The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Oct 2009
Case ReportsTraumatic arteriovenous fistula of the internal mammary vessels.
An uncommon case of traumatic arteriovenous fistula of the left internal mammary artery following penetrating chest trauma is presented. The patient developed a left parasternal machinery murmur six days after thoracotomy to repair a pericardial tamponade after a penetrating left parasternal stab wound. Selective digital subtraction angiography revealed pseudoaneurysm formation with fistulous connection of the left internal mammary artery to the adjacent vein. The fistula was successfully occluded with coil embolization.
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Readmission to the intensive care unit (ICU) after cardiac surgery is associated with higher costs and may be correlated with an increased mortality. We wanted to evaluate predictors of ICU readmission and to analyze the outcome of those patients. ⋯ Patients after valve/combined surgery are more likely to require readmission to the ICU. Respiratory complications were the most common reasons for readmission. To reduce the readmission rate, it is necessary to treat cardio-respiratory problems early, particularly in patients showing predictive risk factors.
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Thorac Cardiovasc Surg · Oct 2009
Combined aortic root and right ventricular outflow tract replacement with mechanical conduits in adult patients after repeated surgery for congenital heart disease.
To manage aortic root aneurysms and right ventricular outflow tract (RVOT) graft dysfunction in adult patients after repeated surgery for congenital heart disease, we performed combined prosthetic aortic root and RVOT replacement. ⋯ Combined aortic root and RVOT replacement with mechanical conduits in adult patients after repeated surgery for congenital heart disease is a complex operation requiring long CPB time. However, this procedure has the potential to avoid a predictable reoperation associated with conventional biological graft replacement.
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Thorac Cardiovasc Surg · Oct 2009
Impact of graft size and commissural resuspension height on aortic valve competence in valve-sparing aortic replacement under physiological pressures.
Valve competence in valve-sparing aortic root replacement has been described as being influenced by commissural height as well as graft size. The aim of this study was to investigate the impact of a gradual reduction of commissural height and graft diameter on aortic insufficiency under physiological conditions in an IN VITRO model. ⋯ Valve competence is impaired both by the reduction of commissural height and by reduced graft size. In particular, reimplantation of aortic valves into undersized grafts promotes valve insufficiency even if commissural height is well adjusted.