Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Nov 2010
Case ReportsIsolated ventricular septal rupture secondary to blunt trauma.
A ventricular septal rupture (VSR) is a rare complication of blunt chest trauma. We describe the case of a 25-year-old man who developed a VSR as a result of a high-speed road accident. ⋯ Redo surgery was necessary at nine months due to patch detachment and embolization of the glue in the right lower lobe. The patient is asymptomatic, at 13-month follow-up.
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Interact Cardiovasc Thorac Surg · Nov 2010
Flap valved closure of ventricular septal defects with increased pulmonary vascular resistance.
Closure of ventricular septal defect (VSD) in children with elevated pulmonary vascular resistance (PVR) is associated with significant morbidity and mortality with pulmonary hypertensive (PH) episodes being a major postoperative problem. Flap valved closure of VSD is reported to decrease morbidity and mortality. We report our experience of closure of a VSDs in patients with severe PH, using a valved patch in an effort to reduce the risk of operation. ⋯ Obvious opening and closing of the flap valve was detected by echocardiography in eight patients. There were no late deaths due to cardiac causes. Closure of a large VSD in patients with severe pulmonary hypertension could be performed with low morbidity and mortality when a flap valve patch was used.
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Interact Cardiovasc Thorac Surg · Nov 2010
ReviewIs close radiographic and clinical control after repair of acute type A aortic dissection really necessary for improved long-term survival?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether radiographic and clinical control after surgery for acute type A aortic dissection (AAD) is needed for improved long-term survival. Altogether, 118 relevant papers were identified using the reported search, of which seven represented the best evidence to answer the question. ⋯ A suggested timeframe for computed tomographic (CT) imaging after surgery for AAD is before discharge, at six and 12 months postdissection and, if stable, annually thereafter. Patients with large aneurysms (aortic diameter≥50 mm) should be maintained at radiographic intervals of six months or less. If the thoracic aneurysm is moderate in size and remains stable over time, magnetic resonance imaging instead of CT-scanning is reasonable to minimize the patient's radiation exposure.
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Interact Cardiovasc Thorac Surg · Nov 2010
The stented elephant trunk procedure combined total arch replacement for Debakey I aortic dissection: operative result and follow-up.
The stented elephant trunk technique in aortic arch replacement combined with transaortic stented graft implantation into the descending aorta has been introduced as a means of eliminating the residual false lumen in the descending thoracic aorta and improving long-term outcomes of surgical intervention for Debakey I aortic dissection. This report summarizes the operative and follow-up data with this new procedure. Between August 2004 and May 2009, 28 stented elephant trunk operations were performed for Debakey I aortic dissection at Nanjing First Hospital. ⋯ Thrombus obliteration of the residual false lumen in the descending aorta was observed in 91.7% of the aortic dissections three months postoperatively. The survival rate was 87.5% at five years and the freedom from reoperation rate was 91.7%. Total aortic arch replacement combined with transaortic stented graft implantation into the descending aorta is an effective treatment for Debakey type I aortic dissection.