The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Jun 1980
Comparative StudyAggressive management of potential penetrating cardiac injuries.
Since 1970 all patients admitted with penetrating injuries near the cardiac silhouette are transferred immediately to the operating room for resuscitation and evaluation for immediate thoracotomy. The clinical courses of 10 patients with penetrating cardiac injuries treated between 1962 and 1969 were analyzed and compared with those of 33 patients who presented between 1970 and 1977 and were managed more aggressively. ⋯ Of 53 patients with injuries in the area of the cardiac silhouette, 33 (62%) actually sustained cardiac injury. The high probability of cardiac injury in patients with external wounds in the silhouette and the improved survival rate seen with aggressive surgical therapy justifies the change to this policy.
-
J. Thorac. Cardiovasc. Surg. · Jun 1980
The use of "fresh" unstented homograft valves for replacement of the aortic valve. Analysis of 8 years' experience.
Between August, 1969 and May 1978, 679 patients underwent homograft replacement of the aortic valve. Isolated elective valve replacement was performed in 411 patients. Thirty-four patients had total aortic root replacement with reimplantation of the coronary arteries. ⋯ Systemic embolism was not recorded in any patient despite the fact that anticoagulants were not used. The clinical results were judged to be good or excellent in 89% of patients. It is concluded that homograft replacement of the aortic valve gives satisfactory results with a low incidence of late valve failure.
-
J. Thorac. Cardiovasc. Surg. · Jun 1980
Case ReportsPost-traumatic bronchial stenosis and acute respiratory insufficiency.
A 31-year-old woman sustained multiple injuries, including severe contusion of the right lung with massive subcutaneous emphysema. Four weeks later she was transferred to our institution with post-traumatic adult respiratory distress syndrome and carbon dioxide retention, resulting from a postlaceration stenosis of the left main-stem bronchus. Bronchoplasty was contraindicated because of the serious condition of the patient. ⋯ Bronchoplasty was performed on postadmission day 50 and resulted in gradual recovery of pulmonary function. Six months following discharge, the patient continues a steady improvement. Management of the patient's injuries represented a unique challenge previously unencountered.
-
J. Thorac. Cardiovasc. Surg. · Jun 1980
Training, examination, and certification of a thoracic surgeon. A position paper of the American Board of Thoracic Surgery.
The training of a thoracic surgeon is a complex process, requiring a minimum of six to seven years. Reliable examination of the trainee is similarly complex, requiring evaluation by various methods at different periods of time. Great care has been taken to keep the methods of examination free from bias and impartial by making the Residency Review Committee for Thoracic Surgery and the American Board of Thoracic Surgery completely independent organizations, unrelated to any other national professional organization. ⋯ The process of training, examination, and certification of a thoracic surgeon has evolved based on the experience obtained over the past three decades and has repeatedly proved to provide a satisfactory measure of competency in thoracic surgery. It is an achievement of which all thoracic surgeons can feel justly proud. Modifications in the structure and function of the certification process will continue to be made as changes in our medical knowledge occur.