The Annals of thoracic surgery
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Total anomalous pulmonary venous connection has been one of the more challenging congenital heart defects in newborns and young infants despite improvements in surgical technique, cardiac anesthesia, neonatal myocardial preservation, and postoperative care. Since 1981, 30 patients with total anomalous pulmonary venous connection have undergone primary total correction. Mean age at operation was 28 +/- 6 days and mean weight, 3.3 +/- 0.7 kg. ⋯ Growth in survivors is closely monitored. The height growth percentile is less than 5% in 15% +/- 8% of survivors and the weight growth percentile, less than 5% in 17 +/- 8%. During the past decade, with a consistent surgical approach to neonates and infants with total anomalous pulmonary venous connection, it has been possible to achieve low early mortality, low attrition, and excellent late results.
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Case Reports
Distal aortic arch aneurysmectomy and coronary revascularization through a left thoracotomy.
A successful single operation of a distal aortic arch aneurysm and coronary artery disease through a left lateral thoracotomy using a simple hypothermic retrograde cerebral perfusion technique for cerebral protection in a 64-year-old man is reported. During ventricular fibrillation accompanying cooling to 15 degrees C, a left internal thoracic artery was anastomosed with the left anterior descending coronary artery, and the aneurysm was replaced with a patch during hypothermic retrograde cerebral perfusion.
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Prosthetic valve thrombosis is associated with high mortality. The treatment of choice remains operation. This is a case report of the successful combination therapy of tissue plasminogen activator and urokinase for an isolated thrombosed prosthetic mitral valve in a postpartum patient in whom operation was thought to carry an unacceptable risk. Combined thrombolytic therapy or therapy with a single agent with a long half-life and a prolonged infusion time is suggested as an emergent treatment option for prosthetic mitral valve thrombosis.
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Manual cardiopulmonary resuscitation is currently the standard treatment for cardiac arrest patients both in and out of the hospital. Accumulated experimental and anecdotal clinical evidence suggests enhanced survival in patients with extreme circulatory decompensation who have been emergently supported with portable cardiopulmonary bypass. Long-term survival is possible even when application is delayed, but early institution of support after cardiac arrest in selected patients offers the best survival advantages. ⋯ Machinery needed to perform emergency cardiopulmonary bypass is currently available in all hospitals with open heart surgery programs. Simple support is often therapeutic but can also serve as a bridge to definitive diagnostic and other therapeutic procedures. Commercial units are becoming more biocompatible and easier to use, making both wider application and more prolonged support likely in the future.