The Thoracic and cardiovascular surgeon
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A case report is described of a 33-years-old male who suffered a bullet pulmonary embolus following an abdominal gunshot injury. The literature of this rare occurrence is discussed together with the role of surgery in its treatment. Operative removal is advocated in all cases and the optimal time for removal is 1-2 weeks following the initial embolus to allow pulmonary induration, which can prevent peroperative embolus migration.
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Thorac Cardiovasc Surg · Dec 1991
Brachial plexus lesions following median sternotomy in cardiac surgery.
The incidence of neurological deficits of the upper extremity was studied in a prospective trial on 201 consecutive patients who underwent median sternotomy at cardiac surgery. In 13 patients (6.5%), a brachial plexus paresis was diagnosed postoperatively. ⋯ In our opinion, brachial plexus lesions following median sternotomy in cardiac surgery depend on the extent of sternal spread and the height of placement of the retractor in dependence of the rigidity of the rib cage. By reason of the iatrogenic cause of brachial plexus lesions, it appears to us that these complications should be included in those of which the patient needs to be informed preoperatively.
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Thorac Cardiovasc Surg · Dec 1991
The arterial switch repair and the obstructive right ventricular outflow tract: does it matter?
Right ventricular outflow tract obstruction (RVOTO) was resected in 5 of 78 neonates (6.4%) with complete transposition of the great arteries (TGA) and in 10 of 26 neonates and infants (38.5%) with double outlet right ventricle (DORV) or TGA associated with ventricular septal defect (VSD). The early mortality in the combined series was 7.7%. ⋯ Sizing of the RVOT and the aortic valve annulus should confirm the diagnosis and establish the indication for resection. Right ventricular outflow tract obstruction is important for the outcome of arterial switch operation (ASO) in neonates and infants with simple and complex TGA: if subaortic obstruction is anticipated and properly dealt with, the surgical risk of anatomic correction is not increased.
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Thorac Cardiovasc Surg · Oct 1991
Early and late results of the modified Waterston shunt with PTFE grafts for palliation of complex congenital cyanotic heart disease in neonates.
During a 12 year period from 1978 to 1989, 35 infants under 4 weeks of age underwent palliative surgery for complex congenital cyanotic heart disease with a short (1-1.5 cm) PTFE graft between the ascending aorta and the right pulmonary artery (modified Waterston shunt). Twenty-three infants had pulmonary atresia and 14 had severe pulmonary stenosis. Underlying cardiac lesions were tetralogy of Fallot (n = 11), single ventricle (n = 7), transposition complexes (n = 6), and intact ventricular septum and hypoplastic right heart syndrome (n = 13). ⋯ We observed a significant difference in the shunt patency rate between 4 and 5 mm grafts: palliation was adequate after 2 years in 52% of the patients when a 4 mm graft was used and in 89% of the 5 mm graft group (p less than 0.005). Reshunting was necessary in 7 infants between 5 and 60 months after primary surgery. Recatheterization was performed in 17 infants for suspected shunt failure (n = 6) or diagnostic reasons (n = 11).(ABSTRACT TRUNCATED AT 250 WORDS)
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Thorac Cardiovasc Surg · Oct 1991
ReviewThe relevance of coronary sinus interventions in cardiac surgery.
The concept of arterialization of the coronary venous system was first discussed almost 100 years ago. Subsequently, those attracted by this approach have chosen the coronary veins as an alternative route for interventional and surgical therapy. Modern techniques of coronary sinus interventions (CSI) have been suggested mainly for temporary support and protection of ischemic myocardium. ⋯ Three major techniques have been suggested for different indications in cardiology and cardiac surgery: 1) ECG-synchronized retroperfusion of arterial blood, which is supposed to positively affect ischemic myocardium by phasic supply of oxygen to deprived areas mainly in cardiac emergencies, 2) retroinfusion of cardioplegia in the arrested heart, which is now a well-established clinical technique, and 3) intermittent coronary sinus occlusion during antegrade cardioplegic delivery in the arrested heart and in the early reperfusion period after surgical revascularization, or in cardiac emergencies. The beneficial effect of pressure-controlled intermittent coronary sinus occlusion is assumed to result from cyclic occlusion and release of the coronary sinus shifting venous blood to underperfused regions, thereby facilitating substrate delivery and subsequent washout of metabolites. Experimental studies and first clinical trials suggest that all methods of CSI are safe and feasible, and the ultimate goals of reduction of infarct size and preservation of jeopardized ischemic myocardium will be achieved.