Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Feb 2011
Case ReportsDirect right atrial insertion of a Hickman catheter in an 11-year-old girl.
Central venous lines are of particular importance in seriously ill children that require parenteral nutrition, chemotherapy, or other medications. The jugular or subclavian veins are ordinarily used for primary access. Alternatives include the femoral veins, the intercostal veins, and transhepatic approaches. ⋯ The following report presents the case of an 11-year-old girl with short-bowel syndrome and a desperate need for parenteral nutrition. Over the course of her treatment, she developed chronic thrombosis of the jugular, subclavian, and femoral veins, as well as thrombosis of the inferior vena cava. As an alternative route for central venous access, we describe a successful direct placement of a tunnelled catheter into the right atrium via a right anterolateral thoracotomy.
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Interact Cardiovasc Thorac Surg · Feb 2011
Comparative StudyDoes a relationship exist between the number of thoracoscopic thymectomies performed and the learning curve for thoracoscopic resection of thymoma in patients with myasthenia gravis?
This study aimed to analyze surgeons' learning curve for thymoma resection with video-assisted thoracoscopic surgery (VATS). Two hundred and eleven myasthenia gravis patients had VATS thymic resections, including 25 patients with a thymoma. Three groups of surgeries, according to the order of operations, were analyzed: Group A comprised the first 70 thymectomies, Group B comprised the second 70 thymectomies, and Group C comprised the final 71 thymectomies. ⋯ A significant difference was observed in the number of thymoma operations (Group A: four patients, Group B: seven patients, and Group C: 14 patients; P: 0.031) and the duration of operation (Group A: 66 min, Group B: 52 min, and Group C: 48 min; P: 0.024). A strong correlation was found between the duration of operation and order of patients (Pearson r: -0.554, P: 0.000). We recommend the start of a program for the resection of thymoma with VATS after surgical staff have performed 70 VATS thymectomy operations.
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Interact Cardiovasc Thorac Surg · Feb 2011
Case ReportsPerioperative implications of retrograde flow in both the subclavian arteries in an adult undergoing surgical repair of coarctation of aorta.
During surgical repair of coarctation of aorta (CoA), management of spinal cord ischemia and prevention of paraplegia is an important issue. The risk factors for paraplegia include level and duration of aortic-clamping, clamping of left subclavian artery (SCA), intraoperative temperature, variability of collateral circulation to the spinal cord, cerebrospinal fluid pressure, upper body arterial pressure, and aortic pressure beyond the aortic clamp. A short clamp time (<30 min), and distal aortic pressure>60 mmHg, minimizes the risks of spinal cord injury. ⋯ Aortic root angiogram had shown retrograde filling of both SCAs. A unique situation in which clamping of SCAs would increase flow to the spinal cord as their clamping would stop stealing of blood and aortic-clamping proximal to CoA will further increase collateral flow; because of these reasons, the patient tolerated prolonged aortic-clamping despite low distal aortic pressure without neurological deficit. However, aortic-clamping increased left ventricular after-load and the patient developed worsening of mitral regurgitation and pulmonary hypertension during aortic clamping.
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Interact Cardiovasc Thorac Surg · Feb 2011
Case ReportsLife-threatening hemoptysis due to left inferior phrenic artery to pulmonary artery fistula rescued by extracorporeal membrane oxygenation therapy.
Life-threatening hemoptysis due to bronchiectasis is an emergency and needs immediate bronchial angiographic embolization or surgical intervention. Most of the bleeding events arise from the bronchial artery. We report a very rare case of a patient who had bronchiectasis, but with bleeding from the left phrenic artery to pulmonary artery fistula, an artery originating from abdominal aorta. In this case, we also demonstrate that extracorporeal membrane oxygenation without heparinization as a bridge tool for life-threatening hemoptysis could allow the patient to undergo definite therapy more successfully.