Interactive cardiovascular and thoracic surgery
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Individual performance indicators for cardiac surgeons in the UK were published in 2004. A comprehensive update published in 2009 reported statistically significant decreases in mortality rates suggesting that the publication of this data may have contributed to this improvement in outcomes. In view of this, the authors present an assessment of the attitudes of cardiac surgeons to individual performance tables, having performed this by sending questionnaires exploring the surgeon's views on performance tables to UK cardiac surgeons in 2005 and 2009. ⋯ The attitude of the consultants towards the possible effect of this data on the management of high-risk patients also changed, with fewer consultants believing they would (P=0.0001) or may (P=0.023) avoid these patients. The observed change in attitude of cardiac surgeons may be due to acclimatization to an established system of audit, improved mortality rates, a desire for more transparency following the Bristol Enquiry, or improved risk stratification. These findings may be of benefit to those tasked with initiating these indicators elsewhere.
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Interact Cardiovasc Thorac Surg · Apr 2011
Case ReportsEnucleation of calcium core and in-situ valve replacement for massive posterior mitral annular calcification.
A 67-year-old female was admitted to our hospital for surgical treatment of the aortic and mitral valvular disease. She had chronic renal failure and dialysis was started 13 years previously. ⋯ The posterior mitral annulus was reconstructed using equine pericardium and aortic and mitral valve replacement was performed. The postoperative course was uneventful.
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Interact Cardiovasc Thorac Surg · Apr 2011
Case ReportsNegative-pressure pulmonary edema presented with concomitant spontaneous pneumomediastinum: Moore meets Macklin.
Negative-pressure pulmonary edema is an unusual complication mainly associated with general anesthesia. It is caused by excessive negative intrathoracic pressure following a deep inspiration against an acute airway obstruction. The resultant decreased intrathoracic pressure amplifies venous return to the right heart and increases pulmonary capillary wedge pressure that can be further amplified by massive sympathetic discharge due to hypoxia. ⋯ We experienced a case of negative pulmonary edema which presented in association with SP. Pneumomediastinum is probably caused by an excessive positive intrathoracic pressure for a subsequent expiration against a closed airway. In the present case, both complications resolved with conservative management.