The Annals of thoracic surgery
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We report obstruction of an anomalous right coronary artery traversing between the pulmonary artery and aorta after placement of a 21-mm bovine bioprosthesis for critical aortic stenosis requiring emergency revascularization. Although this anomaly has been associated with sudden death syndrome, acute coronary ischemia resulting from aortic valve replacement in patients with anomalous coronary artery has not been sufficiently highlighted in the literature. Awareness of this issue may decrease the risk of this complication in patients with anomalous coronary anatomy undergoing aortic or pulmonary valve replacement. Furthermore, the need for careful preoperative imaging in patients undergoing semilunar valve replacement is essential.
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Trocars used during video-assisted thoracic surgery (VATS) present some technical disadvantages due to their rigid structure. We propose the use of an extra-small wound retractor system, designed for general surgery, as alternative to rigid trocar for camera port during VATS. In our experience the wound retractor presents 5 objective advantages: reduces intercostal nerve compression and skin injuries, improves the camera maneuverability, does not displace during operation, and protects the camera by any small parietal bleeding.