The Annals of thoracic surgery
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A Kommerell diverticulum (KD) is an aneurysmal remnant of the dorsal fourth aortic arch. This can be an independent cause of tracheoesophageal compression. We previously reported resection of the KD with left subclavian artery transfer to the left carotid artery for recurrent symptoms in patients with a right aortic arch, left ligamentum, and retroesophageal left subclavian artery after prior ligamentum division. In 2001 we began resecting the KD and transferring the left subclavian artery to the left carotid artery in selected patients as a primary operation. ⋯ In selected patients with a vascular ring we now recommend resection of the associated Kommerell diverticulum and transfer of the retroesophageal left subclavian artery to the left carotid artery as a primary procedure. This strategy requires comprehensive and precise preoperative imaging with either computed tomography or magnetic resonance imaging.
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Comment Letter
Perioperative acute kidney injury after cardiac surgery.
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Comparative Study
Blake drains: a novel method of chest drainage after extracardiac fontan operation with autologous pericardium.
Pleural effusions after Fontan palliation remain a cause of increased length of stay, cost, and morbidity. We report our experience with Blake drains (BDs) and the outpatient pediatric pleural drain pathway after Fontan operation. ⋯ Silicone BDs are safe and effective after ECLT Fontan operation. Hospital length of stay and cost can be significantly decreased when these drains are used with appropriate family involvement and close outpatient surveillance.
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Most cases of blunt cardiac rupture (BCR) are associated with mortality at the scene of the injury. For the fortunate 13% to 17% of patients who survive the journey to the hospital, the treatment is definitive surgical repair. ⋯ We describe a patient who sustained 2 right ventricular tears from blunt trauma in a motor vehicle accident 18 years after coronary artery bypass graft surgery. He did not demonstrate hemodynamic compromise and was successfully managed conservatively.