Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Oct 2011
Case ReportsNeonatal repair of right interrupted aortic arch with cerebro-myocardial perfusion technique.
Right interrupted aortic arch and descending aorta is exceedingly rare and most likely cause respiratory presentation, since patent ductus arteriosus (PDA) courses over the right mainstem bronchus. We report a case of successful neonatal biventricular repair of a right interrupted aortic arch (type B), with an aberrant right subclavian artery ventricular septal defect (VSD) in a 2.7 kg term neonate with DiGeorge syndrome. Patient presented in severe respiratory distress and acidosis at one day old. ⋯ A direct tension-free anastomosis was attained. Her postoperative course was uneventful and her respiratory symptoms disappeared postoperatively. Early surgical correction is mandatory for these patients with unique anatomy and presentation.
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Interact Cardiovasc Thorac Surg · Oct 2011
Case ReportsCombined valve-sparing root replacement and total arch replacement with frozen elephant trunk.
We report a case of simultaneous repair of an extensive thoracic aortic aneurysm from the aortic root to the distal aortic arch. A 54-year-old male had annuloaortic ectasia and a transverse aortic and distal arch aneurysm. Aneurysms of the descending aorta and the abdominal aorta were also demonstrated. ⋯ Total arch replacement with the frozen elephant trunk technique is efficacious to exclude distal arch aneurysm or descending aortic aneurysm through median sternotomy. An aortic valve-sparing operation was developed to preserve the native aortic valve function in order to improve the patient's quality of life. We herein report a case of concomitant total arch replacement using a frozen elephant trunk and aortic valve-sparing operation for extensive thoracic aortic aneurysm.
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Interact Cardiovasc Thorac Surg · Oct 2011
Case ReportsMultiple costal cartilage graft reconstruction for the treatment of a full-length laryngotracheal stenosis after an inhalation burn.
After suffering an inhalation burn, a 22-year-old male was intubated for seven days. Full-length massive scar formation in the upper airway necessitated tracheostomy five months later. After this, the stenosis became complete in the cricoid region, and a long cannula was needed to maintain the severely damaged middle-distal trachea. ⋯ The middle portion of the trachea was expanded with a similar graft inserted into the anterior wall below the tracheostomy. The fixing T-tube was removed three months later, and the patient had an adequate airway two years after the last procedure. We conclude that multiple cartilage graft reconstruction can be successful even after the development of an extremely long airway stenosis following inhalation burn injury.
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Interact Cardiovasc Thorac Surg · Sep 2011
ReviewIs preoperative physiotherapy/pulmonary rehabilitation beneficial in lung resection patients?
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was whether preoperative physiotherapy/pulmonary rehabilitation is beneficial for patients undergoing lung resection. Ten papers were identified using the reported search, of which five represented the best evidence to answer the clinical question. ⋯ A prospective randomised controlled study in 1997, showed that two weeks of PRP followed by two months of postoperative rehabilitation produced a better predicted postoperative forced expiratory volume in one second in the study group than in the control group at three months (lobectomy + 570 ml vs. -70 ml; pneumonectomy + 680 ml vs. -110 ml). We conclude that preoperative physiotherapy improves exercise capacity and preserves pulmonary function following surgery. Whether these benefits translate into a reduction in postoperative pulmonary complication is uncertain.
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Interact Cardiovasc Thorac Surg · Sep 2011
ReviewDo patients with haemophilia undergoing cardiac surgery have good surgical outcomes?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether patients with haemophilia undergoing cardiac surgery have good surgical outcomes. Haemophilia A and haemophilia B are sex-linked recessive inherited diseases affecting males only, with females acting as carriers. ⋯ Intraoperative plasma factor levels can be easily measured before heparin and after protamine sulphate administration, whereas during cardiopulmonary bypass this will require a chromogenic method. Exposure to factor concentrates early in the life might predispose a patient with severe haemophilia to the development of inhibitors. Moreover, the absence of inhibitors should be confirmed before any surgical procedure.