J Cardiovasc Surg
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The aim of this study was to report the case of a patient with chronic dissecting infrarenal abdominal aortic aneurysm (AAA) and to review the literature for this rare vascular disorder. The preoperative assessment, surgical treatment, and postoperative course of a patient with a dissecting AAA and associated left iliac artery dissection were analyzed. The literature is reviewed with respect to etiology and pathogenesis as well as diagnostic and therapeutic management of infrarenal dissecting AAA. ⋯ A review of the literature demonstrates the rarity of dissecting aneurysm exclusively involving the infrarenal aortic segment. Primary dissecting aneurysm of the infrarenal abdominal aorta is a rare morphologic finding. Principles of diagnostic and therapeutic management of common atherosclerotic AAA also apply to dissecting AAA.
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Intraoperative right ventricular infarction immediately after coronary artery bypass grafting is a rare and potentially serious complication. We report a case in which an additional coronary artery bypass graft to a right ventricular branch with 99% stenosis brought about recovery from profound acute right ventricular failure. This case shows that complete revascularization to all graftable vessels, including even the right ventricular branch, is mandatory for successful coronary artery bypass grafting.
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The effects of postthoracotomy pain management on pulmonary function has been assessed. ⋯ A thoracotomy potentially produces a marked reduction in postoperative pulmonary function and the choice of pain management has major implications. Attenuation of postthoracotomy pulmonary dysfunction by effective analgesia should be provided for all patients undergoing chest surgery. Simply providing effective analgesia on its own without regard to pulmonary function is inadequate. Spirometric monitoring should be standard in all thoracic units and is essential for objective comparisons of the efficacy of different methods of pain management.
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A 48-year-old woman presented with a symptomatic right subclavian steal syndrome due to proximal subclavian artery stenosis. Anatomically the innominate artery was absent. Collateral circulation followed the vertebro-vertebral pathway with reversal of blood flow in the ipsilateral vertebral artery. ⋯ Surgical carotid-subclavian transposition permitted relief of clinical symptoms, disappearance of collateral circulation and subtotal regression of the aneurysm. This spontaneous evolution confirmed the role of high-flow in the pathogenesis of some aneurysms and the habitually good prognosis of flow-related aneurysms with correction of the cause. Arteriography still appears essential in diagnosis, pretherapeutic assessment and sometimes post-treatment evaluation in subclavian steal syndrome.
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Case Reports
Primary antiphospholipid syndrome: a cause of catastrophic shunt thrombosis in the newborn.
This is a unique report of systemic-to-pulmonary artery shunt thromboses secondary to primary antiphospholipid syndrome and antithrombin III deficiency in a neonate with cyanotic congenital heart disease. This infant with tricuspid atresia experienced thromboses of two modified Blalock-Taussig shunts en route to a bidirectional cavo-pulmonary shunt and potential future Fontan operation. Chronic warfarin anticoagulation has prevented additional thrombo-embolic events.