Interactive cardiovascular and thoracic surgery
-
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.
-
Interact Cardiovasc Thorac Surg · Nov 2010
Risk factors and mortality associated with deep sternal wound infections following coronary bypass surgery with or without concomitant procedures in a UK population: a basis for a new risk model?
Deep sternal wound infection (DSWI) is a rare but serious complication following coronary artery bypass surgery. Our study investigates the risk factors and mortality associated with DSWI with other risk models for DSWI. Data was collected prospectively on 7602 patients undergoing coronary artery bypass grafting±concomitant surgery between April 1999 and September 2009 including DSWI. ⋯ Logistic regression identified age [odds ratio (OR)=1.055], body mass index (OR=1.076), diabetes (OR=2.00) and chronic lung disease (OR=2.47) as the significant independent determinants of DSWI from the variables considered. Mortality rates and mean STS scores are higher in patients requiring re-opening for DSWI. Not all the STS risk factors were predictors of DSWI in our population.
-
Interact Cardiovasc Thorac Surg · Nov 2010
Case ReportsExtensive cardiac lipoma with aneurysmal right ventricle.
A 56-year-old female with history of mitral valve replacement and automated implantable cardioverter-defibrillator placement presented with dyspnea on exertion for two years and recurrent ascites. Imaging studies, including transthoracic and transesophageal echocardiograms as well as 64-slice computed tomography (CT) angiogram revealed a large mass encasing the entire heart consistent with lipoma. In addition, a right ventricular free wall aneurysm was found. ⋯ The anterior portion of the cardiac lipoma was also resected. Gross specimen revealed an 11.5×6.5×5 cm mass of adipose tissue without malignancy. In this case, the patient presented with symptoms of congestive heart failure due to the aneurysm in the right ventricle.
-
Interact Cardiovasc Thorac Surg · Nov 2010
Case ReportsAcute myocardial infarction caused by coronary embolization of a papillary fibroelastoma of the thoracic ascending aorta.
Papillary fibroelastomas (PFE) are benign endocardial masses and generally originate from the cardiac valves, while PFE arising from the ascending thoracic aorta are an uncommon clinical finding. We report the case of a 78-year-old female who presented to the emergency department with an acute ST segment elevation myocardial infarction. ⋯ Histopathological examination revealed a PFE with thrombotic material. Nowadays, surgical excision of PFE remains, the treatment of choice for symptomatic patients with excellent short- and long-term results but recurrence of PFE following surgical excision has not been reported.