The Annals of thoracic surgery
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A 64-year-old woman underwent tracheal sleeve resection for adenocarcinoma. Thirteen months later minimal granuloma occurred at the anastomosis. Subsequently she had dyspnea from obstruction caused by the increasing size of the granuloma, which necessitated 4 repeated endobronchial debulking procedures and topical mitomycin C (MMC) application. ⋯ Eventually, the granulation tissue and pledgeted sutures were removed from the anastomotic site using rigid bronchoscopy. Follow-up after 8 months showed no recurrence of symptoms, and the granuloma had resolved. Despite improvements in surgical suture material, removal of stitches should still be considered in the management of anastomotic obstruction caused by indolent and intractable granulation after tracheal resection or bronchoplasty.
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Although early primary repair of tetralogy of Fallot has gained wider acceptance, there is some speculation that repair at a younger age may be associated with increased morbidity and resource utilization. ⋯ Extracardiac anomalies, prematurity, low birth weight, and nonelective surgical intervention are predictors of increased morbidity and increased hospital resource utilization and impose a significant cost burden to the care of these patients. Early primary repair of tetralogy of Fallot can be safely performed without any increase in morbidity or increased hospital resource utilization.
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Uniportal video-assisted thoracoscopic surgery (VATS) has recently been introduced for various thoracic diseases. However, management of peripheral lung nodules by uniportal VATS without tracheal intubation has rarely been attempted. We evaluated the feasibility and safety of nonintubated uniportal VATS for peripheral lung nodules. ⋯ Nonintubated uniportal VATS is technically feasible and safe for selected patients and is a less invasive alternative in managing indeterminate peripheral lung nodules.
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Randomized Controlled Trial Multicenter Study Comparative Study
Root replacement surgery versus more conservative management during type A acute aortic dissection repair.
Aortic root management in type A acute aortic dissection is controversial. This study compared outcomes of root replacement (RR) interventions versus more conservative root (CR) management. ⋯ In type A acute aortic dissection patients more-extensive RR interventions are not associated with increased hospital mortality. This supports such an approach in young patients and patients with connective tissue diseases and bicuspid aortic valves. Excellent midterm survival and freedom from root reintervention in both groups suggest stable behavior of the nonreplaced aortic sinuses at 3 years. Thus, pending studies with longer follow-up, the use of aggressive RR techniques can be determined by patient-specific and dissection-related factors.
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Review Case Reports
Giant left ventricular thrombus formation associated with heparin-induced thrombocytopenia.
A 33-year-old man underwent urgent coronary artery de-obstruction for acute thrombotic occlusion of the left descending coronary artery. After 10 days of antiplatelet and heparin therapy, ventriculographic and echocardiographic control revealed a giant thrombus in the left ventricle, an ejection fraction of 40%, and severe mitral regurgitation. ⋯ After urgent mitral valve annuloplasty and left ventricular thrombectomy, the patient was discharged. In the literature, several cases of right atrial and ventricular thrombi have been described; however, to the best of our knowledge, this is the first report of giant left ventricular thrombus during heparin-induced thrombocytopenia.