The Annals of thoracic surgery
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Case Reports
The use of extracorporeal membrane oxygenation therapy in the delayed surgical repair of a tracheal injury.
Acute tracheal injury secondary to intubation can present with varying degrees of severity. Onset of symptoms occur hours or even days after the initial injury. ⋯ The inability to adequately ventilate combined with secondary aspiration injury required that the patient be placed on extracorporeal membrane oxygenation before undergoing surgery. This case demonstrates the use of extracorporeal membrane oxygenation to manage a patient awaiting surgery for severe tracheal tears.
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Case Reports
Aortic arch replacement through a left thoracotomy for right-sided aortic arch aneurysm with complete vascular ring.
Right-sided aortic arch with retroesophageal left subclavian artery and left ligamentum arteriosum is the second most common vascular ring. Aneurysms of the arch in its retroesophageal portion are rare. ⋯ The arch aneurysm was repaired with a staged approach. A right-sided carotid-subclavian artery bypass was performed, followed by distal ascending aorta and aortic arch replacement under hypothermic circulatory arrest through a left thoracotomy.
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Diffuse pulmonary neuroendocrine cell hyperplasia (DIPNECH) is characterized by a diffuse hypertrophy of neuroendocrine cells along the distal bronchioles. This condition is characterized by obstructive lung physiology and the development of small carcinoid tumors. ⋯ Interestingly, the chest wall also demonstrated involvement of DIPNECH indicated by the presence of small carcinoid tumors. The absence of any lung carcinoid tumor greater than 5 mm and the absence of lymph node metastases render the chest wall involvement unlikely to represent metastatic disease.
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An isolated intrapericardial diaphragmatic hernia is very rare. Only 15 cases have been reported, 2 of which are in adults. The defect in the anterior diaphragm allows abdominal contents to enter the pericardial cavity. We report the 16th case--the third in an adult--and its laparoscopic repair.
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We report a case involving a ruptured acute type B aortic dissection originating from an aberrant right subclavian artery (ARSA). A thoracic stent-graft was deployed in the distal arch close to the origin of the ARSA; the entry site at the origin of the ARSA was embolized with metallic coils. Perfusion of the left subclavian artery was preserved without a surgical bypass by using a chimney graft. This procedure is a feasible and less invasive treatment for high-risk sternotomy patients and is an effective strategy for acute aortic dissections involving an ARSA.