The Annals of thoracic surgery
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Comparative Study
Surgery in adults with congenital heart disease: risk factors for morbidity and mortality.
Patients with congenital heart disease are frequently surviving into adulthood, and many of them will require surgery. Unfortunately, outcome data in this patient population are limited. We aimed to identify risk factors associated with adverse events in adults with congenital heart disease undergoing cardiac surgery and establish long-term survival data. ⋯ Surgery in adults with congenital heart disease can be performed with low morbidity and mortality. Nonetheless, there remain important risk factors for adverse events. Awareness and modification of risk factors may help improve outcomes.
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Comparative Study
Ladd's procedure in functional single ventricle and heterotaxy syndrome: does timing affect outcome?
Infants with univentricular hearts often require intervention, such as a systemic to pulmonary shunt, as part of a staged surgical palliation. This physiology is inherently unstable, and interim mortality ranges from 4% to 15%. Heterotaxy syndrome confers a high incidence of intestinal rotation and fixation abnormalities. Controversy persists as to the need for elective Ladd's procedure. The purpose of this study is to review our experience in children with heterotaxy syndrome and functionally univentricular hearts who underwent Ladd's procedure. ⋯ Ladd's procedure in single ventricle heterotaxy patients who are tolerating enteral feeding should be performed after physiologic palliation to a more balanced circulation, ideally after cavopulmonary connection. Symptomatic neonates pose management challenges. Timing of abdominal surgery should be carefully considered, given the significant risk of mortality in these patients.
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Case Reports
Protective effect of previous cardiac operation: survival of contained right ventricular rupture.
Although cardiac contusions are common, cardiac rupture is an uncommon sequela of blunt chest trauma. The mortality rate associated with cardiac rupture is very high, and patients usually do not survive long enough to reach the hospital. We report a 66-year-old man with a history of coronary artery bypass grafting 15 years previously, who was involved in a traffic accident and experienced multiple trauma, including a small contained rupture of the right ventricular outflow tract. ⋯ The patient then underwent a cardiac operation, and the aneurysm was successfully resected. The intraoperative and postoperative courses were uneventful. In this case, the previous cardiac operation with the resulting pericardial adhesions proved to be lifesaving.
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Case Reports
Hybrid repair of subclavian-axillary artery aneurysms and aortic arch aneurysm in a patient with Marfan syndrome.
A patient with Marfan syndrome who had previously undergone a Cabrol procedure and thoracoabdominal aortic replacement had enlarging, symptomatic aneurysms in the subclavian-axillary artery and aortic arch. Both vessels were replaced with prosthetic grafts. ⋯ All the stent graft landing zones were within grafts, avoiding contact between the endoprostheses and fragile aortic wall. The aneurysms were excluded from the circulation, and the patient had no serious complications.
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Comparative Study
Reversible pulmonary trunk banding VIII: Intermittent overload causes harmless hypertrophy in adult goat.
Traditional pulmonary artery banding (PAB) is not always suitable for mature subpulmonary ventricle retraining. We sought to assess in detail the myocardial morphologic adaptations of two different protocols for inducing right ventricular (RV) hypertrophy in an adult animal model. ⋯ This study suggests that a more effective and harmless hypertrophy can be achieved in adult animals using intermittent PAB compared with the traditional approach.