Cardiovascular surgery (London, England)
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Papillary fibroelastoma is rare but one of the most common benign primary cardiac tumors after myxoma. This lesion may be associated with embolization, angina and sudden death. The incidental finding of a small pedunculated papillary fibroelastoma arising from the atrial septum detected by transesophageal two-dimensional echocardiography (TEE) in a patient undergoing coronary artery bypass grafting is reported. The advantage of TEE in diagnosing intracardiac tumors is also described.
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Biography Historical Article
The beginning of stroke prevention by surgery.
Normal variations in the crossflow capacity of the Circle of Willis, and the effects of disease upon this and on the thromboembolic potential of the cervical carotid, together account for the clinical unpredictability of strokes. These two factors form a recurring theme in the history of stroke studies, from 1664 with the publication of Cerebri Anatome, to the duplex and computer-assisted scanning techniques of today. The path followed by the discoverers is traced from Hippocrates to Moniz and Miller Fisher, to show how their work led directly to the technique of carotid endarterectomy.
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The case of a 44-year-old black man who presented with severe dysphagia, cough and chest pain caused by a 12-cm aneurysm developing from a Kommerell's diverticulum at the origin of an aberrant retro-oesophageal left subclavian artery is reported. The aortic arch and descending thoracic aorta were right sided. Diagnosis was established before operation by computed tomography, magnetic resonance imaging and arteriography. ⋯ Resection grafting of the aneurysm including the upper third of the descending aorta via right thoractomy was performed. The patient made an uneventful recovery and was discharged 20 days later. This case appears to be the first successful operation for this pathology.
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Review Case Reports
Cervical aortic arch associated with tetralogy of Fallot.
Forty-seven cases of cervical aortic arch have been reported in the literature. Eleven of these patients had congenital cardiac defects, including tetralogy of Fallot in three. An additional case of cervical aortic arch and tetralogy of Fallot is presented along with a brief review of the literature pertaining to this rare condition.
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Twenty-five patients underwent early and elective valve replacement for infective endocarditis during a 5-year period between April 1985 and March 1991. Indications for urgent surgical intervention performed at a mean 32 (range 6-47) days after admission were intractable heart failure, systemic emboli, septic multiorgan failure and the presence of vegetations. Indication for elective surgery was persistent (mean 42 (range 17-56) days) infection after appropriate antibiotic therapy. ⋯ The reoperation rate was 12%. After a mean follow-up of 49 (range 1-71) months, 21 of the survivors (95%) were in New York Heart Association functional class I or II; the actuarial 5-year survival rate was 87%. Precise preoperative assessment of early operative indications and timely association of medical therapy in unstable patients could represent a step forward in the treatment of acute infective endocarditis.