The Annals of thoracic surgery
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A 35-year-old woman at 13 weeks gestation presented with adenoid cystic carcinoma of the distal left mainstem bronchus with chronic collapse of the left lung requiring carinal pneumonectomy. The extent of the tumor and need for significant retraction during dissection and pneumonectomy resulted in the need for cardiopulmonary bypass. The patient underwent successful left carinal pneumonectomy and subsequently delivered a healthy baby.
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Comparative Study
A protocol-driven approach to cardiac reoperation reduces mortality and cardiac injury at the time of resternotomy.
The purpose of this study was to determine whether an established protocol-driven approach to cardiac reoperations would improve patient outcomes and reduce resternotomy injuries. ⋯ A protocol-driven approach to cardiac reoperations is associated with reduced cardiac injury upon resternotomy and decreased mortality. The protocol-driven use of routine preoperative computed tomography angiography, alternative cannulation planning, avoidance of prior internal mammary artery grafts, and the early initiation of cardiopulmonary bypass before sternotomy for selected cases should be considered to improve operative results and efficiency.
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Catheter-based ablation for atrial fibrillation (AF) performed percutaneously is shown to be limited in patients with nonparoxysmal AF (non-PAF). The full Cox-Maze surgical procedure demonstrated good success with non-PAF, but concerns were raised regarding increased morbidity eliminating the effect of the success rate. This study assessed the safety and efficacy of a stand-alone on-pump Cox-Maze procedure for non-PAF. ⋯ The long-term success rate after the Cox-Maze III procedure in a challenging group of non-PAF patients is acceptable. Our experience suggests the development of educational strategies to overcome the initial learning curve and patient selection criteria for AF surgical ablation.
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This study was undertaken to compare clinicopathologic features and survival between patients with unexpected N1 (clinical N0-pathologic N1) and expected N1 disease (clinical N1-pathologic N1) after operation for non-small cell lung cancer. ⋯ Patients with unexpected N1 disease showed better survival than did those with expected N1 disease, which seemed to be related to the pathologically minimal extent of the primary tumor and nodal involvement.
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We present a case of an abnormal origin of right subclavian artery and right vertebral artery distal to the origin of left subclavian artery in a 2-year-old patient who presented with cyanotic congenital heart disease with single ventricle physiology. The anomalous origin of a right vertebral artery from the proximal descending thoracic aorta is very rare. We have described the cine-angiographic identification of its origin and course, its embryologic development, and its clinical relevance.