General thoracic and cardiovascular surgery
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Gen Thorac Cardiovasc Surg · Sep 2012
Case ReportsSpontaneous hemo-pneumothorax in a patient with Ehlers-Danlos syndrome.
Spontaneous hemo-pneumothorax is one of the pulmonary complications of connective tissue disorders such as Ehlers-Danlos syndrome (EDS). Most thoracic surgeons overlook this fact and they consider it as primary. In the following report, we describe a unique case of spontaneous recurrent hemo-pneumothorax in a young patient with undiagnosed EDS. The aim of this presentation is to raise a high index of suspicion of every thoracic surgeon to include in his differential diagnosis, the connective tissue disorders in any case of spontaneous hemo-pneumothorax.
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Gen Thorac Cardiovasc Surg · Sep 2012
Case ReportsBilateral dissemination of malignant pleural mesothelioma via iatrogenic buffalo chest: a rare route of disease progression.
Buffalo chest refers to the pleuro-pleural communication that results in a single pleural cavity. Iatrogenic buffalo chest can occur following heart or heart-lung transplantation and other major thoracic surgeries. ⋯ The free communication between bilateral pleural cavities had facilitated the rapid progression of tumor and the consequent bilateral malignant pleural effusions had made the management of disease much more difficult, leading to the early fatal outcome. To our knowledge, this is the first case of buffalo chest that was associated with bilateral malignant pleural effusions.
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Gen Thorac Cardiovasc Surg · Sep 2012
Case ReportsEmergent combined repairs for aortic injury and bowel perforation after blunt trauma.
Traumatic aortic rupture is frequently associated with multi-system injuries and is often immediately fatal. Although delayed open repair or endovascular repair has been recommended for an acceptable outcome, an emergency operation is mandatory for a life-threatening condition. We present here a challenging case of survival after immediate, combined repairs for acute aortic injury and bowel perforation.
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Gen Thorac Cardiovasc Surg · Sep 2012
ReviewSurgical reoxygenation injury of the myocardium in cyanotic patients: clinical relevance and therapeutic strategies by normoxic management during cardiopulmonary bypass.
Cyanotic hearts are associated with depleted endogenous antioxidants (glutathione peroxidase, superoxide dismutase, and catalase), and thereby is more susceptible to myocardial ischemia/reperfusion injury during open heart surgery compared with acyanotic ones. Clinically, when surgery is performed on cyanotic infants, cardiopulmonary bypass (CPB) is usually initiated at high PaO(2), without consideration of possible cytotoxic effects of hyperoxia. The concept of "surgical reoxygenation injury of cyanotic myocardium" was proposed, wherein unintended abrupt reoxygenation of cyanotic myocardium at the onset of routine CPB causes oxygen-mediated injury, which may render the reoxygenated myocardium more susceptible to subsequent surgical ischemia/reperfusion injury and accentuates post-CPB myocardial dysfunction. ⋯ The clinical relevance of this injury was shown by subsequent clinical studies, which demonstrated depleted antioxidant reserve capacity and troponin release during the initial reoxygenation on hyperoxic CPB prior to cardioplegic arrest. Furthermore recent randomized clinical trials verified that hyperoxic CPB provokes biochemical multi-organ damage including myocardium, lung, liver, and brain after open heart surgery in cyanotic patients, which can be successfully reduce by normoxic CPB management (i.e., reducing PaO(2) at onset of CPB, gradual reoxygenation and controlled reoxygenation protocol). Based on these experimental and clinical studies, avoidance of using hyperoxic PaO(2) on routine CPB is strongly recommended in the cyanotic patients.
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Gen Thorac Cardiovasc Surg · Sep 2012
Case ReportsMitral valve plasty in an adult patient without a right superior vena cava.
Persistent left superior vena cava without a right superior vena cava is an extremely rare condition. We report the case of a 65-year-old woman with this condition who underwent mitral valve plasty. During cardiac catheterization, the asymptomatic patient with mitral valve prolapse syndrome was found to have a persistent left superior vena cava without a right superior vena cava. ⋯ A cannula was inserted into the persistent left superior vena cava to provide a large surgical field in the left atrium. We selected a technique that involved direct insertion of an L-shaped cannula into the persistent left superior vena cava and obtained a clear view of the surgical field. Proper assessment of the right superior vena cava is necessary when a persistent left superior vena cava is suspected.