Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Oct 2010
Outcomes of airway stenting for advanced lung cancer with central airway obstruction.
Approximately 30% of lung cancer patients will develop central airway obstruction (CAO). Interventional therapeutic bronchoscopy including airway stenting (AS) providing immediate and effective palliation is therefore essential to improve quality of life (QoL). However, no report has demonstrated the survival benefit of AS. ⋯ AS followed by adjuvant therapy provided a four-month increase in MST, although overall survival was not significantly changed. This study represents a single-institution experience. Although an aggressive strategy of AS is justified in order to improve symptoms and QoL, AS itself did not contribute to survival benefit.
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Interact Cardiovasc Thorac Surg · Oct 2010
Case ReportsPneumocephalus following thoracic surgery: the implication of the epidural anesthesia is still exceptional.
Epidural analgesia is the gold standard for the management of pain after thoracopulmonary surgery. However, it is not without side-effects and complications. We report the case of a 52-year-old man who underwent left lower lobectomy for a carcinoid tumor. ⋯ Etiological assessment consisted of isotopic cisternography and cerebromedullar magnetic resonance imaging (MRI), revealing a breach in the fourth left spinal dural nerve sheath. Although it was initially suspected, the thoracic epidural was eventually excluded as the cause. Management consisted of prompt surgical repair.
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Interact Cardiovasc Thorac Surg · Oct 2010
Intercostal-subcostal combined complete port-accessed video-assisted lobectomy.
Video-assisted lobectomy procedures include a broad spectrum of operative techniques that range from complete thoracoscopic surgery to minithoracotomy with a thoracoscope serving only as a light source. We describe a modified method for thoracoscopic approach for lobectomy with thoracic muscle sparing based on a combined complete port-accessed technique with a subcostal incision. We have successfully used this technique for lobectomies in stage I lung tumors. Intercostal muscles and nerve injury preservation allied to fast track rehabilitation perioperative care allowed rapid postoperative recovery.
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Interact Cardiovasc Thorac Surg · Oct 2010
Case ReportsSuccessful support and separation from veno-venous extracorporeal membrane oxygenation support in a three-month-old patient following bidirectional Glenn procedure.
While extracorporeal membrane oxygenation (ECMO) is a useful mechanism of providing support in pediatric patients with cardiopulmonary dysfunction following surgery for congenital heart disease, outcomes have varied dramatically between distinct cardiac diagnoses. Reported outcomes of ECMO support following a bidirectional Glenn procedure in patients with single ventricle physiology are uniformly poor due in part to physiological and anatomical challenges inherent to cannulation in this population. We describe a unique veno-venous cannulation that can be applied to this patient population and has allowed for successful decannulation in our practice.
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Interact Cardiovasc Thorac Surg · Oct 2010
Case ReportsThrombosis of the ascending aorta during mechanical circulatory support in a patient with cardiogenic shock.
Cardiogenic shock after percutaneous coronary intervention (PCI) is a life-threatening complication and is most often related to abrupt vessel closure. We present the case of a patient who developed cardiogenic shock after PCI and was supported with intra-aortic balloon counterpulsation and the Levitronix CentriMag short-term mechanical circulatory support. ⋯ Preoperative transesophageal echocardiography revealed a massive thrombus of the aortic root and ascending aorta despite optimal anticoagulation regimen. The patient succumbed due to multiorgan failure.