion or, rarely, commotio cordis. In cases of rupture of a cardiac cavity, acute and severe cardiac tamponade almost invariably occurs. ⋯ A situation of exceptional hemodynamic balance was established with subacute, progressive cardiac tamponade that evolved during three months, presenting gradual right-heart failure instead of the expected acute and severe cardiac tamponade. The rupture of the atrium was successfully repaired.
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Interact Cardiovasc Thorac Surg · Oct 2009
Multicenter StudyAge- and gender-specific values of estimated glomerular filtration rate among 6232 patients undergoing cardiac surgery.
Impaired preoperative renal function as estimated by glomerular filtration rate (GFR) is an independent risk factor for mortality after cardiac surgery. Little is known about the actual prevalence of renal dysfunction among patients undergoing cardiac surgery in Germany. We performed a retrospective analysis of 6232 patients from 20 to 80 years. ⋯ The actual mortality rates varied between 6.3% (307/4869) for patients with an eGFR>60 ml/min/1.73 m(2), 11.3% (137/1051) for patients with an eGFR of 30-60 ml/min/1.73 m(2) and 16.6% (27/163) for patients with an eGFR<30 ml/min/1.73 m(2). Estimated GFR declines are age- and gender-dependent. Preoperative renal dysfunction is an important predictor of in-hospital mortality after cardiac surgery.
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Interact Cardiovasc Thorac Surg · Oct 2009
Comparative StudyIs the aortic valve pathology type different for early and late mortality in concomitant aortic valve replacement and coronary artery bypass surgery?
We assessed the effects of aortic valve pathology type on the long-term outcomes of patients who underwent concomitant aortic valve replacement (AVR) and coronary artery bypass grafting (CABG) surgery. We retrospectively reviewed 150 patients who underwent AVR-CABG at our institution between January 1997 and December 2006. We divided patients into aortic stenosis (AS), aortic regurgitation (AR), and mixed-type groups consisting of 98 (65.3%), 20 (13.3%) and 32 (21.3%) patients, respectively. ⋯ Significant early mortality risk factors included cross-clamp and cardiopulmonary bypass (CBP) time, number of blood transfusion units, chronic obstructive pulmonary disease (COPD), intra-aortic balloon pump (IABP), inotropic drugs, and pacemaker use. Significant late mortality risk factors included intensive care unit (ICU) stay, IABP, stroke, and dialysis. The aortic valve pathology type in patients undergoing concomitant AVR-CABG does not adversely affect survival.
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Interact Cardiovasc Thorac Surg · Oct 2009
Case ReportsThe acute chest syndrome of sickle cell disease following aortic valve replacement.
The acute chest syndrome (ACS) of sickle cell disease (SCD) is a leading cause of death in SCD, with a high incidence following surgery, though only one case has been reported following cardiac surgery. We present a case of ACS in an adult undergoing aortic valve replacement (AVR) despite instituting established peri-operative optimization measures to prevent sickling. Early diagnosis of this condition in our patient as a distinct clinical entity facilitated appropriate, specific therapy and a good subsequent postoperative recovery. Greater recognition of this syndrome in the growing number of adult sickle cell patients presenting for cardiac surgery may help improve their outcome.
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Interact Cardiovasc Thorac Surg · Oct 2009
Case ReportsNon-operative management of tube thoracostomy induced pulmonary artery injury.
Tube thoracostomy insertion is a common procedure in the management of air and fluid collections in the pleural space. Pulmonary artery injury is a rare but serious complication following intercostal catheterisation. This complication is usually managed surgically. We report a case of successful non-operative management of a pulmonary artery injury after tube thoracostomy.