General thoracic and cardiovascular surgery
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Gen Thorac Cardiovasc Surg · May 2012
Case ReportsComplete atrioventricular block subsequent to thrombosed-type acute aortic dissection.
We report a case of complete atrioventricular block subsequent to thrombosed-type acute aortic dissection. An 81-year-old woman with thrombosed-type acute aortic dissection experienced cardiopulmonary arrest and complete atrioventricular block 6 days after aortic dissection. ⋯ Atrioventricular conductivity disorders that result in complete atrioventricular block are rare complications developing after aortic dissection, especially thrombosed-type aortic dissection. We discuss the cause of atrioventricular block subsequent to aortic dissection.
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Gen Thorac Cardiovasc Surg · May 2012
Short-term and long-term outcomes of postinfarction ventricular septal perforation.
Ventricular septal perforation represents a serious complication after acute myocardial infarction. This study aimed to evaluate the short-term and longterm outcomes of postinfarction ventricular septal perforation (VSP). ⋯ The long-term survival outcome of VSP patients during the postoperative period was comparatively good, but the prognosis of VSP patients with multivessel disease was not satisfactory because of congestive heart failure or ventricular arrhythmia. We believe that postoperative medical treatment for preventing cardiac remodeling is important for improving long-term survival outcomes in such patients.
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Gen Thorac Cardiovasc Surg · Apr 2012
Propensity analysis of outcome in coronary artery bypass graft surgery patients >75 years old.
We looked at the complications and hospital resources of an elderly population undergoing first-time isolated coronary artery bypass graft surgery (CABG) in comparison to a younger counterpart for a propensity matched cohort. ⋯ Elderly patients undergoing CABG had significantly higher rates of postoperative complications. Their prolonged hospital stay and consequently higher resources utilization need to be adequately highlighted to heath care officials and appropriately addressed.
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Gen Thorac Cardiovasc Surg · Apr 2012
Review Historical ArticleTrends in and perspectives on extracorporeal membrane oxygenation for severe adult respiratory failure.
Various approaches such as ventilator management involving lung-protective ventilation, corticosteroids, prone positioning, and nitric oxide have failed to maintain sufficient lung oxygenation or appropriate ventilation competence in very severe acute respiratory distress syndrome (ARDS). Extracorporeal membrane oxygenation (ECMO) has been aggressively introduced for such patients, although in only a few institutions. The clinical usefulness of ECMO in a large-scale multicenter study (CESAR trial, 2009) and continued development/improvement of ECMO devices have facilitated performance of ECMO, with further increase in the number of institutions adopting ECMO therapy. ⋯ ECMO requires establishment of an appropriate management system to minimize fatal complications (e.g., hemorrhage), which requires a multidisciplinary team. This, in combination with a new technique, interventional lung assist, will further extend the indications for ECMO. ECMO can be expected to gain importance as a respiratory support technique.
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Gen Thorac Cardiovasc Surg · Mar 2012
Review Case ReportsFirst experience of robotic extended thymectomy in Japan for myasthenia gravis with thymoma.
We performed robot (da Vinci)-assisted thoracoscopic extended thymectomy (rThx) for myasthenia gravis with thymoma. The patient was a 66-year-old woman who complained of palpebral heaviness. Robotic operation was performed in the supine position by placing four ports in the right chest wall under 10 mmHg CO(2) insufflation using three arms and one assist port. ⋯ The operating time was 298 min, console operating time was 203 min, and the amount of bleeding was small. The postoperative course was uneventful with no complications. This is a report of the first Japanese case of rThx for myasthenia gravis. rThx is a promising technique, and further improvement in the procedure is expected.