Texas Heart Institute journal
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Pericardial cysts are benign intrathoracic lesions that are considered to be congenital. They are usually found incidentally upon chest radiography and typically cause few symptoms. Their true incidence is unknown. ⋯ After the surgery, the patient's fever and chest pain resolved. We know of no other report of a pericardial cyst that had gone undetected upon earlier computed tomography. We believe that surgical treatment of pericardial cysts should be reserved for patients who have severe symptoms due to complications, or when diagnosis is uncertain and malignancy is suspected.
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During carotid endarterectomy, the use of locoregional anesthesia to achieve a combined superficial and deep cervical plexus block can cause cardiovascular, respiratory, and neurologic complications. Seeking to reduce risk and find an easier procedure, we applied locoregional anesthesia and an intermediate cervical plexus block in a series of patients who underwent carotid endarterectomy. From 2006 through 2007, 183 patients underwent primary carotid endarterectomy at our hospital. ⋯ Postoperatively, 2 patients experienced strokes and 1 sustained a myocardial infarction (total rate, 1.6%). We found the intermediate cervical plexus block to be feasible, effective, and safe, with low perioperative and postoperative complication rates. Herein, we report our findings.
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The diagnosis of Wolff-Parkinson-White syndrome is typically reserved for patients who experience ventricular pre-excitation and symptoms that are related to paroxysmal supraventricular tachycardia, such as chest pain, dyspnea, dizziness, palpitations, or syncope. Herein, we report the case of a 38-year-old woman who presented at our outpatient department because of exercise intolerance. Cardiac auscultation revealed a grade 2/6 pansystolic murmur over the left lower sternal border. ⋯ In Wolff-Parkinson-White syndrome, left ventricular systolic dyssynchrony can yield abnormal findings on echocardiography and thallium scanning--even in persons who have no cardiovascular risk factors. Physicians who are armed with this knowledge can avoid performing coronary angiography unnecessarily. Catheter ablation can reverse the dyssynchrony of the ventricle and improve the patient's symptoms.
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In our experience, single-stage open repair of descending thoracic or thoracoabdominal aortic aneurysms with concurrent aortic arch disease is technically feasible via a high left thoracotomy or a thoracolaparotomy. Distal aortic and antegrade brain perfusion, in combination with brain and spinal cord protection, seems to contribute to adequate surgical and neurological outcome.