The Annals of thoracic surgery
-
Although periprocedural myocardial infarction frequently occurs with the robustness of percutaneous coronary intervention, the prognosis of the periprocedural myocardial infarction has been known to be relatively good compared with that of spontaneous myocardial infarction. We present a patient with a postinfarction ventricular septal defect, with cardiogenic shock, that developed 7 days after a percutaneous coronary intervention. Emergency surgical repair combined with coronary artery bypass grafting saved the patient, without complications.
-
Near-infrared spectroscopy (NIRS) is a noninvasive technique that allows continuous monitoring of regional hemoglobin oxygen saturation (rSo2). We evaluated its application to survey oxygenation of the spinal cord region during open thoracoabdominal aortic aneurysm (TAAA) repair and postoperatively in the intensive care unit (ICU). We also validated its association with motor-evoked potential (MEP) monitoring during the operation. ⋯ NIRS is an easily applicable noninvasive tool for continuous surveillance of oxygenation of the spinal cord region during TAAA repair and postoperatively in the intensive care unit. The rSo2 curves provide useful information concerning hemodynamic changes in oxygenation of the spinal cord region and might contribute to early detection of spinal cord ischemia. Further investigation is needed before broad clinical implementation.
-
Case Reports
Thoracic endovascular aortic repair after iatrogenic aortic dissection and false lumen stent grafting.
Iatrogenic aortic dissections are a severe complication after thoracic endovascular aortic repair, and treatment guidelines do not exist. Herein, we report a patient who experienced an iatrogenic type B aortic dissection during elective thoracic endovascular aortic repair and suggest an interventional treatment option.
-
Loeys-Dietz syndrome (LDS) results from mutations in receptors for the cytokine transforming growth factor-β leading to aggressive aortic pathology sometimes accompanied by specific phenotypic features including bifid uvula, hypertelorism, cleft palate, and generalized arterial tortuosity. We reviewed our adult surgical experience with LDS in order to validate current recommendations regarding management of this newly described disease. ⋯ These results confirm the aggressive nature of LDS aortic pathology. However, the improved survival compared with earlier LDS reports suggest that aggressive treatment strategies may alter outcomes and improve the natural history of this syndrome.
-
The bias against integrated thoracic surgery residency applicants during general surgery interviews.
New paradigms for training cardiothoracic surgeons have been introduced, including the integrated thoracic surgery residency. Currently, a limited number of these programs exist, and all candidates apply to both integrated thoracic and general surgery residencies. We sought to investigate the applicants' experiences applying for both types of positions. ⋯ The applicants to the integrated thoracic surgery residencies become interested in cardiothoracic surgery early and tailor their clinical education to this interest. Although they are academically successful, they report significant negativity regarding their applications to both general surgery and integrated thoracic residencies.