The Annals of thoracic surgery
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Comparative Study
Blake drains: a novel method of chest drainage after extracardiac fontan operation with autologous pericardium.
Pleural effusions after Fontan palliation remain a cause of increased length of stay, cost, and morbidity. We report our experience with Blake drains (BDs) and the outpatient pediatric pleural drain pathway after Fontan operation. ⋯ Silicone BDs are safe and effective after ECLT Fontan operation. Hospital length of stay and cost can be significantly decreased when these drains are used with appropriate family involvement and close outpatient surveillance.
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Comparative Study
Postoperative assessment of laryngopharyngeal dysfunction in neonates after Norwood operation.
The purpose of this study was to evaluate the incidence of vocal cord (VC) and swallowing dysfunction in infants after the Norwood operation and to examine the relationship between laryngopharyngeal dysfunction and postoperative outcomes. ⋯ Vocal cord and swallowing dysfunction are common in infants after the Norwood operation and may increase the need for tube feeding regimens. Modification of surgical techniques for dissection and mobilization of the aorta can significantly reduce the incidence of these adverse outcomes.
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Comparative Study
Impact of preoperative anemia on outcome in adult cardiac surgery: a propensity-matched analysis.
Preoperative anemia is not considered an operative mortality risk factor by the majority of the risk stratification tools used in cardiac surgery. However, retrospective studies have found associations between preoperative anemia and morbidity and mortality in cardiac operations. The present study compares the postoperative outcome of a group of moderate-to-severe anemic patients with a propensity-matched group of nonanemic patients undergoing cardiac operations. ⋯ Moderate-to-severe preoperative anemia is a risk factor for major morbidity and operative mortality in adult cardiac operations. This finding is confirmative of the role of preoperative anemia in determining adverse events in major noncardiac operations. The exclusion of preoperative anemia from the existing risk scores is probably a statistical consequence of the associated comorbid conditions that confound the specific role of anemia as a risk factor.
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Case Reports
Three-dimensional transesophageal echocardiography of a thrombus entrapped by a patent foramen ovale.
The substrate of paradoxic embolization is a patent foramen ovale allowing right-to-left passage of embolic material. A thrombus in transit entrapped by a patent foramen straddling an atrial septal aneurysm is an exceedingly transient condition rarely documented on imaging studies. ⋯ Intraoperative real-time three-dimensional transesophageal echocardiography allowed accurate spatial characterization of the thrombus and correlated closely with surgical findings. It provided more realistic intraoperative guidance compared with conventional two-dimensional transesophageal echocardiography.
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An interventional lung assist membrane ventilator (iLA) for arteriovenous extracorporeal CO2 removal was connected to a small-diameter femoral artery by use of a chimney graft in an underweight patient with acute respiratory failure and a previous history of heart-lung transplantation. This concept offers additional therapeutic options in underweight patients requiring extracorporeal CO2 removal with arterial vessels that are too small for percutaneous arterial cannulation with standard-sized percutaneous insertable iLA cannulae.