Journal of cardiac surgery
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We describe an unusual presentation of cardiac tamponade as superior vena cava syndrome post minimally invasive mitral valve repair. The tamponade was caused by local compression of junction between the right atrium and superior vena cava. This case illustrates the importance of using transesophageal echocardiogram in postoperative management of cardiac surgery patients.
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Case Reports
Novel approach to the treatment of distal malperfusion secondary to ascending aortic dissection.
Acute Type A dissection is a surgical emergency. The presence of visceral and extremity malperfusion syndromes increases perioperative mortality twofold. On occasion, significant malperfusion may best be addressed in a staged fashion with preliminary attention to specific vascular beds with delayed repair of the dissection itself. We present a subacute Type A dissection associated with malperfusion of multiple vascular beds (mesenteric, renal, and iliofemoral) managed with a complication-specific approach utilizing endovascular thoracoabdominal aortic repair prior to ascending repair.
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We report a case of a patient who developed an aortic dissection with rupture. This presumably was a delayed injury following blunt thoracic trauma and highlights that concerns for aortic pathology even in this patient population.
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Regarding surgical interventions for type A acute aortic dissection (AAD), it is currently unclear if an initial, less invasive approach followed by later reoperations is safer than an extended approach aimed at preventing future reinterventions. We retrospectively reviewed our surgical cases to clarify the safety of late reoperation after repair of acute AAD. ⋯ Although most cases required extended procedures for late reoperation after repair of acute AAD, reoperations can be performed safely by careful choice of appropriate operative methods and strategies. Our data suggest that ascending aortic replacement is an effective initial procedure for patients with acute AAD.
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Migrating wires as a result of sternal nonunion present clinical challenges. Cardiac Computed Tomographic Angiography helps locate these wires precisely, enabling detailed surgical planning. ⋯ It is usually encountered among patients with sternal dehiscence. Understanding the location and spatial relationships of structures to the wire can be challenging. (64 slice) with high spatial and temporal resolution affords the possibility of enhancing presurgical planning.