The Annals of thoracic surgery
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The aim of this study was to examine the impact of prolonged intensive care unit (ICU) stay on in-hospital mortality and long-term survival. ⋯ Prolonged ICU stay is an important predictor of adverse immediate, short-term, and long-term outcomes after cardiac operations.
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Case Reports
Survival after simultaneous repair of bichamber cardiac and pulmonary vein rupture caused by blunt chest trauma.
A 44-year-old woman was transferred to our institution because of blunt chest trauma. Transthoracic echocardiography revealed decompression of the right ventricle resulting from pericardial effusion. ⋯ Under better visualization after the patient was placed on cardiopulmonary bypass, we identified a 5-cm longitudinal tear and a 2-cm tear in the right atrium (RA), a 2-mm tear in the right ventricle (RV), and a 5-mm tear in the right lower pulmonary vein (PV). Those tears were repaired successfully with 5-0 polypropylene sutures.
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Chronic thromboembolic pulmonary hypertension (CTEPH) is a known sequela of acute pulmonary embolic disease and yet remains underdiagnosed. Although nonsurgical options for patients with CTEPH have become increasingly available, including pulmonary artery hypertensive medical therapy, surgical endarterectomy provides the most appropriate intervention as a potential cure for this debilitating disorder. This article summarizes the most recent outcomes of pulmonary endarterectomy at a single institution over the past 12 years, with emphasis on the surgical approach to segmental-level chronic thromboembolic disease. ⋯ Despite a patient population with more distal disease, results continue to improve. Pulmonary endarterectomy for patients with CTEPH results in significant pulmonary hemodynamic improvement, with favorable outcomes achievable even in patients with distal segmental-level chronic thromboembolic disease.
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Case Reports
Weaning from venovenous extracorporeal membrane oxygenation without anticoagulation: is it possible?
A 19-year-old man affected with severe acute respiratory distress syndrome that was unresponsive to medical treatment was successfully weaned without anticoagulation therapy from venovenous extracorporeal membrane oxygenation (ECMO) because of life-threatening bleeding. The patient received venovenous ECMO with double peripheral cannulation. ⋯ The patient was discontinued from ECMO and extubated after pulmonary function improved. Based on this single experience, management and weaning without any anticoagulant agent might be possible.
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Case Reports
Unusual effect of an atrial septal aneurysm on venous drainage during cardiopulmonary bypass.
Atrial septal aneurysm is an uncommon cardiac anomaly that is usually asymptomatic or occasionally associated with cardioembolic events. We present the unusual impeding effect of an atrial septal aneurysm on venous drainage during cardiopulmonary bypass in a 70-year-old man who underwent aortic valve replacement and coronary artery bypass graft surgery.