The Annals of thoracic surgery
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Case Reports
Iatrogenic iliac artery rupture and type a dissection after endovascular repair of type B aortic dissection.
We report a case of two iatrogenic complications after endovascular repair of a type B aortic dissection treated for abdominal aortic branch ischemia. A rupture of the common iliac artery occurred first during the procedure. ⋯ The proximal part of the aortic endovascular graft had created a tear in the aortic wall resulting in a retrograde type A dissection. Although aortic endovascular grafting is apparently associated with less morbidity and mortality, potentially lethal complications, both acute and delayed, may arise.
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Some patients with univentricular hearts who are candidates for Fontan operation may develop ventricular outflow tract obstruction after pulmonary artery banding (PAB) or Fontan. However, the indication for Damus-Kaye-Stansel (DKS) operation for these patients has not been clear. To clarify the indication, the changes in the diameter of ventricular outflow tract and the feasibility of DKS operation before or with Fontan were investigated. ⋯ The diameter of the ventricular outflow tract decreased after PAB and Fontan operations. DKS operations might be indicated before Fontan if the indexed diameter of ventricular outflow tract after PAB was below 70% and concomitantly with Fontan if it was below 120%.
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Bronchopleural fistulas are a life-threatening complication of pulmonary resection. A 21-year-old woman developed a large bronchopleural fistula after undergoing a pneumonectomy for carcinoid tumor. ⋯ Using either rigid bronchoscopy or thoracoscopy, these fistulas were evaluated and sealed with an albumin-glutaraldehyde tissue adhesive that may have improved strength and biocompatibility compared with other tissue sealants. This approach may be an effective alternative in the treatment of bronchopleural fistulas.
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Methods to assess the six competency categories outlined by the Accreditation Council on Graduate Medical Education are essential to allow residency programs to develop reproducible evaluations of their educational curriculum. Current tools to evaluate competencies are insufficient to perform these tasks, particularly in subspecialty disciplines. The key objective of this initiative was to develop and implement an evaluative tool that would provide data to residents and program leadership regarding their performance and to provide the training program with a reliable way to assess this component of the program. ⋯ The 360-degree feedback results provided valuable information for the residents. It also provided our program with a reproducible, quantifiable tool to assess these competencies. Combined with other instruments, the 360-degree feedback was found to be a particularly valuable instrument.
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Video-assisted thoracic surgery (VATS) is conventionally performed under single-lung ventilation. A small proportion of patients are often excluded from undergoing VATS because of their inability to tolerate single-lung ventilation. We describe a simple technique of selective lobar lung collapse that may help to recruit additional, selected patients for VATS. ⋯ This technique is simple and safe and requires no expensive disposable devices. Although not essential for most patients undergoing VATS, it deserves to be in the armamentarium of the thoracic surgeon. Further studies will be required to better define its application in clinical practice.