The Thoracic and cardiovascular surgeon
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A localized thrombus involving the ascending aorta and arch rarely occurs in the absence of an underlying etiology such as chest trauma, atherosclerosis, a hypercoagulable state or instrumentation. A review of the literature between 1966 - 2003 yielded 38 reported cases of localized aortic arch thrombi, 21 of which were treated by surgical excision of the thrombus using different approaches. In this communication, we describe this clinical entity, with its diagnosis and management. The technical details that are important to ensure the safe conduct of the procedure are discussed.
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Thorac Cardiovasc Surg · Jun 2004
Correction of congenital heart defects in Jehovah's Witness children.
Between August 1989 and July 2003 14 Jehovah's Witness children with congenital heart defects (CHD) aged under 14 years (median 2.9 years) and with a median weight of 14 kg underwent 16 operations with cardiopulmonary bypass (CPB). Five children had been operated on previously between one to three times. Preoperatively, 7 children were prepared with oral iron supplementation and 10 received erythropoietin. Mean hemoglobin (Hb) at admission was 14.4 g/dl (range 10.9 - 19.2). The cardiopulmonary bypass (CPB) circuit was modified to reduce total priming volume. High doses of aprotinin were administered. The modified ultrafiltration (MUF) circuit, used in 7 patients, was parallel to the ECC circuit with continuous circulation of the blood through a small shunt between the arterial and venous lines. Operations performed consisted of VSD closure (3 pts.), ASD closure (3 pts.), Fontan operation (2 pts.), and complete AV canal correction, aortic commissurotomy, Ross operation, Glenn shunt, cor triatriatum correction, MV reconstruction combined with left outflow tract stenosis resection, correction of absent pulmonary valve syndrome, and correction of tetralogy of Fallot in one patient each. There were no deaths. Mean duration of CPB was 192 min and mean aortic cross-clamp time 40 min. The Hb value at the end of the operation was 4.9 - 14.5 g/dl (mean 9.6) and at discharge it was 7.1 - 14.5 g/dl (mean 15.5). No blood or blood products were used in any patient. ⋯ Bloodless cardiac surgery with and without CPB can be safely performed in Jehovah's Witness infants and children.
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Thorac Cardiovasc Surg · Jun 2004
Case ReportsUnusual complications after rewarming for deep accidental hypothermia.
Deep accidental hypothermia is an uncommon pathology. Successful management has been reported in isolated cases, but the majority of patients die from complications after rewarming. ⋯ He was successfully rewarmed with cardiopulmonary bypass, but presented several complications which led to death. These complications included the patient developing acute peritonitis and necrotizing fasciitis, which represent, to our knowledge, complications that have never been associated with deep accidental hypothermia before.
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Thorac Cardiovasc Surg · Apr 2004
Comparative StudyRequirement for renal replacement therapy in patients undergoing cardiac surgery.
Despite refinements in perioperative patient management renal insufficiency requiring renal replacement therapy (RRT) is still a common complication after cardiac surgical procedures associated with impaired patient outcome and increased costs. ⋯ Identifying perioperative risk factors associated with postoperative RRT will help to reduce the incidence of this complication. Avoiding cardiopulmonary bypass seem to be beneficial with regard to the prevalence of postoperative RRT.
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Thorac Cardiovasc Surg · Apr 2004
Case ReportsClinical surgical experience of congenital submitral left ventricular aneurysm.
Submitral left ventricular aneurysm is a rare cardiac pathology, occurring almost exclusively in black African patients. Two cases treated in our institute are reported in the present report. One is a 10-year-old boy with submitral aneurysm and mitral regurgitation, who underwent mitral valve repair and exclusion of the aneurysm with a left atrial approach. ⋯ The aneurysm was excluded by a Dacron patch from outside the left ventricle in addition to cryoablation on the endocardium of the aneurysm. Both patients recovered well after the operation. The present report presents two cases of this rare disease with different surgical approaches.