The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Dec 1994
Review Case ReportsLeft-ventricular aneurysm in a young male due to spontaneous coronary artery dissection.
A case of spontaneous coronary artery dissection in a 26-year-old male with subsequent left-ventricular aneurysm is reported. A coronary bypass operation using left internal mammary artery combined with left-ventricular aneurysmectomy was performed successfully. This is the youngest case in the literature which describes a successful surgical treatment for a spontaneous coronary artery dissection with left-ventricular aneurysm.
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Thorac Cardiovasc Surg · Aug 1994
Review Case ReportsBiatrial drainage of right superior vena cava with anomalous right pulmonary venous connection.
A case of right superior vena cava draining to both atria, predominantly to the left atrium, with anomalous right pulmonary venous connection to the lower right superior vena cava is reported. The haemodynamic significance of these anomalies is discussed, and the technique of surgical repair is described. The literature on this rare but interesting clinical entity is briefly reviewed.
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Thorac Cardiovasc Surg · Aug 1994
Celite and kaolin produce differing activated clotting times during cardiopulmonary bypass under aprotinin therapy.
Since the introduction of the proteinase inhibitor aprotinin in cardiac surgery, a strong increase of the activated clotting time (ACT) during the extracorporeal circulation phase (ECC) was reported in many clinical studies, but with a lack of correlation between ACT and heparin concentration. In searching for a cause of this inconsistency we investigated different surface activators of the ACT in a clinical study. During ECC ACT was measured in parallel, using a Hemochron device and corresponding tubes (nominally 12 mg celite activator) for celite ACT, and a HemoTec device with corresponding double tubes (nominally 0.1 ml kaolin activator) for kaolin ACT. ⋯ With aprotinin alone there were no changes of the aPTT times, whereas the celite ACT times were without any correlation. Our results indicate that using kaolin instead of celite the ACT measurements under aprotinin therapy stay in the same ranges as without application of aprotinin: aprotinin has no detectable influence on kaolin-activated ACT. In our opinion, kaolin should be used as the surface activator for ACT measurements under the conditions of ECC, heparinization, and aprotinin therapy.(ABSTRACT TRUNCATED AT 250 WORDS)
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Thorac Cardiovasc Surg · Jun 1994
Comparative StudyPostoperative visceral hypotension the common cause for gastrointestinal complications after cardiac surgery.
In order to identify peroperative risk factors and to evaluate different etiological factors in developing postoperative gastrointestinal complications, clinical variables were studied in 3493 patients undergoing adult cardiac surgery. There were 86 gastrointestinal complications, 2.9%, with an overall morality among these of 22.1%: the mortality rate was 3.9% for all patients undergoing cardiac surgery at our institution (p < 0.001). Paralytic ileus, intestinal ischemia, and acute cholecystitis were the most frequently seen complications. ⋯ The incidence of peroperative myocardial infarction, low postoperative cardiac output necessitating massive use of vasopressor substances and/or intraaortic balloon pumping were significantly more often observed in patients who subsequently developed gastrointestinal complications. The common etiological factor in developing gastrointestinal complications of any kind, after cardiac surgery, seems to be postoperative splanchnic hypoperfusion with visceral ischemia. In order to reduce postoperative morbidity and mortality it is essential to identify patients at risk, support preoperative poor cardiac function, and to carefully monitor these patients postoperatively for abdominal complications to reach an early diagnosis.
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Thorac Cardiovasc Surg · Jun 1994
Case ReportsChylothorax after blunt chest trauma: an unusual case with a long latent period.
We report on a case of closed chest trauma with an unusual latent period of 11 weeks in a woman 26 years old. The patient had a dual thoracic duct with a dual lesion and was evaluated using lymphography and CT. We discuss the pathogenetic mechanism and the unusual radiological appearance with discontinuity of the duct, and an increase in back pressure which promotes dilatation of lymphatic vessels and nodes. ⋯ Pleuroperitoneal shunting was effective after failure of conservative treatment. Two years after discharge the patient is asymptomatic with normal chest X-ray image. She is near term in a normal pregnancy and without signs of silent malignancy.