European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jan 1990
Case ReportsSystemic atrioventricular conduit for extracardiac bypass of hypoplastic systemic atrioventricular valve.
The management of severe congenital mitral stenosis in infants and children is still controversial. We describe our experience with the use of a systemic atrioventricular (SAV) extracardiac conduit to bypass a hypoplastic systemic atrioventricular valve. An SAV extracardiac conduit has been used in six patients (left atrium--left ventricle in five, right atrium--right ventricle in one). ⋯ Postoperative cardiac catheterization performed in five patients showed reduction of the transmitral gradient from a mean of 16 mmHg to a mean of 5 mmHg. Calcification of the bioprosthetic valve occurred in two patients 3 1/2 years and 2 years respectively after the operation; one died from concomitant subaortic stenosis and one underwent conduit replacement. Although its long-term efficacy is limited, the SAV conduit seems the most reliable surgical option for infants and children with hypoplastic systemic atrioventricular valves unsuited to conventional surgery.
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Eur J Cardiothorac Surg · Jan 1989
Case ReportsA concealed impalement injury of the chest--an unusual intrathoracic foreign body.
Penetrating injuries of the chest in civilian practice are rare. A case is presented of an unusual injury with a large wooden chair fragment which remained concealed for several days until the development of life threatening complications. Aspects of the evaluation of penetrating thoracic injuries are discussed.
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Eur J Cardiothorac Surg · Jan 1989
Internal mammary artery bypass: effect on longevity and recurrent angina pectoris in 2900 patients.
Internal mammary artery bypass (IMA) to the anterior descending coronary artery was performed in 2900 patients from January 1978 to December 1987. The average age of the patients was 64 years. Males accounted for 68% (1972 patients) and 82% (2378 patients) were in New York Heart Association (NYHA) class III. ⋯ Survival at 9 years was 78% from all causes and 83% when noncardiac deaths were excluded. Recurrent angina was present in 546 patients (39%). These data suggest that a patent-IMA to the anterior descending protects against recurrent angina and death from cardiac causes and should be the conduit of choice.
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Eur J Cardiothorac Surg · Jan 1989
Case ReportsSpontaneous intercostal pulmonary hernia with subsegmental incarceration.
A case of acute intercostal pulmonary herniation due to vigorous coughing secondary to chronic bronchitis is reported in a 70-year-old male. Protruding pleura-covered lung tissue was found bulging through an intercostal space defect between the left midaxillary line and the infrasternal costochondral arch. ⋯ Treatment was accomplished by anterior fixation of the ribs and by the basic principles of hernia repair between adjacent ribs. A case report and a brief survey of aetiological and anatomical classification is presented.
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Eur J Cardiothorac Surg · Jan 1988
Case ReportsSurgical pathology of bullae with and without pneumothorax.
Experience with 2030 patients admitted for an actual episode of spontaneous pneumothorax, and with 370 patients hospitalized for bullous emphysema is thoroughly analyzed. Out of these groups, 400 patients (318 and 82 respectively) underwent an open thoracotomy. Macroscopic operative findings were divided into 8 groups. ⋯ More than 30% of the patients could not be included in either the juvenile type, isolated apical disease, or in the category of bullae associated with generalized emphysema. Reasons for an early rupture of apical subpleural blebs and the high resistance to check valve pressure of bullae following alveolar disruption are discussed. The observations lead to the conclusion that surgical pathology and treatment problems in bullous emphysema and in spontaneous pneumothorax have a lot in common and their arbitrary separation is not justified.