The Annals of thoracic surgery
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Contralateral pneumothorax is a rare complication after pneumonectomy. We present a patient with bullous emphysema and a defect in the medial wall of a ventrally located bulla that drained via the postpneumonectomy space, producing subcutaneous emphysema without a pneumothorax in the remaining lung. The patient fully recovered after conservative treatment.
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Chronic thromboembolic pulmonary hypertension (CTEPH) is a known sequela of acute pulmonary embolic disease and yet remains underdiagnosed. Although nonsurgical options for patients with CTEPH have become increasingly available, including pulmonary artery hypertensive medical therapy, surgical endarterectomy provides the most appropriate intervention as a potential cure for this debilitating disorder. This article summarizes the most recent outcomes of pulmonary endarterectomy at a single institution over the past 12 years, with emphasis on the surgical approach to segmental-level chronic thromboembolic disease. ⋯ Despite a patient population with more distal disease, results continue to improve. Pulmonary endarterectomy for patients with CTEPH results in significant pulmonary hemodynamic improvement, with favorable outcomes achievable even in patients with distal segmental-level chronic thromboembolic disease.
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Acute kidney injury requiring renal replacement therapy (RRT) is associated with increased mortality after cardiac surgery. Studies examining the impact of RRT after lung transplantation (LTx) are limited. We evaluated risk factors and outcomes associated with RRT after LTx. ⋯ In the largest study to evaluate acute kidney injury after LTx, the incidence of RRT is 5.51%. The need for post-LTx RRT dramatically increases both short- and long-term mortality. Several variables, including preoperative renal function, are predictors of post-LTx RRT and could be used to identify transplant candidates at risk for acute kidney injury.
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Morbid obesity is associated with increased resource utilization in coronary artery bypass grafting.
Studies have shown good outcomes for morbidly obese patients who undergo cardiac surgery. However, little is known about how much additional resource utilization treating these challenging patients requires. We hypothesized that morbidly obese patients (body mass index ≥40 kg/m(2)) undergoing coronary artery bypass grafting needed longer operating room times and had longer hospital and intensive care unit stays than non-morbidly obese patients. ⋯ Although good outcomes can be achieved for morbidly obese patients who undergo coronary artery bypass grafting, these patients require considerably more resource utilization in the operating room and intensive care unit, and they spend more time in the hospital after surgery. At a cardiac surgical operating room cost of approximately $50 per minute and $4,500 per intensive care unit day, the financial implications for morbidly obese patients who need coronary artery bypass grafting are not insignificant.
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Case Reports
Survival after simultaneous repair of bichamber cardiac and pulmonary vein rupture caused by blunt chest trauma.
A 44-year-old woman was transferred to our institution because of blunt chest trauma. Transthoracic echocardiography revealed decompression of the right ventricle resulting from pericardial effusion. ⋯ Under better visualization after the patient was placed on cardiopulmonary bypass, we identified a 5-cm longitudinal tear and a 2-cm tear in the right atrium (RA), a 2-mm tear in the right ventricle (RV), and a 5-mm tear in the right lower pulmonary vein (PV). Those tears were repaired successfully with 5-0 polypropylene sutures.