The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · May 1979
Case ReportsRunaway pump head: new cause of gas embolism during cardiopulmonary bypass.
Massive gas embolism was narrowly avoided during a recent case of cardiopulmonary bypass for aortic valve replacement. Cause of the mishap was an arterial pump head that had rapidly accelerated spontaneously, emptying the oxygenator of blood within seconds. No gas entered the patient's vascular system, but a period of circulatory arrest was required in order to purge the extracorporeal circuit of gas and to re-establish blood flow. Only an instantaneous response by the perfusionist prevented massive gas embolism.
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A 59-year-old man underwent resection of aneurysm of the descending thoracic aorta with graft replacement. A postoperative chylothorax was managed by nonsurgical means and subsided. ⋯ This was found to be a chylous pseudocyst. Management of chylothorax and the details of this unique case are described.
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J. Thorac. Cardiovasc. Surg. · May 1979
Case ReportsTricuspid valvular incompetence and rupture of the ventricular septum caused by nonpenetrating trauma.
A young adult involved in an automobile accident had tricuspid valvular incompetence and rupture of the ventricular septum owing to blunt trauma. He had a successful repair of the ventricular septal defect and replacement of the tricuspid valve. ⋯ Rupture of the membranous portion of the ventricular spetum is extremely rare. This is the first report of a patient having a combination of these lesions.
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The literature concerning postcardiotomy delirium contains confusing definitions and contradictory results. In a critical review of the subject, we conclude that cardiac status, the severity of physical illness, the complexity of the surgical procedure, and preoperative organic brain disease are the determining factors in postcardiotomy delirium. Preoperative anxiety, denial, and depression also have some correlation. ⋯ Long-term follow-up studies suggest that psychological problems impair functional recovery from heart surgery. The suggested treatment of patients with delirium includes chemotherapy, psychotherapy, and environmental support. Finally we suggest that investigation of biochemical abnormalities in delirium may prove to be a model for clarifying the role of neurotransmitters in functional psychiatric illnesses.