The Annals of thoracic surgery
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The systemic morphologic right ventricle (RV) in congenitally corrected transposition of the great arteries or after atrial switch for transposition of the great arteries is associated with late ventricular failure. Although the role of the left ventricular assist device (LVAD) in supporting the failing LV is established, the indications and outcomes of using LVAD in a systemic RV remain unclear. We assessed the role of a third-generation LVAD for systemic RV support. ⋯ The third-generation VAD provides durable support for systemic RV failure as a bridge to transplant and as a strategy to reduce pulmonary vascular resistance. Although concomitant subpulmonic LV failure is common, systemic RV support alone was achieved in all patients.
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Uncommonly, adults with functionally univentricular hearts are becoming candidates for a Fontan procedure. The purpose of this study was to evaluate the course of patients undergoing the modified Fontan procedure with an extracardiac conduit in recent years. ⋯ The modified Fontan procedure with use of an extracardiac conduit can be performed in adults with encouraging early and midterm results. The majority of late survivors had improved quality of life. The incidence of late death, reoperation, arrhythmias, and thromboembolic events was low during follow-up.
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Although early primary repair of tetralogy of Fallot has gained wider acceptance, there is some speculation that repair at a younger age may be associated with increased morbidity and resource utilization. ⋯ Extracardiac anomalies, prematurity, low birth weight, and nonelective surgical intervention are predictors of increased morbidity and increased hospital resource utilization and impose a significant cost burden to the care of these patients. Early primary repair of tetralogy of Fallot can be safely performed without any increase in morbidity or increased hospital resource utilization.
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Uniportal video-assisted thoracoscopic surgery (VATS) has recently been introduced for various thoracic diseases. However, management of peripheral lung nodules by uniportal VATS without tracheal intubation has rarely been attempted. We evaluated the feasibility and safety of nonintubated uniportal VATS for peripheral lung nodules. ⋯ Nonintubated uniportal VATS is technically feasible and safe for selected patients and is a less invasive alternative in managing indeterminate peripheral lung nodules.
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Surgical stabilization of the rib fractures has been successfully performed for the management of pain in multiple rib fractures, fixation of chronically painful nonunion, reduction of overriding ribs, and flail chest cases. Herein we report a patient who was treated with titanium rib clips after a motor vehicle accident leading to pulmonary parenchymal laceration and multiple painful rib fractures. ⋯ The patient underwent the second operation for restabilization of the broken ribs. We review the relevant literature, with particular emphasis on the management of this complication.