The Annals of thoracic surgery
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Giant false or pseudoaneurysm of the aorta is a rare but dreadful complication occurring several months or years after cardiac or aortic surgery. We describe a surgical approach that allowed safe reentry in the chest in five patients, with a mean follow-up of almost seven years. ⋯ The technique of separate carotid cannulation and selective antegrade brain perfusion with cold blood during circulatory arrest at moderate core hypothermia has, in our opinion, many advantages. In addition to allowing harmless opening of the chest in the presence of most dangerous mediastinal false aneurysms, it implies no general deep hypothermia, reduced duration of cardiopulmonary bypass, and circulatory arrest of the lower part of the body, and safe and permanent brain protection throughout chest opening and mediastinal division. It has allowed us to safely reoperate on patients who are generally considered as a major surgical risk.
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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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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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We report the case of a patient who had an intubation-related tracheal injury who we treated by deployment of a covered tracheal stent. This approach may be preferable to other alternatives in patients with a prohibitive risk of mortality with surgical repair or in an injury with sequelae not suitable for conservative management.
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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.