Interactive cardiovascular and thoracic surgery
-
Interact Cardiovasc Thorac Surg · Aug 2012
Case ReportsAn unusual cause of acute abdominal pain after cardiac surgery: acute epiploic appendagitis.
Abdominal complications following cardiac surgery remain unusual, but are associated with high mortality. The most common abdominal surgical complications are mesenteric ischaemia, diverticulitis, pancreatitis, gastrointestinal bleeding and cholecystitis. We describe a case of a 73-year old woman with acute abdominal pain mimicking cholecystitis on day 10 after aortic valve replacement. ⋯ Depending on its localization, it mimics many diagnoses requiring surgery: colitis, diverticulitis, appendicitis and cholecystitis. An abdominal CT scan is the diagnostic imaging tool of choice. All physicians involved in post-cardiac surgery care should be aware of this self-limiting disease that usually resolves with non-steroidal anti-inflammatory drugs and watchful waiting, and to avoid unnecessary surgery because the spontaneous evolution of epiploic appendagitis is usually benign.
-
Interact Cardiovasc Thorac Surg · Aug 2012
Case ReportsSuccessful bovine arch replacement for a type A acute aortic dissection in a pregnant woman with severe haemodynamic compromise.
Acute aortic dissection is very uncommon in pregnant women and the acute type A aortic dissection carries a high mortality rate outside specialized centres. There are a few cases reported with successful outcomes for the mother and the foetus from major cardiac centres. We are reporting our first experience of acute aortic dissection during the third trimester of pregnancy in a patient with Marfan features, profound haemodynamic compromise on arrival and a bovine aortic arch. Both the mother and the baby are doing well two years postoperatively.
-
Interact Cardiovasc Thorac Surg · Aug 2012
ReviewIs radiofrequency ablation more effective than stereotactic ablative radiotherapy in patients with early stage medically inoperable non-small cell lung cancer?
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was 'is radiofrequency ablation more effective than stereotactic ablative radiotherapy in patients with early stage medically inoperable non-small cell lung cancer?' Altogether, over 219 papers were found, of which 16 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. ⋯ RFA is not recommended for centrally based tumours. Patients with small apical tumours, posteriorly positioned tumours, peripheral tumours and tumours close to the scapula where it may be difficult to position an active electrode are more optimally treated with SABR. Treatment for early stage inoperable NSCLC should be tailored to individual patients, and under certain circumstances, a combined approach may be beneficial.
-
Interact Cardiovasc Thorac Surg · Aug 2012
Case ReportsVenous thoracic outlet syndrome caused by a congenital rib malformation.
Venous thoracic outlet syndrome (VTOS) represents a rare disorder. Hypertrophy of the anterior scalene musculature is the cause of the compression syndrome in most cases. To our knowledge, we describe the first reported case worldwide of a venous compression syndrome caused by a congenital malformation of the 1st and 2nd ribs. Treatment by transaxillary partial rib resection was necessary and a very good postoperative result was achieved.
-
Interact Cardiovasc Thorac Surg · Aug 2012
Does the number of wires used to close a sternotomy have an impact on deep sternal wound infection?
We studied the influence of the number of sternotomy mechanical fixation points on deep sternal wound infection (DSWI). ⋯ DSWI is associated with hypoxia, ischaemia, sepsis and mechanical sternal instability. DSWI may be prevented by using nine or more paired fixation points when closing with standard peri-sternal wires.