General thoracic and cardiovascular surgery
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Gen Thorac Cardiovasc Surg · Aug 2011
High-velocity penetrating thoracic trauma with suspected cardiac involvement in a combat support hospital.
The most common cardiac injuries in the United States are blunt trauma from motor vehicle accidents or low-velocity trauma from stabbings. During military conflict, high-velocity injuries, including gunshot wounds (GSW) and fragment injury from improvised explosive devices (IED), are relatively more common. ⋯ This case series is too small to draw definitive conclusions; however, a multidisciplinary approach to high-velocity injuries with potential for cardiac involvement augments preoperative assessment for myocardial injury and may allow selective nonoperative management.
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A cleft of the sternum is a rare congenital anomaly. We report a rare case of complete sternal cleft in a 25-year-old woman. After surgical correction of the pectus excavatum, complete closure by direct approximation of the freshened sternal remnants to the midline, without interposition of tissue graft or inert prosthesis, was achieved in our patient. The functional and cosmetic result was excellent after complete healing.
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Comprehensive evaluation of our patients before putting them under "the knife" can never be overemphasized. It is our duty to care for the patients. ⋯ For many years, we have striven to make our method thorough and safe for all patients. We propose here a simple, comprehensive preassessment form that is easily applicable in any unit.
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Gen Thorac Cardiovasc Surg · Aug 2011
Case ReportsPatch annulo-aortoplasty in an adult patient with congenital supravalvular aortic stenosis and a small aortic annulus.
A 39-year-old woman with familial homozygous hypercholesterolemia had supravalvular and valvular aortic stenosis. Modified Nick's procedure and aortic valve replacement was performed to relieve both the supravalvular and annular stenoses. ⋯ Histological examination of the aortic cusps showed sclerotic change due to hypercholesterolemia. These findings indicated that familial homozygous hypercholesterolemia caused valvular aortic stenosis and exacerbated congenital supravalvular aortic stenosis.
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Gen Thorac Cardiovasc Surg · Jul 2011
The importance of preoperative magnetic resonance imaging in valve surgery for active infective endocarditis.
Valve surgery for active infective endocarditis (IE) can cause fatal brain hemorrhage. Our current study aimed to evaluate the incidence of septic cerebral lesions in active IE patients by performing preoperative magnetic resonance imaging (MRI) including T(2)*- weighted sequences and magnetic resonance angiography (MRA) before urgent valve surgery, and to investigate whether such preoperative evaluation affects postoperative outcomes. ⋯ MRI of patients with active IE revealed a high incidence of cerebral lesions caused by IE. The use of MRI to detect septic embolism and intracerebral hemorrhage may provide important information for better surgical outcomes.