Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Aug 2012
Case ReportsEndovascular stenting for type B dissection involving a right-sided aortic arch.
Endovascular stent-graft repair is emerging as the treatment of choice for complicated type B aortic dissection. In this report we describe a patient who presented with type B aortic dissection involving a right-sided aortic arch (RAA), a rare congenital vascular anomaly. ⋯ Given the greater complexity of conventional surgical repair and the limited experience with this rare malformation, endovascular repair was preferred and successfully performed. We report the first case of endovascular repair of type B dissection involving RAA, confirming that endovascular treatment is technically feasible also when the dissection involves this unusual vascular malformation.
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Interact Cardiovasc Thorac Surg · Aug 2012
Case ReportsPreservation of systemic tricuspid valve function by pulmonary conduit banding in a patient with corrected transposition of the great arteries.
Systemic tricuspid valve regurgitation increases mortality and morbidity in patients with a corrected transposition of the great arteries. A 17-year old male with a physiologically corrected transposition after the closure of a ventricular septal defect and conduit placement between a morphological left ventricle and pulmonary artery presented with exertional dyspnoea. The transthoracic echocardiography showed a severe conduit stenosis, and cardiac catheterization revealed a pressure gradient of 114 mmHg. ⋯ Pulmonary conduit banding was performed under transoesophageal echocardiography guidance, during which the left ventricular to right ventricular pressure ratio increased from 0.33 to 0.60 and the degree of tricuspid regurgitation decreased mildly. The patient was discharged uneventfully at postoperative day 16. Conduit banding might be a useful technique to preserve the systemic tricuspid valve function during conduit re-replacement in patients with a corrected transposition.
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Interact Cardiovasc Thorac Surg · Aug 2012
Case ReportsHaemostasis of a right ventricle-gunshot wound using a novel haemostatic vacuum device.
Heart wounds are frequently fatal. The haemorrhage from a right ventricle-gunshot wound in a male patient was successfully controlled using a novel haemostatic vacuum device. This case report shows how this simple, quick and efficient method can be used to control critical bleedings.
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Interact Cardiovasc Thorac Surg · Aug 2012
Case ReportsSpontaneous ascending aortic intramural haematoma in a patient on dabigatran.
A patient on oral anticoagulation with dabigatran presented with chest pain and dyspnoea. A CT scan of the chest revealed an intramural haematoma of the ascending aorta with a large pericardial effusion. The patient underwent a modified Bentall procedure. In the absence of a specific antidote for this novel oral anticoagulant medication, even in an emergency situation, successful surgical treatment was possible with an aggressive use of available prohaemostatic agents.
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Interact Cardiovasc Thorac Surg · Aug 2012
Does the number of wires used to close a sternotomy have an impact on deep sternal wound infection?
We studied the influence of the number of sternotomy mechanical fixation points on deep sternal wound infection (DSWI). ⋯ DSWI is associated with hypoxia, ischaemia, sepsis and mechanical sternal instability. DSWI may be prevented by using nine or more paired fixation points when closing with standard peri-sternal wires.