Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jan 2012
ReviewRight ventricular failure after cardiac surgery: management strategies.
Right ventricular failure after cardiac surgery is a difficult clinical dilemma. We review the physiology of right ventricular failure in addition to current management strategies to address it.
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Recent results have demonstrated a major reduction in lung cancer mortality through computed tomography screening and no benefit from chest radiograph (CXR) screening. This presents a huge potential for benefit but also poses challenges regarding management of details to minimize harm. Many unresolved questions remain that must be addressed to implement computed tomography screening for lung cancer in a thoughtful and responsible way.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2012
Multicenter StudyThe role of papillary muscle relocation in ischemic mitral valve regurgitation.
Aim of our study was to compare the results of combined approach papillary muscles relocation (PPMr) + mitral annuloplasty (MA) vs only restrictive annuloplasty (RA) in ischemic mitral regurgitation, guided by 3-dimensional (3D) echocardiography. Sixty-nine patients with severe ischemic mitral regurgitation who had PPMr + MA and coronary artery bypass grafting were matched 1:1 with patients who underwent isolated RA and coronary artery bypass grafting. A comprehensive pre- and postoperatory 2-dimensional and 3D transesophageal echocardiographic examination followed by a 3D offline assessment of the mitral valve apparatus was performed. ⋯ Recurrent mitral regurgitation equal to or greater than moderate occurred in 2 (2.8%) and 8 (11.5%) in PPMr + MA group and RA group, respectively (P < 0.02). The PPMr promoted a significant reversal in left ventricle remodeling compared with the isolated RA. PPMr + MA reduce the tenting area and the coaptation depth with respect to RA, with less incidence of recurrent mitral regurgitation.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2012
Case ReportsHuge ruptured and infected pseudoaneurysm of the ascending aorta and aortic arch with erosion of sternum after previous cardiac surgery.
A 77-year-old woman underwent aortic valve replacement and coronary bypass grafting in 2007 in the Emirates. Evolution was uneventful until December 2011. After repeated episodes of unspecific infections, a computed tomographic scan showed a large pseudoaneurysm of the distal ascending aorta. ⋯ The patient was transferred to our institution. The challenges of this case included safe surgical approach (sternotomy, cannulation, perfusion, cerebral protection) as well as complete removal and extensive debridement of the infected material and reconstruction of the aortic arch. Using fully biological material, reconstruction of the ascending aorta and proximal arch was successfully performed.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2012
Mechanical support for pulmonary veno-occlusive disease: combined atrial septostomy and venovenous extracorporeal membrane oxygenation.
The use of atrial septostomy for refractory pulmonary hypertension and right ventricular failure results in an adequate left ventricular preload and improved cardiac output at the expense of a profound hypoxic shunt. Combined dual-lumen venovenous extracorporeal membrane oxygenation and atrial septostomy provides extracorporeal gas exchange of venous return before the directional right atrial to left atrial shunt, can be deployed percutaneously, and results in an ambulatory patient with stable hemodynamics.