Interactive cardiovascular and thoracic surgery
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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.
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Interact Cardiovasc Thorac Surg · Feb 2011
How good patient blood management leads to excellent outcomes in Jehovah's witness patients undergoing cardiac surgery.
The refusal of blood products makes open-heart surgery in Jehovah's witnesses (JW) an ethical challenge. We demonstrate how patient blood management strategies lead to excellent surgical outcomes. ⋯ Patient blood management leads to excellent short- and long-term outcomes in JW. Combined efforts in regard to preoperative hematological parameter optimization, effective volume management and meticulous surgical techniques make this possible but raise the cautionary note why this is only possible in JW patients.
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Interact Cardiovasc Thorac Surg · Feb 2011
Bilateral single-port thoracoscopic sympathectomy with the VasoView device in the treatment of palmar and axillary hyperhidrosis.
Primary or essential hyperhidrosis is a disorder characterized by excessive sweating beyond physiological needs. It is a common disease (with an incidence of up to 2.8%) that causes intense discomfort for patients. Video-assisted thoracoscopic bilateral sympathectomy is an effective surgical treatment with high success rates and improvement in quality of life. ⋯ Problems with intraoperative bleeding management have been solved by using thoracoscopes with integrated electrocautery scissors. In this report, we describe successful transaxillary bilateral single-port thoracoscopic T2-T5 sympathectomy with the VasoView® device in three patients with palmar and axillary hyperhidrosis. The VasoView® device, with its integrated electrocautery scissors, was originally designed for endoscopic vessel harvesting in coronary artery bypass surgery, but it has proven highly effective for single-port thoracoscopic sympathectomy.
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Interact Cardiovasc Thorac Surg · Feb 2011
Colopharyngoplasty for intractable caustic pharyngoesophageal strictures in an indigenous African community--adverse impact of concomitant tracheostomy on outcome.
Surgical management of caustic strictures of the upper digestive tract poses difficult challenges. This is because reconstruction above the cricopharyngeal junction interferes with the mechanisms of swallowing and respiration. This report reviews the outcome of colopharyngeal reconstruction of severe diffuse pharyngoesophageal caustic strictures in an indigenous African community. ⋯ In this African community, colopharyngoplasty provided an effective mean of restoration of upper digestive tract continuity in patients with severe caustic pharyngoesophageal strictures. Tracheostomy in this setting portends a significant long-term mortality risk.