The Annals of thoracic surgery
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Aortobronchial fistula is a rare complication of thoracic aortic operations that is fatal if not promptly diagnosed and repaired. The case of a 23-year-old woman who presented with an aortobronchial fistula after three previous left thoracotomies for thoracic aortic procedures is described.
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Technique of right heart protection and deairing during heartmate vented electric LVAD implantation.
Continued experience with the TCI Heartmate Ventricular Assist System has led to improvements in our ability to avoid and manage right heart dysfunction during weaning from cardiopulmonary bypass. The advent of the electric device has intensified the need for these techniques because of its elevated minimal heart rate (50 beats/min) at start-up and the demands this places on the native right heart. We have developed and here describe a technique we have used successfully in our last 8 patients to assist in deairing and filling of the ventricular assist device, to partially support the right heart during the initial wean from cardiopulmonary bypass, and to avoid occasional overdistention of the right heart during early high left ventricular assist device flow.
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Retained hemothorax and infected thoracic collections after trauma can be seen in up to 20% of patients initially treated with tube thoracostomy and have traditionally been treated nonoperatively, often with prolonged hospital stays. ⋯ Videothoracoscopy is an accurate, safe, and reliable operative therapy to evacuate retained thoracic collections. In 90% of the patients in whom the procedure was completed, good results were obtained, reducing hospital stay and possible complications. Videothoracoscopy should be the initial treatment in trauma patients with retained thoracic collections and should be used earlier and more frequently in these patients.
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We have previously shown the feasibility of assessing internal thoracic artery (ITA) size and blood flow hemodynamics before and after coronary artery bypass grafting using color-flow duplex ultrasound. This noninvasive method would be an ideal diagnostic tool for the evaluation of ITA graft status after therapeutic interventions in a patient with angina after coronary artery bypass grafting. The purpose of this study was to investigate the effects of nitroglycerin on the diameter and blood flow velocities of the left native ITA before coronary artery bypass grafting and the ITA graft postoperatively. ⋯ We conclude that instantaneous noninvasive measurement of ITA graft size and blood flow velocities after a therapeutic drug intervention may be clinically useful, particularly in a post-coronary artery bypass grafting patient with recurrent angina.