Interactive cardiovascular and thoracic surgery
-
Interact Cardiovasc Thorac Surg · Dec 2008
Case ReportsTotal cavopulmonary connection for functionally single ventricle with pulmonary atresia and abnormal arborization of pulmonary arteries--exclusion of overwhelmed area by collateral arteries from Fontan circulation.
Functionally single ventricle with major aortopulmonary collateral arteries and pulmonary atresia is very rare. Surgical indication for this combination of abnormalities is still unclear and Fontan procedure is still a crucial challenge for the patient who has this anomaly. We report a case with asplenia, functionally single ventricle, pulmonary artesian and pulmonary abnormal arborization who successfully underwent staged Fontan operation. In this case, the left upper lobe area, where the flow from a Glenn shunt was overwhelmed by the collateral arterial blood flow, was excluded from the Fontan circulation by the ligation of the left upper pulmonary arterial branch at its most proximal side at the time of fenestrated extracardiac total cavopulmonary connection.
-
Interact Cardiovasc Thorac Surg · Dec 2008
Case ReportsEndovascular repair after stent elephant trunk procedure for extensive thoracic aortic aneurysm.
Hybrid surgical-endovascular procedure was conducted in a 46-year-old male with extensive thoracic aortic aneurysm. Ascending aorta and arch replacement combined with stent elephant trunk implantation was performed first. ⋯ Postoperative CTA showed total coverage of the descending aorta by stent-grafts and the descending aortic aneurysm was totally thrombo-excluded. Stent elephant trunk may be a better alternative to conventional elephant trunk in hybrid surgical-endovascular approaches in treatment of extensive thoracic aortic aneurysm.
-
Interact Cardiovasc Thorac Surg · Dec 2008
Case ReportsA rapid bail-out technique for reinsertion of a displaced tracheostomy tube in difficult situations.
Safe and rapid repositioning of a displaced tracheostomy tube is vital to protect the airway and to avoid a potentially life threatening situation. This article describes a simple bail-out technique to avert prolonged airway compromise. This is particularly useful in patients with obesity, large goitre or maxillofacial injuries.
-
Interact Cardiovasc Thorac Surg · Dec 2008
Case ReportsLeft ventricular pseudoaneurysm after pericardiocentesis.
We present the case of a patient with recurrent episodes of pericardial effusion and fever. During approximately one month, the patient was treated with double pericardiocentesis for cardiac tamponade and the last of them was interrupted for the suspect of left ventricular puncture due to aspiration of arterial blood from the needle used for pericardiocentesis. Considering the suspect of infective pleuro-pericarditis and patient's symptoms, a surgical drainage of the pericardial effusion was performed via right thoracotomy. ⋯ Exclusion of the LV pseudoaneurysm was performed using a Prolene 0 running suture on two strips of bovine pericardium, avoiding ECC use. The patient was discharged on the 7th postoperative day. Iatrogenic pseudoaneurysm caused by pericardiocentesis represents a very rare complication and it should be prevented by identifying the high-risk patients.
-
Interact Cardiovasc Thorac Surg · Dec 2008
Rapid and safe establishment of cardiopulmonary bypass in repair of acute aortic dissection: improved results with double cannulation.
There is no agreement at present as to which is the optimal site for artery cannulation for cardiopulmonary bypass in repair of acute aortic dissection (AAD). We have employed right axillary artery cannulation (RAAC) in combination with femoral artery cannulation to overcome the drawbacks of single cannulation. From January 2000 to August 2006, 88 patients underwent emergency surgical repair of the aortic arch (mean age 65+/-13 years, 37 men) for AAD. ⋯ The perioperative stroke rate was 5.7% (5 of 88). The hospital mortality rate of the 25 patients with preoperative malperfusion was 4.0% (1 of 25); the fatal case had coronary malperfusion. Our approach for AAD was associated with a low mortality even in patients with malperfusion.