Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Sep 2010
ReviewThe role of pulmonary embolectomy in the treatment of acute pulmonary embolism: a literature review from 1968 to 2008.
Acute massive or submassive pulmonary embolism (PE) requires prompt diagnosis, risk-stratification and aggressive treatment. Mortality rates can rise up to 70% within the first hour of presentation and are strongly correlated with the degree of right ventricular (RV) dysfunction, cardiac arrest, and consequential congestive heart failure. While anticoagulation is universally employed, there are inadequate data to establish definitive guidelines for the management of massive PE despite the availability of multiple treatment modalities. ⋯ Although traditionally reserved as rescue therapy for cases of failed thrombolysis, surgical embolectomy is a safe procedure with low mortality when performed early and in a selected group of patients. Sufficient evidence exists to extend the criteria for surgical embolectomy from strictly rescue therapy to include hemodynamically stable patients with RV dysfunction. Multidisciplinary approach to this condition coupled with a meticulous surgical technique has significantly lowered the mortality associated with this surgical procedure over the last 10 years.
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Interact Cardiovasc Thorac Surg · Sep 2010
Case ReportsChallenging pacemaker implantation in a patient with acquired dextrocardia after pneumonectomy, skoliosis and complete heart block.
Pacemaker implantation after pneumonectomy is rare and there have been no previously reported cases of acquired dextrocardia after implantation. The authors report the case of a pacemaker implantation in a patient with complete heart block, impaired left ventricular function, sclerosis of heart valves and radiation induced vasculopathy resulting in ostial stenosis of the right coronary artery 30 years after radiochemotherapy in childhood. Acquired dextrocardia after right pneumonectomy for mucoepidermoid carcinoma made implantation a challenge due to and poor fluoroscopic visualization of the heart and increased radio-opacity of the right chest when compared to congenital dextrocardia.
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Interact Cardiovasc Thorac Surg · Sep 2010
Case ReportsPrimary pleomorphic liposarcoma of pericardium.
We report a case of a 42-year-old man, who presented with a three-weeks' history of dyspnea and chest oppression induced by light activity, who had a large mass in the pericardium. Computed tomography showed a non-homogeneous density lobulated mass in the pericardial sac. ⋯ The patient is still alive 18 months after the diagnosis was made. The rare incidence of the liposarcoma of the pericardium can easily lead to a misdiagnosis clinically, and the final diagnosis here was made histopathologically.