J Cardiovasc Surg
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The most frequent chest X-ray finding of descending thoracic aortic aneurysm is an enlargement of medial mediastinum. Haemoptysis caused by thoracic aortic aneurysm is rare and, normally, when it occurs, it is due to an aorto-bronchopulmonary fistula. We report the case of an 88 year-old male, heavy smoker with arterial hypertension, who had been operated on for abdominal aneurysm five years before, whose unique symptom was scant haemoptysis and radiologically presented a cavity mass in the upper left lobe. Autopsy revealed that the pulmonary cavity mass was due to a descending thoracic aortic aneurysm.
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The choice of palliative procedure for neonates with congenital cyanotic heart defects remains controversial. Several reports have questioned whether the classic Blalock-Taussig shunt is adequate in neonates, because it shows a high rate of mortality and early shunt failure. The purpose of this study is to evaluate the early and late results of classic Blalock-Taussig shunt in neonates. ⋯ The classic Blalock-Taussig shunt has a low operative mortality and has provided excellent long-term palliation in the neonate. We conclude that a classic Blalock-Taussig shunt should be considered a reasonable choice in neonates requiring a palliative procedure for congenital cyanotic heart defects.
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Comparative Study
Mitral valve prolapse. Comparison between valvular repair and replacement in severe mitral regurgitation.
The aim of this study was to analyse long term results of mitral valve repair of degenerative mitral regurgitation compared to valve replacement. ⋯ Considering these results we conclude that, in patients with severe degenerative mitral insufficiency, mitral valve repair is warranted whenever it is possible. The advantages given by maintaining the native valve suggest that surgery should be considered in asymptomatic patients before the occurrence of the left ventricular dysfunction.
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To assess whether a modified technique of acute normovolemic hemodilution (ANH) reduces the utilization of blood products and donor exposures, and/or improves hemostasis in surgery of the thoracoabdominal aorta. ⋯ The ANH technique reduces homologous transfusions and donor exposures, and has a beneficial effect on hemostasis. Moreover, the technique may be useful in the management of cross clamping hypertension.
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Emergency room thoracotomy (ERT), a controversial procedure, was introduced to improve resuscitation of trauma patients. No study has been conducted to evaluate the importance of the time in the field (down time) in the initial survival of penetrating chest trauma requiring ERT. In addition to this, many factors have been considered to predict the success of ERT, but they are multiple and are not easy to assess in the brief period of decision making to perform an ERT. We decided, therefore, to see if the pre hospital time could be used as the principal parameter to predict whether TERT in emergency Department (ED) with the arrival of penetrating chest trauma is useful. ⋯ The only role of ERT in our opinion is in patients who arrive within 30 minutes of pre hospital time, with a witnessed vital signed in the field. Multiple wounds, low SBP and higher caliber bullet injuries are also negative prognostic factors.