The Annals of thoracic surgery
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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.
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Review Meta Analysis
In search of the ideal pulmonary blood source for the Norwood procedure: a meta-analysis and systematic review.
A clear consensus regarding the optimal source of pulmonary blood flow in patients with hypoplastic left heart syndrome undergoing the Norwood procedure is lacking. ⋯ Our pooled analysis demonstrated no survival benefit for the MBTS or RV-PAS in patients undergoing the Norwood procedure. There appears to be an advantage with the RV-PAS with regard to interstage mortality at the cost of an increased rate of shunt intervention.
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The aim of this project was to develop a set of quality indicators to assess surgical decision making in the care of patients with non-small cell lung cancer (NSCLC). ⋯ By use of a modified Delphi process, 17 indicators to assess the quality of processes of surgical care for patients with NSCLC were developed.
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Review Case Reports
Direct injury to right coronary artery in patients undergoing tricuspid annuloplasty.
Direct injury to the right coronary artery as a result of reparative operation on the tricuspid valve is a rare, probably underdiagnosed, but serious complication, which often involves dramatic clinical consequences. So far, only five cases have been described in the literature. ⋯ Occlusion of the right coronary artery in patients undergoing tricuspid annuloplasty is a rare complication that may occur if great annulus dilatation is present, thus altering both normal annular geometry and the relationship between the right coronary artery and the tricuspid annulus, particularly when DeVega annuloplasty is performed. Such an entity should be considered in the immediate postoperative period in an unstable patient, especially when complementary tests support this diagnosis. Prompt recognition and treatment can positively affect the patient's outcome, most often by means of an emergency revascularization strategy.
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Although red blood cell (RBC) transfusions are frequently used in cardiac operations, an increasing amount of data has demonstrated deleterious consequences. Consequently, the appropriate use of this limited resource is unclear. In this review, we discuss the relationship between anemia and the outcomes of cardiac surgical procedures, the risks associated with RBC transfusion, and the impact of blood transfusions on mortality and morbidity after cardiac operations. The review concludes with a discussion of randomized trials comparing restrictive versus liberal transfusion strategies and a consideration of blood conservation techniques.