The Annals of thoracic surgery
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Right diaphragmatic plication was performed in a 62-year-old man who underwent right sleeve pneumonectomy and then required prolonged mechanical ventilation owing to right diaphragmatic paralysis. The plication was very effective in allowing him to be weaned from the ventilator. The transdiaphragmatic pressure, the ratio of gastric to esophageal pressure swing, and the work of breathing per liter of ventilation improved remarkably after plication. Our experience indicates the beneficial effect of such a plication on contralateral lung function from the standpoint of clinical and respiratory mechanics.
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The Damus-Kaye-Stansel operation is useful in the management of complex congenital heart defects. We reviewed our experience with 23 patients who underwent a Damus-Kaye-Stansel procedure. The anastomotic technique was individualized depending on the anatomy. ⋯ Four patients underwent late revision of the Damus-Kaye-Stansel connection. All survivors are asymptomatic. We conclude that the Damus-Kaye-Stansel connection provides excellent midterm results when the proximal anastomosis is adapted to the anatomy of the patient.
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Diaphragmatic paralysis developed in an adult after a cardiac operation. The patient suffered from recurrent fevers and could not be weaned from mechanical ventilatory support. Diaphragmatic plication was performed and enabled rapid and sustained weaning from respiratory support.
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Video-assisted thoracoscopic technique was evaluated in 28 patients who underwent operation for massive pericardial effusion. Excellent results were obtained using this newly developed approach for inspection of all pericardial surfaces as well as pleural and pulmonary disorders. No perioperative or postoperative complications ensued. ⋯ From our experience, video-assisted thoracoscopy was a safe and effective procedure, especially for those patients with combined pericardial effusion and abnormal pulmonary or pleural pathology in whom subxiphoid pericardial window was not clearly diagnostic at the time of operation. It was effective also in the situation with recurrent or loculated pericardial effusion which allowed localization and drainage of it. We believe that the use of videothoracoscopy to visualize the whole pericardial and pleural cavity will continue to be of great benefit to patients with combined pericardial and pleural/lung diseases.
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Comment Letter Case Reports
Percutaneous cardiopulmonary bypass for hypothermic cardiac arrest.