J Cardiovasc Surg
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Between October 1981 and December 1983 21 premature infants of mean gestational age 27.5 weeks (range 26-29 weeks) underwent surgical closure of persistent ductus arteriosus. Mean birth weight was 1080 g. There was no operative mortality. ⋯ In 18 infants a trial of Indomethacin therapy had failed. This experience supports the view that surgical closure of PDA in infants born before 30 weeks gestation can be accomplished safely. We believe that surgical treatment of PDA represents the optimal therapy in this high risk group of infants.
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Aortocaval fistula is an unusual complication of ruptured abdominal aortic aneurysm. A case of coincident rupture of an abdominal aortic aneurysm into both the retroperitoneum and the inferior vena cava is presented. The symptoms and the treatment are discussed.
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The case of a two year old girl with anomalous origin of the left coronary artery from the pulmonary artery is described. She was never in heart failure but had cardiomegaly and anginal pain. The ECG showed a typical infarct pattern with left ventricular hypertrophy. ⋯ T. F. E.) graft.
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Mediastinitis remains a serious complication of median sternotomy which requires prompt and aggressive surgical management. Debridement and closed irrigation has been the conventional mode of treatment. Failure to respond results in open drainage and delayed healing with its associated increased morbidity and mortality. ⋯ Sternal dissolution, the presence of anaerobic organisms, large volumes of purulent and necrotic material, however, were responsible for continued mediastinitis and further sternal dehiscence. Open irrigation and delayed closure with muscle flaps should be reserved for these patients and appears to decrease significantly morbidity and length of hospital stay. Surgical debridement and closed irrigation, however, remains the primary method of treatment of the less virulent forms of mediastinitis following median sternotomy.
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Massive arterial air embolism occurred in two patients during 1250 open heart operations. Emergency measures led to complete recovery in both cases. Flow reversal, hypothermia and anti-oedema measures may be adequate in some clinical situations for total recovery after this catastrophic accident.