The Annals of thoracic surgery
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The surgical management of 15 patients with partial anomalous pulmonary venous connection (PAPVC) to the high superior vena cava (SVC) is described. This new technique redirects the anomalous pulmonary venous flow into the left atrium through the cardiac end of the SVC, transected and oversewn above the anomalous pulmonary vein or veins, by coaptation of the atrial septal defect (or of the surgically created septal defect in patients with an intact atrial septum) to the intracardiac orifice of the SVC. ⋯ Surviving patients enjoy full activity. Except for one symptomatic SVC obstruction due to technical error (since relieved), this technique has achieved total correction of these congenital defects with marked reduction in the undesirable postoperative sequelae often associated with other methods of repair.
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Prior to proximal aortic cross-clamping, baseline measurements of spinal cord blood flow and function were done. Blood flow was evaluated with radioactive microspheres and function determined by assessment of somatosensory evoked potential (SEP). Group 1 (N = 6) animals had aortic cross-clamping for 5 minutes after ischemic spinal cord dysfunction (SEP loss) was documented. ⋯ Measurements of spinal cord blood flow at the time of SEP loss revealed similar degrees of spinal cord ischemia in all groups. No significant differences were observed in the duration of aortic cross-clamping prior to SEP loss among the three groups. The data indicate that short periods of cross-clamping (5 minutes) following SEP loss are well tolerated, whereas longer periods (10 minutes) are associated with a high incidence of paraplegia.(ABSTRACT TRUNCATED AT 250 WORDS)
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Case Reports
Aortobronchial fistula: a late complication of division of the persistent ductus arteriosus.
An 11-year-old girl had nearly fatal hemoptysis due to false aneurysm and aortobronchial fistula following ductus division 9 years previously. Silk suture material was implicated as a causative agent in association with dilation of the aortic isthmus. ⋯ Twenty-two cases of false aneurysm have been described, 86.3% following ligation. The use of elective hypotension during ligation and monofilament suture during division may prevent this serious late complication in the future.
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Comparative Study
Postsurgical stage I bronchogenic carcinoma: morbid implications of recurrent disease.
Three hundred forty-six patients with post-surgical non-small cell Stage I bronchogenic carcinoma were followed from 5.0 to 10.8 years (median, 7.0 years). Recurrent cancer developed in 135 patients (39%). Seventy-five recurrences were nonregional metastases (55.6%); 35 (25.9%), a subsequent primary lung cancer; and 25 (18.5%), local recurrence only. ⋯ Currently, 174 patients are alive. Lung cancer survival (Kaplan-Meier) was 69.1% at 5 years and 61.9% at 9 years. At 2 years following detection of subsequent lung cancer, 51.8% of patients with subsequent primary lung cancer had survived lung cancer compared with 23.4% for those with local recurrence and only 8.9% for those with nonregional metastases.
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Between June, 1982, and July, 1983, 6 children with partial anomalous pulmonary venous connection to the middle or high segment of the superior vena cava (SVC) underwent repair of the anomaly by division of the SVC proximal to the site of entry of the anomalous pulmonary veins. Continuity between the cephalad end of the SVC and the right atrium was established by direct anastomosis to the right atrial (RA) appendage or by creation of a pedicle conduit of RA appendage, RA free wall, and pericardium. ⋯ All children have survived, remain in normal sinus rhythm, and have no evidence of vena caval or pulmonary venous obstruction. Follow-up cardiac catheterizations, angiocardiograms, and Holter recordings support the efficacy of this technique as an alternative in the management of anomalous pulmonary veins joining the SVC well above the cavoatrial junction.