Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jul 2011
Case ReportsMalpositioning of the chest tube across the anterior mediastinum is risky in chronic obstructive pulmonary disease patients with pneumothorax.
Malpositioning is one of the most common complications of chest tube insertion and is associated with increased morbidity and mortality. We present two cases of patients with chronic obstructive pulmonary disorder (COPD) in whom malpositioned chest tubes penetrated through the anterior mediastinum to the contralateral pleural cavity, and were later removed without complications. Both patients had a relatively wide retrosternal airspace and received blunt dissection with a trocar for percutaneous chest tube insertion, which may have increased the risk of chest tube penetration through the anterior mediastinum during tube thoracostomy. Further, the precise location of the malpositioned chest tubes could not be confirmed by single-view anteroposterior portable chest radiography, and computed tomography (CT)-scan was more helpful in the diagnosis and management of the cases reported herein.
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Interact Cardiovasc Thorac Surg · Jul 2011
Randomized Controlled TrialResults of coronary artery bypass grafting alone and combined with surgical ventricular reconstruction for ischemic heart failure.
In this study, we included 236 patients with ischemic heart failure and ejection fraction (EF) <35% who underwent surgical treatment. Patients were randomized in two groups. There were 116 patients who underwent coronary artery bypass grafting (CABG) with surgical ventricular reconstruction (SVR) and 120 patients who underwent CABG alone. ⋯ However, after isolated CABG EF did not increase significantly (32±7 preoperatively and 34±11 postoperatively). One- and three-year rates were 95% and 78% after SVR with CABG and 83% and 78% after CABG alone. Despite the more aggressive surgical strategy, left ventricular reconstruction did not increase operative mortality and early results were significantly effective compared with coronary artery bypass grafting alone.
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Interact Cardiovasc Thorac Surg · Jul 2011
ReviewShould all patients who have mesothelioma diagnosed by video-assisted thoracoscopic surgery have their intervention sites irradiated?
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether patients diagnosed with mesothelioma by video-assisted thoracoscopic surgery should have their intervention sites irradiated to prevent metastatic seeding. Altogether 334 papers were found using the reported search, of which nine represented the best evidence to answer the clinical question. ⋯ One reported that median survival between patients with and without local metastases was not significantly different (P=0.64) while another article described no local metastases in PIT sites. None of the studies reported significant skin or side reactions and treatment was generally well tolerated. Based on the available evidence, we conclude that PIT is not currently justified.
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Interact Cardiovasc Thorac Surg · Jul 2011
Comparative StudyContinuous cardiac output monitoring with an uncalibrated pulse contour method in patients supported with mechanical pulsatile assist device.
We evaluated the accuracy of an uncalibrated pulse contour method called Pressure Recording Analytical Method (PRAM) compared with continuous thermodilution for cardiac output (CO) monitoring in patients implanted with a pulsatile left ventricular assist device (LVAD). Twelve adult patients implanted with the HeartMate I-XVE device were studied. CO was simultaneously evaluated by PRAM and by continuous thermodilution. ⋯ A good correlation was found between LVAD-CO and either ThD-CCO (r=0.88) or PRAM-CO (r=0.86), but an overestimation of 10% was observed for both PRAM-CO (mean bias -0.44 l/min) and ThD-CCO (mean bias -0.40 l/min). Our results demonstrated good agreements between PRAM-CO, ThD-CCO and LVAD-CO. PRAM derives CO from a peripheral artery without calibration and may be a complementary tool in the hemodynamic assessment of patients supported with a VAD.
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Interact Cardiovasc Thorac Surg · Jul 2011
Case ReportsCardiogenic shock due to pheochromocytoma rescued by extracorporeal membrane oxygenation.
This is the case of a 49-year-old female presenting in sustained cardiogenic shock due to an adrenal pheochromocytoma. She was rescued by venoarterial extracorporeal membrane oxygenation. ⋯ Successful open adrenalectomy was performed under protective extracorporeal life support and full anticoagulation early after cardiogenic shock. The patient could be weaned off mechanical support rapidly and made a full cardiopulmonary recovery.