Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Apr 2011
Case ReportsSpontaneous hemomediastinum and hemothorax after dissecting bronchial artery aneurysm.
Spontaneous hemomediastinum is a rare pathological event due to bleeding disorders, mediastinal organ hemorrhage or idiopathic causes. It usually presents with chest pain and dyspnea, which can lead to confusion with other clinical conditions. The election diagnostic method is computed tomography and treatment depends on underlying etiology, aimed on controlling hemorrhages, if present. In this paper, we present a case of spontaneous hemomediastinum and hemothorax after bronchial artery aneurysm dissection treated with endovascular embolization and chest drainage.
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Interact Cardiovasc Thorac Surg · Apr 2011
Comparative StudyLong-term morbidity and quality of life after surgical repair of transposition of the great arteries: atrial versus arterial switch operation.
Since a growing number of patients after surgical repair of transposition of the great arteries (TGA) survive until adulthood the focus of attention has shifted to the management of associated long-term morbidity and quality of life (QoL). Therefore, we reviewed all patients that underwent surgical repair of TGA at our institution and compared long-term results after atrial and arterial switch operation. Between 1973 and 2000, a total of 302 patients underwent either atrial switch operation (n=222) or arterial switch operation (n=80). ⋯ There was a trend towards a more favourable outcome of the arterial switch group concerning freedom from re-interventions, severe systemic ventricular dysfunction and need for heart failure medication. However, also the arterial switch operation was associated with an increased incidence of loss of sinus rhythm and neo-aortic valve regurgitation during late follow-up. Health related QoL according to the SF-36 questionnaire was not significantly different between both groups and comparable to a healthy population.
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Individual performance indicators for cardiac surgeons in the UK were published in 2004. A comprehensive update published in 2009 reported statistically significant decreases in mortality rates suggesting that the publication of this data may have contributed to this improvement in outcomes. In view of this, the authors present an assessment of the attitudes of cardiac surgeons to individual performance tables, having performed this by sending questionnaires exploring the surgeon's views on performance tables to UK cardiac surgeons in 2005 and 2009. ⋯ The attitude of the consultants towards the possible effect of this data on the management of high-risk patients also changed, with fewer consultants believing they would (P=0.0001) or may (P=0.023) avoid these patients. The observed change in attitude of cardiac surgeons may be due to acclimatization to an established system of audit, improved mortality rates, a desire for more transparency following the Bristol Enquiry, or improved risk stratification. These findings may be of benefit to those tasked with initiating these indicators elsewhere.