The Annals of thoracic surgery
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Bronchiolitis obliterans syndrome (BOS) is the main cause of late morbidity and mortality in lung transplantation. This study was designed to accurately determine the prevalence of this syndrome of chronic lung allograft dysfunction (which is presumed to be due to chronic rejection). ⋯ (1) Bronchiolitis obliterans syndrome is truly a clinical syndrome, not simply a pathologic entity; (2) BOS displays considerable latency in onset and progression; (3) lung transplant recipients must therefore be followed up for a sufficient interval to determine the actual prevalence and mortality rate of BOS; and (4) the prevalence and mortality rates of BOS are higher than previously appreciated, exceeding 50% and 40%, respectively.
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Bypass grafting for complex forms of coarctation has been poorly documented as an alternative to decrease the high complication rate associated with anatomic repair. ⋯ On the basis of these results, bypass grafting appears to be a safe alternative in this select group of patients. The lateroisthmic bypass graft is the procedure of first choice, and the ascending aorta-descending aorta bypass graft should be reserved for failure of previous lateroisthmic bypass grafting.
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Tracheobronchial rupture after tracheal intubation has been infrequently reported. We report 6 cases of membranous tracheal rupture after endotracheal intubation treated at our institution over 7 years. ⋯ Tracheal intubation-related airway ruptures are rare but probably underestimated. Early recognition and emergent repair are essential, because failure to do so could result in potentially lethal events.
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Congenital septal defects with a large left-to-right shunt often cause pulmonary hypertension, which complicates surgical repair of the defects. ⋯ The unidirectional valve patch is useful for management of patients having operation to close cardiac septal defects in the presence of severe pulmonary hypertension.
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Nonspecific primary allograft dysfunction is an important cause of perioperative death in cardiac transplant recipients. We report a case of severe nonspecific allograft dysfunction that was ultimately reversible after 18 days of biventricular mechanical circulatory support. Allograft recovery was echocardiographically recognized by a positive inotropic response to isoproterenol and milrinone. This case illustrates the potential for recovery of even extreme allograft dysfunction.