European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Mar 2010
Tracheal lacerations after endotracheal intubation: a proposed morphological classification to guide non-surgical treatment.
Postintubation tracheobronchial lacerations (PITLs) are traditionally managed surgically. We sought to evaluate the rationale for non-surgical management of PITL. ⋯ Level I or II PITL should be managed non-surgically. When adequate respiratory status is present, Level IIIA PITL can be managed conservatively in selected institutions only, because these injuries are high-risk injuries. Any PITL associated with injury involving the oesophagus or with mediastinitis (Level IIIB) must be treated as soon as possible by surgery.
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Eur J Cardiothorac Surg · Mar 2010
Pneumomediastinum: is this really a benign entity? When it can be considered as spontaneous? Our experience in 47 adult patients.
Spontaneous pneumomediastinum is uncommon and is traditionally considered a benign, self-limited disorder that usually occurs in young adults without any apparent precipitating factor or disease. The purpose of this study is to present 47 new cases because of their different clinical behaviours. ⋯ (1) It is known that occasional consumption of cocaine causes diffuse alveolar damage, haemorrhage, etc. The cause-effect relationship consumption-appearance in a few hours of spontaneous pneumomediastinum leads us to appreciate this form of consumption as a causal factor rather than a predisposing/precipitating factor as it appears in the literature on the topic. (2) Spontaneous pneumomediastinum is considered a benign disorder but, as shown by our series, a bad outcome may represent an immediate life-threatening condition, forcing an invasive manoeuvre. We always recommend performing a chest CT scan on admission to predict the evolution.
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Eur J Cardiothorac Surg · Mar 2010
Surgical treatment of benign tracheo-oesophageal fistulas with tracheal resection and oesophageal primary closure: is the muscle flap really necessary?
Nowadays, despite the advances of the low-pressure high-volume cuffs, post-intubation tracheo-oesophageal fistula (TEF) still poses a major challenge to thoracic surgeons. The original technique includes interposition of muscle flaps between suture lines to avoid recurrence. It is not clear if this manoeuvre is indispensable and, in fact, we and others have faced problems with it. Our aim is to present our experience with TEF management in a consecutive group with no muscle interposition. ⋯ The single-staged repair with tracheal resection and anastomosis with oesophageal closure provides good short- and mid-term results for TEF management. The interposition of a muscle flap between suture lines may not be crucial to prevent recurrence.
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Eur J Cardiothorac Surg · Mar 2010
Case ReportsTransapical off-pump aortic valve-in-a-valve implantation in two elderly patients with a degenerated porcine bioprosthesis.
Re-operative heart-valve replacement is a high-risk procedure and even more so in elderly patients. Another option in high-risk patients with a degenerated aortic xenograft is the implant of a second aortic bioprosthesis using a transcatheter approach. We report two cases of patients with a severely degenerated porcine aortic bioprosthesis who were successfully treated by a transapical valve-in-a-valve implantation.
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Eur J Cardiothorac Surg · Mar 2010
Low cardiopulmonary bypass perfusion temperatures are associated with acute kidney injury following coronary artery bypass surgery.
Acute kidney injury (AKI) is a common complication after coronary artery bypass surgery (CABG). The role of hypothermia in postoperative renal function remains controversial. We set out to examine the effect of varying cardiopulmonary bypass (CPB) temperatures on early postoperative renal function. ⋯ Lower CPB perfusion temperatures are significantly associated with AKI following CABG. In addition to the known age-related decline in renal function, it appears that hypothermia may contribute to renal injury during cardiac surgery.