The Annals of thoracic surgery
-
We herein present the case of a 75-year-old woman undergoing double valve replacement who experienced a massive bronchial hemorrhage due to a Swan-Ganz catheter pulmonary artery perforation after weaning from cardiopulmonary bypass. Early institution of extracorporeal membrane oxygenation allowed treatment of severe hypoxemia, refractory to mechanical ventilation, and the discontinuation of hemoptysis. Once clinical stability was achieved, the patient underwent pulmonary artery angiography with successful pseudoaneurysm embolization. It is hoped that this information can provide further insight into the management of such a complication.
-
Tracheobronchial injuries are rare but potentially life-threatening complications of endotracheal intubations or endobronchial interventions. This retrospective analysis discusses the criteria for the operative and nonoperative management of tracheal lacerations. ⋯ The decision for operative or nonoperative treatment of iatrogenic tracheobronchial lacerations is determined by the ventilating situation and the local extent of the injury. Nonoperative management of iatrogenic tracheobronchial injuries may be a save option in patients with uncomplicated ventilation, superficial or sufficiently covered tears, and moderate and nonprogressive emphysema. Immediate surgical repair remains warranted in those patients who require mechanical ventilation that cannot be delivered past the laceration.
-
Case Reports
Atrial septal rupture, flail tricuspid valve, and complete heart block due to nonpenetrating chest trauma.
This is a report of a patient with an atrial septal defect with right-to-left shunting, flail tricuspid valve, and complete heart block secondary to blunt chest trauma after a motor vehicle accident. The patient surgically repaired with pericardial recreation of atrial septum, bioprosthetic tricuspid valve replacement, and pacemaker insertion. The patient had minimal problems during the hospital course and subsequently made a full postsurgical recovery.
-
Impact of residency status on perfusion times and outcomes for coronary artery bypass graft surgery.
A price of training residents in cardiothoracic surgery is often perceived to be a loss in intraoperative efficiencies, leading to prolonged cardiopulmonary bypass and perfusion time. Because these indicators are also thought to adversely affect operative outcome, we investigated the association between residency training status, perfusion times, and outcomes. ⋯ Residency programs have longer CABG perfusion times than nonresidency cardiothoracic surgery programs, but these differences are minor. Adjusted procedural outcomes at residency training programs are similar to those at nonresidency centers; thus, patients do not appear to be adversely impacted by the time costs of surgical training.
-
Severe pulmonary hypertension is a common complication of congenital cardiac defects with large left to right shunt, and the closure of a large ventricular septal defect (VSD) with elevated pulmonary vascular resistance (PVR) is associated with significant morbidity and mortality. A unidirectional monovalve homologous aortic patch was designed to close the large VSD with severe pulmonary hypertension in an effort to decrease the morbidity and mortality. ⋯ Closure of a large VSD in patients with severe pulmonary hypertension could be performed with low morbidity and mortality when a unidirectional monovalve homologous aortic patch was used and the long-term result was satisfactory.