Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Feb 2009
Case ReportsSystemic air embolism in a patient with ingestion of a foreign body.
Air embolism is defined as the entry of gas into a vascular structure. Frequently it is iatrogenic and can result in serious morbidity and mortality. We describe the case of a 59-year-old woman who presented with mediastinitis as a result of ingestion of a fishbone. Mediastinal debridement was performed which was complicated in the postoperative period by a systemic air embolism, as documented by computed tomography and clinical features.
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Interact Cardiovasc Thorac Surg · Feb 2009
Impact of 3-mm Blalock-Taussig shunt in neonates and infants with a functionally single ventricle.
Functionally single ventricle (f-SV) is susceptible to volume overload. Atrioventricular valve regurgitation (AVVR) tends to develop and ventricular function deteriorates due to excessive pulmonary blood flow following modified Blalock-Taussig shunt (mBTS). On the other hand, a small caliber graft has risks of early obstruction and poor growth of pulmonary vascular beds. ⋯ The AVVR remained mild or less. Ventricular end-diastolic volume and ejection fraction were 171+/-61% of the normal value and 64+/-6%, respectively. We conclude that a 3-mm mBTS was useful in preventing f-SV from volume overload and was effective for growing good pulmonary vasculature and achieving a right heart bypass.
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Interact Cardiovasc Thorac Surg · Feb 2009
Case ReportsCardiac arrest as a major complication of bilateral cervico-dorsal sympathectomy.
Severe palmar and/or axillary hyperhidrosis can be socially and psychologically very disturbing. We present a case of a patient who suffered from a 43 s asystolic cardiac arrest the night following a second contralateral thoracoscopic T(2)-T(3) sympathectomy for severe axillary and truncal hyperhidrosis. The cardiovascular effects of cervico-dorsal sympathectomy will be reviewed. Evaluation required to prevent such a serious cardiac complication will also be discussed.
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Interact Cardiovasc Thorac Surg · Jan 2009
Factors affecting post minimally invasive direct coronary artery bypass grafting incidence of myocardial infarction, percutaneous transluminal coronary angioplasty, coronary artery bypass grafting and mortality of cardiac origin.
In the present study we identify parameters which influence the incidence of myocardial infarction (MI), need for percutaneous coronary intervention (PCI), coronary artery bypass grafting (CABG) and cardiac mortality after minimal invasive coronary artery bypass grafting (MIDCABG). With a mean follow-up of 30+/-11.2 months, 390 patients were assessed with Wald test-corrected chi(2) analysis to identify preoperative factors which correlate with a higher incidence of post-MIDCABG MI, PCI, CABG and mortality from cardiac causes. We found an increased incidence of postoperative MI in patients with 2-vessel (8.7%) and 3-vessel (7.7%) vs. 1.3% 1-vessel coronary artery disease (CAD) (P=0.023), and in patients with preceding cardiac procedure (CABG and PCI: 8.4% vs. 2.0% without, P=0.023). ⋯ Preoperative low ejection fraction (EF) (multivariate, P<0.001), preoperative MI (P=0.007) and extent of CAD (P=0.001) were associated with a higher post-MIDCABG mortality. None of the parameters correlated with subsequent CABG MIDCABG. The extent and history of CAD, history of cardiac interventions and low EF seem to influence the outcome adversely and should be considered deciding pro or against the MIDCAB-option.
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Interact Cardiovasc Thorac Surg · Jan 2009
ReviewCould we use abdominal compressions rather than chest compression in patients who arrest after cardiac surgery?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether abdominal cardiopulmonary resuscitation (CPR) could be used instead of external cardiac massage either to protect the recent sternotomy or while chest compressions are not possible whilst a sternotomy is being performed. Altogether 386 papers were found using the reported search, of which 10 represented the best evidence to answer the clinical question. ⋯ We found only one paper in a porcine model that looked at the effectiveness of abdominal only CPR although it did show that abdominal CPR was actually 60% better than chest CPR. Interposed abdominal and chest compressions has been much more extensively studied and has been shown to be significantly better in return of spontaneous circulation than chest compressions alone. We conclude that currently there is very little evidence to support abdominal only CPR although these studies may support the concept that it may potentially increase the coronary and cerebral perfusion pressure.