Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Nov 2010
ReviewIs close radiographic and clinical control after repair of acute type A aortic dissection really necessary for improved long-term survival?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether radiographic and clinical control after surgery for acute type A aortic dissection (AAD) is needed for improved long-term survival. Altogether, 118 relevant papers were identified using the reported search, of which seven represented the best evidence to answer the question. ⋯ A suggested timeframe for computed tomographic (CT) imaging after surgery for AAD is before discharge, at six and 12 months postdissection and, if stable, annually thereafter. Patients with large aneurysms (aortic diameter≥50 mm) should be maintained at radiographic intervals of six months or less. If the thoracic aneurysm is moderate in size and remains stable over time, magnetic resonance imaging instead of CT-scanning is reasonable to minimize the patient's radiation exposure.
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Interact Cardiovasc Thorac Surg · Nov 2010
Case ReportsAcute myocardial infarction caused by coronary embolization of a papillary fibroelastoma of the thoracic ascending aorta.
Papillary fibroelastomas (PFE) are benign endocardial masses and generally originate from the cardiac valves, while PFE arising from the ascending thoracic aorta are an uncommon clinical finding. We report the case of a 78-year-old female who presented to the emergency department with an acute ST segment elevation myocardial infarction. ⋯ Histopathological examination revealed a PFE with thrombotic material. Nowadays, surgical excision of PFE remains, the treatment of choice for symptomatic patients with excellent short- and long-term results but recurrence of PFE following surgical excision has not been reported.
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Interact Cardiovasc Thorac Surg · Nov 2010
Case ReportsAlterations in the medial layer of the main pulmonary artery in a patient with longstanding Fontan circulation.
In the past, pulmonary arterial (PA) structure has been extensively investigated with the aim of providing an insight into operative indication for patients with congenital heart disease (CHD). Although PA histological analysis is applied less frequently in the current era, demographic changes of CHD patients require a refocussing of attention. With an exponential increase in the number of adult CHD patients, it is important to realise how structural changes evolve long after previous procedures as a certain proportion of such cases necessitate surgical or interventional manipulation on their PAs. ⋯ Immunohistological analysis showed severe alterations, especially in the medial layer; not only attenuation of muscular component but also disarray and fragmentation of elastic fibres were remarkable, which should represent the adaptive response to longstanding diminished lung perfusion. To our knowledge, these observations have not been well described in the literature, presumably because previous studies were conducted primarily with respect to 'increased' pulmonary flow, and hence little is known regarding structural alterations in response to 'decreased' perfusion. Our findings are provided with a review of the literature.
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Interact Cardiovasc Thorac Surg · Nov 2010
Risk factors and mortality associated with deep sternal wound infections following coronary bypass surgery with or without concomitant procedures in a UK population: a basis for a new risk model?
Deep sternal wound infection (DSWI) is a rare but serious complication following coronary artery bypass surgery. Our study investigates the risk factors and mortality associated with DSWI with other risk models for DSWI. Data was collected prospectively on 7602 patients undergoing coronary artery bypass grafting±concomitant surgery between April 1999 and September 2009 including DSWI. ⋯ Logistic regression identified age [odds ratio (OR)=1.055], body mass index (OR=1.076), diabetes (OR=2.00) and chronic lung disease (OR=2.47) as the significant independent determinants of DSWI from the variables considered. Mortality rates and mean STS scores are higher in patients requiring re-opening for DSWI. Not all the STS risk factors were predictors of DSWI in our population.
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Interact Cardiovasc Thorac Surg · Nov 2010
Flap valved closure of ventricular septal defects with increased pulmonary vascular resistance.
Closure of ventricular septal defect (VSD) in children with elevated pulmonary vascular resistance (PVR) is associated with significant morbidity and mortality with pulmonary hypertensive (PH) episodes being a major postoperative problem. Flap valved closure of VSD is reported to decrease morbidity and mortality. We report our experience of closure of a VSDs in patients with severe PH, using a valved patch in an effort to reduce the risk of operation. ⋯ Obvious opening and closing of the flap valve was detected by echocardiography in eight patients. There were no late deaths due to cardiac causes. Closure of a large VSD in patients with severe pulmonary hypertension could be performed with low morbidity and mortality when a flap valve patch was used.