Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Mar 2010
Cardiac troponin I levels after cardiac surgery as predictor for in-hospital mortality.
Troponin is a specific marker of myocardial damage. Increased troponins, however, are observed after almost all cardiac surgery. The clinical significance of this elevation is controversial. The aim of this study was to evaluate if troponin I (cTnI) measured 1 h after cardiac surgery provides additional information to identify patients at risk for hospital mortality. ⋯ Postoperative cTnI level, measured within the first hour after cardiac surgery, can identify a subgroup of patients with increased risk for hospital mortality. These patients may benefit from better monitoring, eventually with specific diagnostic and therapeutic interventions.
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Interact Cardiovasc Thorac Surg · Mar 2010
Case ReportsInfected aneurysm of the aortic arch with purulent pericarditis caused by Streptococcus pneumoniae.
A 76-year-old woman had a chest pain and high fever, and was admitted to the intensive care unit diagnosed as acute pericarditis. Enhanced CT-scan showed a 47-mm aneurysm in the aortic arch which seemed to be impending rupture and the part of the aorta looked like a pseudoaneurysm. Emergent total aortic arch replacement with a rifampicin-bonded Dacron graft was performed. ⋯ The infection of the aorta, with erosion into the pericardial space, seemed to be the cause of purulent pericarditis. Antibiotic therapy was commenced immediately after surgery and continued for four weeks. Though she had neurological deficit after surgery, her infection was well controlled and there was no recurrence of infection 11 months after surgery.
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Interact Cardiovasc Thorac Surg · Mar 2010
Case ReportsThe rupture of descending thoracic aorta due to the necrosis of aortic intimal sarcoma.
Aortic intimal sarcoma is rare and the prognosis is very poor. We experienced a case of ruptured aortic intimal sarcoma in the descending aorta. A 69-year-old man underwent an emergency operation for the rupture of descending aorta. ⋯ The histological examination of aortic wall showed aortic intimal sarcoma. The patient developed a local recurrence and abdominal dissemination of the tumor three months after surgery. We report the case and discuss about the diagnosis and treatment of thoracic aortic intimal sarcoma.
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Interact Cardiovasc Thorac Surg · Mar 2010
Case ReportsOperative stabilization of skeletal chest injuries secondary to cardiopulmonary resuscitation in a cardiac surgical patient.
Chest injury, including sternal and rib fractures, is the most common complication of cardiopulmonary resuscitation (CPR) that usually heals spontaneously. However, a small subset of patients has fractures that need mechanical treatment. We present a case of flail chest with sternum and left anterior rib fractures secondary to CPR in a cardiac surgical patient, which was mechanically ventilated due to respiratory complications. ⋯ The patient had an uneventful postoperative course, painfree, and experienced no sternal instability or infection throughout a six-month follow-up period. Sternal instability after cardiac surgery occurs infrequently but can be challenging to manage. Titanium plate fixation is an effective method to stabilize complicated flail chest, with clinical utility in a cardiothoracic practice.
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Interact Cardiovasc Thorac Surg · Mar 2010
Case ReportsIntraoperative fluorescence imaging during surgery for coronary artery fistula.
A 45-year-old man had a history of myocardial infarction at one month prior to admission. Coronary angiography revealed a dilated fistula originating from the left anterior descending coronary artery to the pulmonary artery. Two orifices of the draining artery were closed through pulmonary arteriotomy. ⋯ Before and after the cardiopulmonary bypass, fluorescent dye angiography was performed with indocyanine green. Fluorescence imaging revealed complete closure of the fistula and no residual shunt flow. Postoperative coronary angiography revealed neither a residual fistula nor injury to the coronary artery.