The Thoracic and cardiovascular surgeon
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Necrotizing pneumonia, pulmonary abscess, and lung gangrene are rare complications of severe pulmonary infection with devitalization and sloughing of lung tissue. Pulmonary necrosis is often associated with alcoholism and other chronic disorders with known immunodeficiency. Mortality is significant and both treatment strategies as well as the role of surgery are controversially debated. ⋯ Necrotizing pulmonary infections are infrequent but are life-threatening disease entities. Patients often present with severe comorbidity and chronic disorders causing immunodeficiency. If initial medical therapy fails surgery offers a reasonable therapeutic approach. Aim of surgical therapy is resection of all gangrenous lung parenchyma and effective drainage of pleural empyema. Then recovery is feasible in up to 80%.
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Thorac Cardiovasc Surg · Oct 2013
Case ReportsAortic mispuncture during routine catheterization requires emergency cardiac operation.
Transseptal puncture for left heart catheter or left atrial appendage occlusion is a highly standardized routine intervention in interventional cardiology. However, mispuncture is rare but can be life threatening at worst. Here, we report the case of a combined mispuncture of the right atrium and the ascending aorta resulting in a pericardial effusion with a hemodynamic effective tamponade requiring urgent cardiac operation for successful life saving.
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Thorac Cardiovasc Surg · Oct 2013
Pancreaticopleural fistula-induced empyema thoracis: principles and results of surgical management.
Pancreaticopleural fistula is a very uncommon complication of pancreatitis resulting from pancreatic duct disruption with leakage of pancreatic secretions into the pleural cavity. Fistulization occurs either through the esophageal hiatus or straight through the diaphragm. Pleural effusion with dyspnea is the main presenting symptom, and delayed diagnosis is frequent. Initial conservative treatment fails in a significant number of cases. Ascending infection via the fistulous tract results in empyema and life-threatening sepsis. ⋯ Surgical management combining minimally invasive thoracic surgery and removal of the fistulous tract is highly effective. If initial medical treatment fails, surgery should be considered early to prevent severe sepsis. Further improvement seems achievable by reducing the time between fruitless conservative efforts and surgical intervention.
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Thorac Cardiovasc Surg · Oct 2013
Case ReportsHybrid approach to treat total thoracic aortic aneurysm in a patient undergoing emergency surgery for descending aortic rupture.
Rupture of the descending aorta is a life-threatening complication requiring emergency intervention. The endovascular approach (TEVAR) has been recently introduced to treat the descending aorta in the emergency setting, resulting in better early postoperative outcome as compared with traditional surgery. However, when the pathology involves the aortic arch and ascending aorta, TEVAR alone cannot be performed, requiring an alternative approach. We describe a one-stage hybrid repair via midline sternotomy to treat rupture of the descending thoracic aortic segment in toto.
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Thorac Cardiovasc Surg · Sep 2013
Review Case ReportsRecurrent left atrial and left ventricular thrombosis due to heparin-induced thrombocytopenia: case report and short review.
The combination of heparin-induced thrombocytopenia (HIT) II, left ventricular failure with extracorporeal membrane oxygenation (ECMO) therapy, and recurrent left ventricular thrombosis is rare and predicts a poor outcome. In this case, HIT II occurred after an ischemic cardiogenic shock. We initiated ECMO and intra-aortic balloon pump therapy during coronary artery bypass grafting and ventricular thrombectomy. Despite continued therapeutic therapy with heparin and later argatroban, the patient developed solid and recurrent thrombotic masses in the left atrium and left ventricle.