Interactive cardiovascular and thoracic surgery
-
Interact Cardiovasc Thorac Surg · Feb 2011
Case ReportsDirect right atrial insertion of a Hickman catheter in an 11-year-old girl.
Central venous lines are of particular importance in seriously ill children that require parenteral nutrition, chemotherapy, or other medications. The jugular or subclavian veins are ordinarily used for primary access. Alternatives include the femoral veins, the intercostal veins, and transhepatic approaches. ⋯ The following report presents the case of an 11-year-old girl with short-bowel syndrome and a desperate need for parenteral nutrition. Over the course of her treatment, she developed chronic thrombosis of the jugular, subclavian, and femoral veins, as well as thrombosis of the inferior vena cava. As an alternative route for central venous access, we describe a successful direct placement of a tunnelled catheter into the right atrium via a right anterolateral thoracotomy.
-
Interact Cardiovasc Thorac Surg · Feb 2011
How good patient blood management leads to excellent outcomes in Jehovah's witness patients undergoing cardiac surgery.
The refusal of blood products makes open-heart surgery in Jehovah's witnesses (JW) an ethical challenge. We demonstrate how patient blood management strategies lead to excellent surgical outcomes. ⋯ Patient blood management leads to excellent short- and long-term outcomes in JW. Combined efforts in regard to preoperative hematological parameter optimization, effective volume management and meticulous surgical techniques make this possible but raise the cautionary note why this is only possible in JW patients.
-
Interact Cardiovasc Thorac Surg · Feb 2011
Bilateral single-port thoracoscopic sympathectomy with the VasoView device in the treatment of palmar and axillary hyperhidrosis.
Primary or essential hyperhidrosis is a disorder characterized by excessive sweating beyond physiological needs. It is a common disease (with an incidence of up to 2.8%) that causes intense discomfort for patients. Video-assisted thoracoscopic bilateral sympathectomy is an effective surgical treatment with high success rates and improvement in quality of life. ⋯ Problems with intraoperative bleeding management have been solved by using thoracoscopes with integrated electrocautery scissors. In this report, we describe successful transaxillary bilateral single-port thoracoscopic T2-T5 sympathectomy with the VasoView® device in three patients with palmar and axillary hyperhidrosis. The VasoView® device, with its integrated electrocautery scissors, was originally designed for endoscopic vessel harvesting in coronary artery bypass surgery, but it has proven highly effective for single-port thoracoscopic sympathectomy.
-
Interact Cardiovasc Thorac Surg · Feb 2011
Case ReportsPerioperative implications of retrograde flow in both the subclavian arteries in an adult undergoing surgical repair of coarctation of aorta.
During surgical repair of coarctation of aorta (CoA), management of spinal cord ischemia and prevention of paraplegia is an important issue. The risk factors for paraplegia include level and duration of aortic-clamping, clamping of left subclavian artery (SCA), intraoperative temperature, variability of collateral circulation to the spinal cord, cerebrospinal fluid pressure, upper body arterial pressure, and aortic pressure beyond the aortic clamp. A short clamp time (<30 min), and distal aortic pressure>60 mmHg, minimizes the risks of spinal cord injury. ⋯ Aortic root angiogram had shown retrograde filling of both SCAs. A unique situation in which clamping of SCAs would increase flow to the spinal cord as their clamping would stop stealing of blood and aortic-clamping proximal to CoA will further increase collateral flow; because of these reasons, the patient tolerated prolonged aortic-clamping despite low distal aortic pressure without neurological deficit. However, aortic-clamping increased left ventricular after-load and the patient developed worsening of mitral regurgitation and pulmonary hypertension during aortic clamping.