The Annals of thoracic surgery
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In 1998, a 32-year-old woman in week 38 of pregnancy was referred to our hospital because of swelling of the lower extremities and dyspnea at rest. A massive pulmonary embolism and thrombi in the right and left atria were detected. ⋯ Both the mother and the fetus recovered without severe complications. Postoperatively, activated protein S deficiency was detected.
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We report a case of left atrial appendage aneurysm in a 1-year-old child. The patient was asymptomatic, and a mediastinal liquid mass that was confirmed to be an aneurysm of the left atrial appendage was incidentally revealed by transthoracic echocardiography. Aneurysmectomy was performed during cardioplegic arrest under the support of cardiopulmonary bypass. The postoperative course was uneventful.
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Comparative Study
Effect of a selection and postoperative care protocol on survival of infants with hypoplastic left heart syndrome.
We report the development and implementation of a program designed to assign patients preoperatively to either transplant or Norwood procedure based on a score derived from known risk factors and to enhance postoperative care of infants undergoing the Norwood procedure. ⋯ We report improved survival following the Norwood procedure after the implementation of an institutional management approach aimed at improving the outcome of infants with hypoplastic left heart syndrome and may help neutralize historical biases toward Norwood procedure or transplantation.
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Conventional surgery for thoracic aortic emergencies, such as contained or free rupture of thoracic aortic aneurysms, acute type B dissections, and traumatic rupture of the thoracic aorta, is frequently associated with a high rate of mortality and morbidity. To obviate this risk, endovascular surgery is considered to be a valid alternative procedure. ⋯ Endovascular surgery is a safe technique, showing encouraging early and midterm results and allowing for prompt treatment of associated lesions in complex multitrauma patients.
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Comparative Study
Does off-pump CABG reduce gastrointestinal complications?
The aim of this study was to compare gastrointestinal complications and associated risk factors among patients undergoing cardiac surgery using off- and on-pump revascularization techniques. ⋯ The incidence rates of gastrointestinal complications were similar in the on- and off-pump coronary artery bypass groups, the type of gastrointestinal complications, however, was different. Mortality rate due to these complications was also similar and remained high, regardless of the type of surgery. Cardiopulmonary bypass did not emerge as a risk factor for gastrointestinal complications, but prolonged cardiopulmonary bypass (longer than 98 minutes) resulted in a high incidence of such complications. Old age and advanced arteriosclerosis emerged as risk factors in both groups resulting in gastrointestinal complications suggesting the ischemic nature of the injury.