The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Feb 2007
Case ReportsMediastinal bronchogenic cyst with respiratory distress from airway and vascular compression.
A 45-year-old female, who had undergone emergency drainage of a cyst, complained of severe dyspnea. Chest computed tomography scans showed a large mass, compressing the right pulmonary artery, superior vena cava, and tracheal bifurcation. ⋯ Immediately after surgery, her symptoms resolved completely. Mediastinal bronchogenic cysts in the subcarinal space can cause severe respiratory distress from airway and vascular compression.
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Thorac Cardiovasc Surg · Dec 2006
Case ReportsArch thrombus formation in an apparently normal aorta as a source for recurrent peripheral embolization.
A floating thrombus in an apparently normal aortic arch is a rare and often neglected source for systemic embolic events. When no other underlying pathology for systemic embolization can be found, transesophageal echo (TEE) and magnetic resonance imaging (MRI) are the diagnostic methods of choice and should be performed in order to detect thrombus formations in the thoracic aorta. ⋯ Successful bilateral thrombectomy was performed. To prevent repeat embolization, we performed surgery under deep hypothermic circulatory arrest with removal of the thrombus and plication of the aortic wall at the site of thrombus adhesion.
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Thorac Cardiovasc Surg · Dec 2006
Randomized Controlled Trial Comparative StudyPressure-controlled versus volume-controlled one-lung ventilation for MIDCAB.
One-lung ventilation is limited by hypoventilation and hypoxemia because of increasing airway pressure and intrapulmonary shunt. Previous clinical studies compared pressure-controlled versus volume-controlled ventilation during one-lung ventilation in patients with pre-existing pulmonary disease. We studied 50 patients undergoing thoracotomy and one-lung ventilation because of cardiovascular disease. ⋯ We observed, that peak airway pressure, dead space ventilation and arterial carbon dioxide partial pressure were significantly higher during volume-controlled ventilation. After one-lung ventilation patients with pressure controlled ventilation had lower alveolar-arterial oxygen tension difference and a higher arterial oxygen partial pressure with significant differences for those patients in the intensive care unit. We conclude that pressure-controlled ventilation may be useful to improve gas exchange and alveolar recruitment during one lung ventilation.
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Thorac Cardiovasc Surg · Dec 2006
Case ReportsDelayed diagnosis of a complete bronchial rupture after blunt thoracic trauma.
Bronchial ruptures due to blunt chest traumas are rarely encountered injuries. They can be missed in the emergency room depending on the clinical findings. We present a case report of a previously healthy 32-year-old woman who received multiple rib and clavicula fractures on the right side in a traffic accident. ⋯ Her control chest radiography, which was taken 7 weeks later, showed a totally opaque left hemithorax but no findings of pneumothorax were present. Fiberoptic bronchoscopy and virtual bronchoscopy showed a left main bronchial rupture. The patient was treated with an end-to-end anastomosis via left posterolateral thoracotomy.
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Thorac Cardiovasc Surg · Dec 2006
Case ReportsTreatment of a benign tracheoesophageal fistula in a ventilator dependent quadriplegic patient.
Management of an acquired benign tracheoesophageal fistula in a patient who is dependent on mechanical ventilation is controversial, since the usual procedure is weaning before repair. Here, we describe surgical treatment of a tracheoesophageal fistula in a quadriplegic patient with 28 months of follow-up, who has to remain permanently on mechanical ventilation with a tracheostomy cannula.