The Annals of thoracic surgery
-
Comparative Study
A propensity-matched comparison of pleurodesis or tunneled pleural catheter in patients undergoing diagnostic thoracoscopy for malignancy.
Patients with a suspected malignant pleural effusion occasionally require thoracoscopy to achieve a diagnosis. It is unclear whether chemical pleurodesis or the placement of a tunneled pleural catheter (TPC) that can be used for intermittent pleural drainage produces superior palliation, a shorter hospital stay, and less morbidity. This investigation compares these 2 treatment groups. ⋯ This investigation found that a TPC provided palliation of patients' malignant pleural effusions and freedom from reintervention equal to that of talc pleurodesis after thoracoscopy while resulting in a shorter mean length of hospital stay and interval to the initiation of systemic therapy. Lower rates of operative morbidity were also seen in the TPC treatment group. This method of palliation of a malignant pleural effusion should be considered when diagnostic thoracoscopy reveals a malignant pleural effusion.
-
According to the 2007 American Thoracic Society/Infectious Diseases Society of America statement on nontuberculous mycobacterial diseases, more evidence for the benefits of adjuvant nontuberculous mycobacterial lung disease surgical intervention is needed before its wide application can be recommended. ⋯ Pulmonary resection combined with chemotherapy is safe, with favorable treatment outcomes, for patients with localized nontuberculous mycobacterial lung disease. Our results support the liberal use of operations for nontuberculous mycobacterial lung disease whenever indicated.
-
Ventricular septal rupture occurring as a result of blunt trauma is a very rare clinical condition. Compression of the heart between the sternum and the vertebral column during late diastole or isovolumetric contraction resulting in sudden increase in the intracardiac pressure is a prerequisite for its occurrence. Sudden relief of the inner pressure becomes impossible when the heart is full, thereby resulting in myocardial contusion and rupture. We report a case of a young schoolboy who presented to us with this serious disease and was successfully treated with surgical closure of the defect with a polytetrafluoroethylene patch.
-
Case Reports
Right ventricular outflow tract cannulation for right ventricular assist device implantation.
A need persists for implantable devices that provide support for the failing right ventricle. The anatomy of the right ventricle presents unique challenges at the time of right ventricular assist device implant. We describe a technique for right ventricular outflow tract cannulation that minimizes the risk of right ventricular assist device inflow cannula obstruction and right ventricular compression.
-
The long-term outcome of modified Fontan operation concomitant with a valve operation for atrioventricular valve (AVV) regurgitation is not well described. ⋯ Given worse results with poor ventricular function, early intervention against valve pathology before development of ventricular failure may improve long-term outcomes. Multiple methods are appropriate for a variety of valve lesions; however, circular annuloplasty remains a reliable repair option due to its technical simplicity.