The Annals of thoracic surgery
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The success of solid organ transplantation has resulted in an increasing pool of patients that subsequently require cardiac surgical procedures, yet the perioperative management of these patients is not well documented. We report a single institutional experience with the management techniques used and the outcomes of the cardiac surgical procedures performed in solid organ transplant recipients with functioning allografts. ⋯ Although the short-term morbidity was significant, the low mortality and low incidence of permanent graft dysfunction indicate that solid organ transplant recipients can safely and effectively undergo subsequent cardiac surgical procedures.
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Nonpenetrating cardiac trauma resulting in cardiac chamber or valvar rupture is uncommon, requiring a high degree of suspicion for diagnosis. A case involving avulsion of the tricuspid and mitral papillary muscles with resultant interventricular septal rupture is reported. This case illustrates the importance of transesophageal echocardiography in the rapid diagnosis of blunt cardiac trauma. Surgical treatment of this condition is also discussed.
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Pulmonary artery pseudoaneurysm has been described as a complication of Swan-Ganz catheterization and right heart catheterization. Isolated cases of this condition occurring in blunt and penetrating chest trauma have been reported. ⋯ A persistent opacification of the lung field resulted in evaluation with computed chest tomography and color-flow Doppler ultrasonography. A pseudoaneurysm of the lingular segmental artery was identified and successfully obliterated by Gelfoam coil embolization.
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Patients with indwelling chest tubes inserted for the purpose of evacuating pleural air traditionally are treated in the hospital. The current emphasis on cost-effective medical care and a recent report describing the early discharge of patients who had undergone lung volume reduction operations and had a persistent air leak prompted us to review our overall experience with outpatient tubes in a general thoracic surgical practice. ⋯ The presence of a chest tube, with or without an air leak, does not always require hospitalization. Admission can be avoided in most patients with primary spontaneous pneumothorax and in selected patients with pneumothorax of other causes. The postoperative hospital stay can be shortened for many patients who have a prolonged air leak after pulmonary resection. Ambulatory tube management also makes feasible outpatient thoracoscopy for noneffusive processes.
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Historical Article
The development of valvular heart surgery over the past 50 years (1947-1997): personal recollections.
The development of valvular heart surgery over the past 50 years has required the efforts and creative genius of many surgical pioneers. It has been filled with exhilarating short-term successes and some devastating failures. This article traces the 50 years of persistence and determination that have brought us to a time when the majority of patients with heart valve disease can be returned to a happy and fulfilling life by valvuloplasty or by valve replacement.