The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Aug 1981
Case ReportsRight ventricular bullet embolectomy without cardiopulmonary bypass.
Victims of gunshot wounds may be noted to have bullets overlying the cardiac silhouette on roentgenogram. Direct cardiac penetration, bullet embolus to the heart, and missile proximity to the heart are all possibilities which must be differentiated. ⋯ At the time of exploration, an intracardiac bullet embolus was fortuitously palpated and trapped within the apex of the right ventricle. Right ventriculotomy and embolectomy without cardiopulmonary bypass were performed to prevent retrograde or distal migration.
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J. Thorac. Cardiovasc. Surg. · Jun 1981
Case ReportsPathological study of infective endocarditis on Hancock porcine bioprostheses.
A pathological study has been performed on 10 infected Hancock bioprostheses removed from nine patients who died of prosthetic endocarditis. The devices had been in place from 2 to 87 months (average 37.5), the interval between operation and onset of infection averaging 30 months. The offending organisms were Gram negative bacteria in three patients (Klebsiella pneumoniae, Enterobacter cloacae, and Serratia marcescens), Gram positive bacteria in two (Staphylococcus aureus and Streptococcus viridans), and fungi in four (Candida species in three and Aspergillus species in one). ⋯ Therefore surgical intervention appears appropriate in the presence of severe hemodynamic complications after adequate antibiotic treatment. However, infection of these particular prostheses still carries an extremely high mortality. In the present series, this poor outcome might be explained by the frequently associated septic and thromboembolic events.
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J. Thorac. Cardiovasc. Surg. · Jun 1981
Case ReportsPrimary malignant lymphoma of the trachea. Report of a case successfully treated by primary end-to-end anastomosis after circumferential resection of the trachea.
A 67-year-old Japanese man with exertional dyspnea was found by laminagraphy to have tracheal obstruction. The stricture was localized at the cervical and mediastinal trachea and was 5.0 cm long on an x-ray film. Eight tracheal rings were successfully resected and the ends of the trachea were anastomosed. ⋯ The patient had serum hepatitis postoperatively, but now he is living normally without any difficulty in respiration. No signs of recurrence have been seen in the 5 years, 4 months since the operation. From this experience, the rarity and the possibility of curative operation of this tumor are discussed.
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J. Thorac. Cardiovasc. Surg. · Apr 1981
Case ReportsBlunt traumatic rupture of the heart. Successful repair of simultaneous rupture of the right atrium and left ventricle.
A case is reported of a 48-year-old man who sustained simultaneous rupture of the right atrium and left ventricle following blunt trauma in a motor vehicle accident. Rupture of one or more cardiac chambers in blunt cardiac trauma is not uncommon. However, survival to reach the hospital is rare. ⋯ Prompt exploration is essential, as few patients survive longer than 60 minutes after injury. Ready availability of cardiopulmonary bypass is emphasized. Atrial rupture can be managed without bypass, but left ventricular rupture, as in this case, would seem impossible to repair without it.
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We evaluated 643 patients surviving aortic, mitral, and aortic and mitral ("double") valve replacement with the Björk-Shiley prosthesis from 1 to 72 months (median 38 months) postoperatively. Intermediate-term survival rate was similar to that reported for other prosthetic and bioprosthetic devices. Factors unrelated to the device, but related to preoperative patient characteristics or intraoperative or early postoperative events, had important association with late survival rate. ⋯ Improvement in New York Heart Association (NYHA) functional class occurred in the majority of patients. We conclude that the Björk-Shiley valve is durable and effective, but, as with other devices, is associated with problems of thromboembolism and thrombosis. Intermediate-term survival is related also to non-device, patient-associated characteristics.