Kyobu geka. The Japanese journal of thoracic surgery
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Penetrating cardiac injuries are life-threatening emergencies. We present a case of a 24-year-old construction worker who accidentally shot himself with a nail gun. Chest X-ray showed a 6 cm-long nail overlapping the cardiac shadow. ⋯ Median sternotomy was performed and cardiopulmomary bypass was established. Then, the nail was removed and the left ventricular wound was repaired by 4-0 Prolene mattress sutures buttressed with felt-strips. He had an uncomplicated postoperative course and was discharged 7 days postoperatively.
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Treatment of infective endocarditis (IE) associated with aortic annular destruction remains a formidable surgical challenge. Discussions about the optimum modality for reconstruction are still continuing. In such severe endocarditis, we have performed aortic root replacement using the Freestyle stentless bioprosthesis with the full root technique. ⋯ The 10 hospital survivors were followed up for a mean of 27.7±23.1 months (range 5 to 82). Although late death occurred in 2 patients, recurrent IE was not observed in any patients during the follow-up. The results of our study suggest that the Freestyle stentless bioprosthesis could be an excellent alternative to a homograft in the treatment of infective endocarditis associated with aortic annular destruction.
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Case Reports
[Discrete type subaortic stenosis disclosed by hemolytic anemia after aortic and mitral valve replacement].
We report a case of discrete type subaortic stenosis disclosed by hemolytic anemia 7 years after aortic and mitral prosthetic valve replacement. A 53-year-old female complained of general fatigue, dyspnea, macrohematuria and hemolysis. She had undergone aortic valve replacement for non-coronary cusp perforation 15 years before, and mitral valve replacement and tricuspid annuloplasty 7 years before. ⋯ Intraoperative findings showed discrete type subaortic stenosis due to extensive pannus formation, but that the previously implanted prosthetic valves were intact. The blood flow biased by the interference of the subaortic stenosis might have obstructed closure of the mitral prosthetic valve and caused mitral regurgitation. Postoperatively, hemolysis and mitral regurgitation were diminished, and aortic stenosis was improved.
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Between 1992 and 2011, 22 patients underwent surgery of reconstruction of thoracic wall with curved metal plates for multiple rib fracture and resection of thoracic wall tumor. They were divided into 2 groups according to original disorders. Twelve cases of group A accepted surgical stabilization of traumatic multiple rib fractures with the metal plates fixed on the fractured ribs as an external brace. ⋯ Only 2 patients needed removal of the fixed plates due to pyothorax caused by pneumonia after crushing thoracic injuries. The long metal reconstruction plates with many perforations were very useful for reconstruction of chest wall because they were long enough to cover the whole length of widely resected chest defects and moderately soft enough to be appropriately bent or twist by hand at the time of operation. Moreover long-term result of the reconstructed chest wall was safe and satisfactory without severe complication.
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We examined the effect of local administration of tranexamic acid( TA) on reducing aspirin-induced bleeding in off-pump coronary artery bypass grafting(CABG). ⋯ The use of local administration of tranexamic acid indicated the reduction of postoperative bleeding even in patients with preoperative aspirin use.