Texas Heart Institute journal
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We designed this study to define determinants of gastrointestinal complications after cardiac surgery. From January 1992 through December 2000, 11,058 patients underwent cardiac surgery on cardiopulmonary bypass at our institution. Data were prospectively collected and univariate and multivariate analyses conducted. ⋯ Furthermore, excessive anticoagulation after valve replacement may lead to GI hemorrhage. Valve surgery, often requiring anticoagulation, increases bleeding. Monitoring mechanical ventilation and hemodynamic parameters, adopting early extubation and mobilization measures, preventing infections, and strictly monitoring renal function and anticoagulation may prevent catastrophic abdominal complications.
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Case Reports
Benzocaine-induced methemoglobinemia: a potentially fatal complication of transesophageal echocardiography.
We describe the cases of 2 patients who developed benzocaine-induced methemoglobinemia after the administration of benzocaine as premedication for transesophageal echocardiography. The use of intravenous methylene blue resolved the cyanosis in both patients. Physicians who perform procedures involving the application of topical anesthesia need to be aware of this side effect to prevent morbidity and mortality.
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Rupture of the pericardium with luxation of the heart after blunt trauma is a fairly rare condition but carries a high mortality rate. In this report, we describe our experience with a case of right luxation of the heart in a young patient with multiple injuries due to an automobile accident. The patient, who was in hemodynamic failure, underwent successful emergency surgical treatment to replace the heart in its anatomic site. We discuss the diagnosis and management of this dangerous event.
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Case Reports
Aortic insufficiency in a patient with Marfan syndrome after aortic root reconstruction with a tailored-sinus graft.
A patient with Marfan syndrome underwent valve-preserving aortic root reconstruction with a Robicsek-Thubrikar graft. Intraoperative transesophageal echocardiography showed aortic insufficiency after extracorporeal circulation was discontinued. Placing 3 subcommissural annuloplasty sutures corrected the severe aortic insufficiency. Herein, we discuss the mechanism and prevention of aortic regurgitation after aortic root replacement with a new graft that contains pre-designed aortic sinuses.
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Case Reports
Management of intramural hematoma of the ascending aorta and aortic arch: the risks of limited surgery.
We present the case of a 57-year-old woman who had an intramural hematoma of the ascending aorta and aortic arch. After initial blood pressure control and imaging studies, the patient underwent limited surgical repair that consisted of ascending aortic replacement. ⋯ Current world medical literature regarding thoracic aortic intramural hematoma is presented. This case supports the treatment of intramural hematomas of the ascending aorta and arch by surgical replacement of both segments with a Dacron graft, with the patient under deep hypothermic circulatory arrest.