Journal of cardiac surgery
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Regarding surgical interventions for type A acute aortic dissection (AAD), it is currently unclear if an initial, less invasive approach followed by later reoperations is safer than an extended approach aimed at preventing future reinterventions. We retrospectively reviewed our surgical cases to clarify the safety of late reoperation after repair of acute AAD. ⋯ Although most cases required extended procedures for late reoperation after repair of acute AAD, reoperations can be performed safely by careful choice of appropriate operative methods and strategies. Our data suggest that ascending aortic replacement is an effective initial procedure for patients with acute AAD.
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Migrating wires as a result of sternal nonunion present clinical challenges. Cardiac Computed Tomographic Angiography helps locate these wires precisely, enabling detailed surgical planning. ⋯ It is usually encountered among patients with sternal dehiscence. Understanding the location and spatial relationships of structures to the wire can be challenging. (64 slice) with high spatial and temporal resolution affords the possibility of enhancing presurgical planning.
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Isolated coronary artery fistula in the newborn is a very rare congenital anomaly. When symptomatic, treatment options include surgical management with ligation and/or patch closure or transcatheter coil embolization. We describe the case of a newborn with symptomatic left coronary-right ventricular fistula, which was managed operatively with off-pump ligation and on-table angiogram for confirmation of fistula obliteration and normal distribution of flow in the coronary artery. We point out the advantages of on-table angiography to evaluate and potentially treat residual structural pathology after cardiac surgery.