The Annals of thoracic surgery
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Editorial Biography Historical Article
One hundred years of cardiac surgery.
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Randomized Controlled Trial Clinical Trial
Defining the role of aprotinin in heart transplantation.
Heart transplantation is associated with excessive bleeding due to recipient coagulopathy, frequent need for reoperative median sternotomy, and prolonged cardiopulmonary bypass. Aprotinin reduces bleeding and the inflammatory response after cardiopulmonary bypass, but there are concerns about efficacy and side effects. ⋯ Aprotinin decreases bleeding after reoperative heart transplantation without renal dysfunction. Decreased inflammation is manifested as reduced fluid requirement and improved pulmonary and right heart function, which benefit patients during the posttransplantation period. Aprotinin at recommended doses is effective and safe for patients undergoing reoperative heart transplantation.
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Randomized Controlled Trial Clinical Trial
Postresection irradiation for T2 N0 M0 non-small cell carcinoma: a prospective, randomized study.
Stage I nonirradiated T2 N0 non-small cell lung carcinoma has a postoperative prognosis not very different from stage II irradiated T1 N1 carcinoma. The hypothesis was that more locoregional malignant sites are overlooked in T2 N0 M0 than in T1 N0 M0 tumors, considering the better prognosis of this last group, and that T2 N0 cancer might benefit from postresection irradiation. ⋯ Stage I T2 N0 M0 non-small cell lung carcinoma tends to manifest distant metastasis. Prospective studies of stratified systemic adjuvant therapy should improve the present moderate result of radical resection in this group of tumors.
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Traumatic thoracic aortic rupture is a rare injury in the pediatric patient. Experiences with thoracic aortic rupture in patients less than 17 years of age are needed to help identify factors that can influence injury occurrence, diagnosis, management, and outcome. ⋯ The multiply injured child with severe blunt trauma and an abnormal chest roentgenogram requires a search for aortic injury. We believe the most effective algorithm to follow for the diagnosis of traumatic thoracic aortic rupture in the child involves selective performance of chest computed tomography and transesophageal echocardiography. Our experience suggests that the mechanism of injury, the duration to diagnosis of an aortic injury, and failure to use seat belts may contribute to morbidity. A high index of suspicion and a systematic approach to the diagnosis and to the management strategy for injuries to the thoracic aorta can contribute to a good outcome in those few children who survive the injury.
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Case Reports
Heart transplantation complicated by a patent foramen ovale of the recipient atrial septum.
A patent foramen ovale after heart transplantation is a relatively uncommon occurrence. We report a case of a 58-year-old man with profound hypoxemia after orthotopic cardiac transplantation for end-stage ischemic cardiomyopathy. Transesophageal echocardiography demonstrated the presence of a patent foramen ovale in the recipient atrial cuff. Primary closure was performed with correction of the right-to-left shunt.