The Annals of thoracic surgery
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Spontaneous coronary artery dissection is an extremely rare event occurring especially in pregnant women, either peripartum or postpartum. Urgent coronary angiography has to be performed to confirm the diagnosis and to determine the appropriate therapeutic strategy. ⋯ While she was on aortic balloon counterpulsation the patient underwent a cesarean section and gave birth to a healthy child. Subsequently she successfully underwent off-pump coronary artery bypass surgery.
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Randomized Controlled Trial Comparative Study
Attenuated renal and intestinal injury after use of a mini-cardiopulmonary bypass system.
Transient, subclinical myocardial, renal, intestinal, and hepatic tissue injury and impaired homeostasis is detectable even in low-risk patients undergoing conventional cardiopulmonary bypass (CPB). Small extracorporeal closed circuits with low priming volumes and optimized perfusion have been developed to reduce deleterious effects of CPB. ⋯ The use of the mini-CPB system during myocardial revascularization represents a viable nonpharmacologic strategy that can attenuate the alterations in the hemostatic system, reduce bleeding and transfusion requirements, decrease systemic inflammatory response, and reduce immediate postoperative renal and intestinal tissue injury.
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Comparative Study
Propensity-matched analysis of three techniques for intrathoracic esophagogastric anastomosis.
A cervical side-to-side stapled esophagogastric anastomosis appears to decrease morbidity compared with traditional hand-sewn techniques. We evaluated our experience with this novel technique in intrathoracic anastomoses and compared the outcome with circular-stapled or hand-sewn techniques. ⋯ In this carefully matched group of patients, intrathoracic use of the side-to-side stapled esophagogastric anastomosis in esophageal cancer patients is safe and effective. Postoperative dysphagia and need for stricture dilation may be decreased using a stapled compared with a traditional hand-sewn anastomosis.
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Comparative Study
Bypass graft and native postanastomotic coronary artery patency: assessment with computed tomography.
Multidetector computed tomography has been shown to be useful in the evaluation of coronary artery bypass grafts in previous studies. We studied the accuracy of multidetector computed tomography in the detection of patency and significant stenosis of both grafts and native postanastomotic coronary arteries. ⋯ Multidetector computed tomography allows a very accurate assessment of arterial and venous conduits and of postanastomotic native coronary arteries in patients with previous bypass graft. Despite high feasibility (93.1%), limitations of the method were breath-hold duration (35 to 40 s) and postanastomotic assessment of small vessels (which, however, precluded the analysis in only 4.6% of cases).
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Improvement of quality of life by minimally invasive repair of pectus excavatum (MIRPE) has been demonstrated only for the period with implanted pectus bar. The aim of this study was to demonstrate the effects of MIRPE on psychosocial and physical well-being after removal of the pectus bar. ⋯ The positive impact of MIRPE on psychosocial and physical well-being in children and adolescents persists after bar removal. Thus we consider MIRPE to be justified for cosmetic reasons.