Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jan 2009
ReviewHybrid thoracoabdominal aortic aneurysm repair: concomitant visceral revascularization and endovascular aneurysm exclusion.
Thoracoabdominal aortic aneurysms (TAAA) remain a formidable surgical challenge, with conventional open repair associated with significant rates of mortality and morbidity. Furthermore, many of these patients are elderly with significant comorbidities and may not be candidates for repair. Consequently, the availability of a "hybrid" option, including open visceral debranching with concomitant endovascular aneurysm exclusion, may have advantages in these high-risk patients, including the potential to offer therapy to those ineligible for conventional repair. ⋯ In all cases, endovascular exclusion of the aneurysm has been performed at the same operation. The procedure is applicable to all types of TAAA (Extent I-V), although a bifurcated abdominal aortic endograft may be required if inadequate distal landing zone for a tube endograft exists above the aortic bifurcation. Results to date suggest this technique of "hybrid" TAAA repair to be a safe alternative to conventional repair for TAAA in older patients with significant comorbidity, with results in our institution similar to those previously published for younger patients undergoing conventional repair in high-volume centers.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2009
Bronchoscopic evaluation of the trachea and dilation of the trachea.
Flexible and rigid bronchoscopy are the thoracic surgeon's stethoscope. These tools are vital to evaluating, diagnosing, and treating a tracheobronchial pathologic condition. Airway dilation, used appropriately and selectively, is an effective method of treating various tracheal pathologic conditions.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2009
ReviewEndovascular repair of blunt thoracic aortic injuries.
Blunt traumatic aortic injury is a highly fatal injury caused from rapid deceleration of the thorax. Most victims do not survive to obtain emergency medical care. Immediate open surgical repair had been the standard of care for decades, but more recent strategies and the emergence of thoracic aortic endografting have changed protocols for the treatment of this highly lethal lesion. This article reviews the current treatment of blunt thoracic aortic injury and the use of thoracic aortic stent grafting for this patient population.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2009
ReviewAnatomical, histologic, and genetic characteristics of congenital chest wall deformities.
There is a large and diverse group of congenital abnormalities of the thorax that manifest as deformities and/or defects of the anterior chest wall and, depending on the severity and concomitant anomalies, may have cardiopulmonary implications. Pectus excavatum, the most common anterior chest deformity, is characterized by sternal depression with corresponding leftward displacement and rotation of the heart. Pectus carinatum, the second most common, exhibits a variety of chest wall protrusions and very diverse clinical manifestations. ⋯ Collagen, as a major structural component of rib cartilage, is implicated by genetic and histologic analysis. Poland syndrome is a unique unilateral chest/hand deficiency that may include rib defects, pectoral muscle deficit, and syndactyly. Cleft sternum is a rare congenital defect resulting from nonfusion of the sternal halves, which leaves the heart unprotected and requires early surgical intervention.