The heart surgery forum
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The heart surgery forum · Jan 2002
Multiple off-pump coronary revascularization with "aorta no-touch " technique using composite and sequential methods.
Although off-pump coronary artery bypass grafting (OPCAB) has been widely applied in patients who are considered high risk for cardiopulmonary bypass (CPB), there is still a risk of stroke during the operation because of the ascending aortic partial clamp for proximal anastomosis. In the present study, we report the initial results of an "aorta no-touch " technique using an in-situ graft and composite and sequential grafting methods. ⋯ OPCAB performed with the aorta no-touch technique using an in-situ graft and composite and sequential grafting methods provides excellent early clinical results and graft patency.
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The heart surgery forum · Jan 2002
Review Case ReportsMitral valve aneurysm associated with aortic valve endocarditis and regurgitation.
Mitral valve aneurysms are rare complications occurring most commonly in association with aortic valve infective endocarditis. [Decroly 1989, Chua 1990, Northridge 1991, Karalis 1992, Roguin 1996, Mollod 1997, Vilacosta 1997, Cai 1999, Vilacosta 1999, Teskey 1999, Chan 2000, Goh 2000, Marcos- Alberca 2000] While the mechanism of the development of this lesion is unclear, complications such as perforation can occur and lead to significant mitral regurgitation. [Decroly 1989, Karalis 1992, Teskey 1999, Vilacosta 1999]; The case of a 69-year-old male with Streptococcus Sanguis aortic valve endocarditis and associated anterior mitral leaflet aneurysm is presented. Following surgery, tissue pathology of the excised lesion revealed myxomatous degeneration and no active endocarditis or inflammatory cells. This may add support to the hypothesis that physical stress due to severe aortic insufficiency and structural weakening, without infection of the anterior mitral leaflet, can lead to the development of this lesion.
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The heart surgery forum · Jan 2002
Thoracic epidural anesthesia for cardiac surgery via left anterior thoracotomy in the conscious patient.
Cardiac surgery is perceived to be maximally invasive and fraught with complications. In response to this perception, cardiothoracic surgeons have been refining traditional techniques to minimize their invasive nature. Epidural anesthesia has been used safely and effectively for numerous surgical procedures to reduce morbidity associated with general anesthesia. In hopes of achieving a similar result, we set out to determine the feasibility of using thoracic epidural anesthesia for limited cardiac surgery through a left anterior thoracotomy for patients who were awake and spontaneously breathing. ⋯ Thoracic epidural anesthesia for limited cardiac surgical procedures by means of a left anterior thoracotomy is feasible, even in patients with diminished pulmonary function. Furthermore, this method offered no significant technical hurdles. Nevertheless, the applicability of this technique to other procedures remains unclear. We believe that these results warrant controlled comparison of regional versus general anesthesia for limited cardiac surgery.