European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Dysphagia aortica describes swallowing difficulty caused by external compression from a tortuous or aneurysmal aorta. We present 5 cases in which dysphagia to solids accompanied a localised high pressure barrier (HPB) on manometry suggestive of dysphagia aortica, and explore other investigation modalities useful to confirm the diagnosis. ⋯ Dysphagia aortica commonly coexists with motility disorders and GORD. Video solid bolus swallow allowed us to determine the clinical significance of a manometric HPB in 4 out of 5 patients suspected on dysphagia aortica where standard evaluation would have failed. We recommend its use in those patients with a manometric HPB suggestive of dysphagia aortica in whom standard barium swallow is normal.
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Eur J Cardiothorac Surg · Feb 1997
Case ReportsPercutaneous occlusion of the entry to a leaking false aneurysm after ascending aortic replacement for aortic dissection type A facilitating surgical repair.
A leaking false aneurysm occurred after ascending aortic replacement for aortic dissection type A. Percutaneous balloonocclusion of the entry to the false aneurysm facilitated elective surgical repair.
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Eur J Cardiothorac Surg · Feb 1997
Aprotinin in aortic surgery requiring profound hypothermia and circulatory arrest.
The use of aprotinin in cardiac surgery to improve haemostasis and reduce blood loss particularly in patient groups at increased risk of bleeding is well established. Previous retrospective studies in profound hypothermic surgery have highlighted concerns that in this circumstances aprotinin may paradoxically cause increased bleeding and intravascular thrombosis. We therefore adopted a modified protocol for administering aprotinin, which was not started until cardiopulmonary bypass had been reinstituted after circulatory arrest. ⋯ We cannot implicate aprotinin in increased postoperative blood loss, renal dysfunction or mortality when used with hypothermic circulatory arrest according to this protocol. Elucidating the role of aprotinin in hypothermic circulatory arrest requires a randomised prospective study.
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This paper was undertaken to determine the long-term outcome of active infective endocarditis treated with antibiotic and radical excision of infected tissues by surgery. ⋯ These data suggest that surgery for active infective endocarditis yield a high probability of eradicating the infection with relatively low operative mortality and good long-term results.
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Eur J Cardiothorac Surg · Jan 1997
Comparative StudyEfficacy and safety of videothoracoscopic lung biopsy in the diagnosis of interstitial lung disease.
The aim of this study was to determine the efficacy and safety of videothoracoscopic lung biopsy (VTLB) in the diagnosis of infiltrative lung disease (ILD) and compare the results of VTLB with the results previously obtained in patients with open lung biopsy at the same institution. ⋯ VTLB is a valid alternative to OLB in most cases. Along with a comparable efficacy, VTLB has several advantages that should make it the method of choice for patients with only minimally impaired respiratory function. In contrast, the role and advantages of VTLB compared to OLB in patients with severe lung disease, require further investigation.