J Cardiovasc Surg
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Case Reports
Intraoperative fiberoptic angioscopy to evaluate the completeness of pulmonary embolectomy.
Intraoperative angioscopy was performed in three patients who underwent pulmonary embolectomy for massive pulmonary embolism. Angioscopy followed conventional techniques such as extracting the clot by a gallstone forceps, using a Fogarty catheter in the pulmonary tree or squeezing of the lungs. The rationale for angioscopy was to assess the result of these usual "blind" techniques. ⋯ Our initial experience suggests that intraoperative angioscopy appears to be useful in the detection of residual thrombus material, especially in the asanguinous, arrested heart. The small size of the angioscope allows easily access to the secondary, and up to the tertiary pulmonary branches. Clots can be visualized and extracted under direct visual control.
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Case Reports
Chylous ascites following abdominal aortic aneurysmectomy: surgical management with a peritoneovenous shunt.
The development of chylous ascites after emergency repair of a ruptured abdominal aortic aneurysm (AAA) is an extremely rare complication with potentially grave mechanical, nutritional, and immunologic consequences. A 54-year-old man with recurrent, symptomatic chylous ascites ultimately required insertion of a peritoneovenous shunt after non-operative measures failed to provide relief. This is the fourth reported case of chylous ascites following ruptured AAA and only the second treated by peritoneovenous shunt placement.
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Bullet embolism is a rare complication of vascular trauma. During the last ten years we have treated six patients with bullet embolism. Three patients had inferior vena caval injuries with embolizations of the bullets to the heart or pulmonary arteries. ⋯ Emboli in the distal pulmonary artery branches were left undisturbed in two patients. All six patients survived without any complications. A 14-year review of the literature is presented in order to emphasize some important features of this rare pathology.