The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jul 2013
Do tumor location and grade affect survival in pT2N0M0 esophageal squamous cell carcinoma?
The TNM staging system for esophageal cancer in the seventh edition of the AJCC Cancer Staging Manual incorporates tumor grade and location for staging pT2-3N0M0 esophageal squamous cell carcinoma. Patients with pT2N0M0, classified as stage IIA according to the sixth edition of the AJCC Cancer Staging Manual, can now be classified as stage IB, IIA, or IIB. We discuss whether these changes lead to a better prediction of the prognosis of these patients and aimed to find out other factors to forecast patient prognosis. ⋯ For pT2N0M0 esophageal squamous cell carcinoma, the seventh edition of the AJCC Cancer Staging Manual does not provide a more distinguishable prediction of prognosis compared with the sixth edition. Tumor grade is an independent prognostic factor in patients with pT2N0M0 esophageal squamous cell carcinoma, whereas tumor location is not. Furthermore, alcohol consumption is an independent prognostic factor that may imply a worse prognosis.
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J. Thorac. Cardiovasc. Surg. · Jul 2013
A refined hemispheric model of normal human aortic valve and root geometry.
Better understanding of aortic root geometry could improve diagnosis and reconstruction of pathologic aortic valves. In this study, a previous model of hemispheric aortic valve leaflets nested within a cylindrical aorta was refined in humans with normal aortic valves. ⋯ The normal human aortic valve is an elliptical structure, and ellipsoidal refinements improve representation of leaflet geometry. The left and noncoronary cusps commissure is located posteriorly; the right coronary cusp is located anteriorly. This model could be useful in quantifying pathologic geometry and in engineering devices for aortic valve reconstruction.
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J. Thorac. Cardiovasc. Surg. · Jul 2013
Temporary right ventricular mechanical circulatory support for the management of right ventricular failure in critically ill patients.
Management of right ventricular (RV) failure after left ventricular assist device (LVAD) implantation is not evidence based. Temporary circulatory assistance has recently been reported to be of value for managing postoperative RV failure after LVAD implantation, but only in small series of patients or isolated case reports. We report here our experience with the use of temporary right ventricular assist devices (RVADs) in LVAD recipients. ⋯ The development of RV failure in LVAD recipients is a serious problem associated with high mortality. Temporary RV mechanical support is an acceptable way to manage postoperative RV failure in these severely ill LVAD recipients.
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J. Thorac. Cardiovasc. Surg. · Jul 2013
Use of cardiovascular computed tomography in the diagnosis and management of coarctation of the aorta.
Coarctation of the aorta is a common malformation accounting for 5% to 8% of all congenital heart defects. Although echocardiography and magnetic resonance imaging are most frequently used in the diagnosis and management of coarctation of the aorta, the role of multidetector computed tomography in congenital heart defects has been expanding and its use has been increasing over the last few years. ⋯ Knowledge of the cardiac computed tomography appearance of coarctation of the aorta and associated abnormalities is critical for accurate diagnosis and management, which includes providing information to plan surgical or percutaneous therapy. We present various forms of coarctation of the aorta on cardiac computed tomography.
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J. Thorac. Cardiovasc. Surg. · Jul 2013
Early and midterm outcomes of quick proximal arch replacement with mild hypothermia and rapid rewarming for type A acute aortic dissection.
We assessed the efficacy of our unique procedure with mild hypothermic circulatory arrest and rapid rewarming during emergency surgery for type A acute aortic dissection. ⋯ Our original technique is a safe and less-invasive procedure that enables a quicker surgery. The midterm outcome also was favorable.