Kyobu geka. The Japanese journal of thoracic surgery
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Case Reports
[Extremely elderly patient in whom the pacing lead was implanted via the femoral vein].
We report on an extremely elderly patient in whom we were unable to insert a pacing lead via the subclavian or internal jugular vein because of a superior vena cava obstruction; we instead inserted the pacing lead via the femoral vein. The patient was a 98-year-old male. Thirty-nine years previously, pacemaker implantation was performed for complete atrioventricular block. ⋯ Myocardial electrode implantation was also considered, but general anesthesia was deemed problematic because of the patient's extreme age. A pacing lead was inserted via the right femoral vein, and the generator was implanted in the right lower abdomen. Postoperative pacing was satisfactory.
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A 68-year-old woman underwent aortic valve replacement to treat her aortic regurgitation. The operation was performed successfully. Just before coming off cardiopulmonary bypass, massive hemorrhage occurred through the endotracheal tube. ⋯ The endotrachial bleeding was treated successfully by selective coil embolization of the bronchial artery. No further bronchial bleeding occurred. Although we found the bleeding site, we could not identify the cause of hemorrhage.
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A 58-year-old male was compressed between 2 trucks during a traffic accident, and was brought to a local hospital with chest and back pain. Computed tomography showed pericardial effusion, and pericardiocentesis was performed. As cardiac rupture was suspected by the aspiration of blood, the patient was immediately transferred to our hospital. ⋯ After recovery from shock, the patient underwent median sternotomy. Surgery was performed without using cardiopulmonary bypass, and the rupture site in the right atrium was closed by direct surtures. The patient recovered without cardiac event and was discharged on the 46th postoperative day.