The Annals of thoracic surgery
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Case Reports
Unusual effect of an atrial septal aneurysm on venous drainage during cardiopulmonary bypass.
Atrial septal aneurysm is an uncommon cardiac anomaly that is usually asymptomatic or occasionally associated with cardioembolic events. We present the unusual impeding effect of an atrial septal aneurysm on venous drainage during cardiopulmonary bypass in a 70-year-old man who underwent aortic valve replacement and coronary artery bypass graft surgery.
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Although commonly reserved as a last line of defense, experienced centers have reported excellent results with pulmonary embolectomy for massive and submassive pulmonary embolism (PE). We present a contemporary surgical series for PE that demonstrates the utility of peripheral extracorporeal membrane oxygenation (pECMO) for high-risk surgical candidates. ⋯ Heparin therapy with pECMO support is a rapid, effective option for patients who might benefit from pulmonary embolectomy but are at high risk for surgery.
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Case Reports
Repair of prosthetic mitral valve paravalvular leak using an off-pump transapical approach.
Patients who present with significant paravalvular regurgitation after mitral valve replacement remain a difficult patient population and high-risk surgical candidates. We present 3 cases of transapical closure of mitral valve paravalvular leak (PVL) after mitral valve replacement using Amplatzer closure devices (AGA Medical Corp, Plymouth, MN). All 3 patients experienced decreased regurgitation at the site of the closure as well as symptomatic improvement in their heart failure.
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Few data are available on the clinical outcome of patients with acute coronary syndrome (ACS) complicated by refractory cardiogenic shock or cardiac arrest who receive percutaneous extracorporeal life support (ECLS). We investigated the in-hospital outcome and predictors of mortality in these patients. ⋯ Despite hemodynamic support with ECLS, patients with ACS complicated by cardiogenic shock or cardiac arrest refractory to conventional treatment had high mortality. However, the higher than 30% in-hospital survival rate in this extremely critical population indicates that ECLS might improve outcomes in ACS by saving the lives of patients in this specialized category. Unsuccessful angioplasty, asystole or pulseless electrical activity before ECLS introduction, and ECLS-related complications were predictors of in-hospital mortality.