The heart surgery forum
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The heart surgery forum · Jan 2008
Case ReportsA complex case of congenital cardiac anomaly: pulmonary atresia and ventricular septal defect associated with major aortopulmonary collaterals.
Pulmonary atresia and ventricular septal defect associated with major aortopulmonary collaterals (MAPCAs) is a rare, complex, and heterogeneous congenital cardiac anomaly. The majority of untreated patients present with severe congestive heart failure and respiratory distress in the first decade of life. We describe a 15-year-old cyanotic boy, both of whose pulmonary arteries arise from the arcus aorta via patent ductus arteriosus. In addition to this anomaly, the patient has MAPCAs originating from the descending aorta that perfuse the right upper lobe of the lung, a persistent superior vena cava, an aberrant right subclavian artery, pulmonary atresia, and ventricular septal defect.
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The heart surgery forum · Jan 2008
Routine use of the direct thrombin inhibitor bivalirudin for off-pump coronary artery bypass grafting is safe and effective.
Anticoagulation with unfractionated heparin has been the standard of care for more than a half-century for patients undergoing cardiac surgery. The risk of heparin-induced adverse reactions dictates the need for a safe and effective alternative, particularly in off-pump coronary artery bypass (OPCAB) surgery, an approach associated with a perioperative prothrombotic condition that may negatively influence graft patency. Between March 2003 and January 2005, 243 consecutive patients underwent OPCAB with bivalirudin (0.75 mg/kg bolus with 1.75 mg/kg per hour infusion). ⋯ Bivalirudin is a safe and effective anticoagulant that may be routinely used as an alternative to heparin and protamine in patients undergoing OPCAB. This is evidenced by low hospital mortality and morbidity rates. Further follow-up is warranted to discern the influence of bivalirudin on long-term clinical outcomes.
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The heart surgery forum · Jan 2008
Case ReportsEsophageal perforation after catheterization of the subclavian vein.
The insertion of a central venous catheter (CVC) via the subclavian vein is often associated with complications. We report a case in which a patient suffered an esophageal lesion with severe bleeding and a pneumothorax with mediastinal shift induced by the insertion of the dilator of a CVC. ⋯ The patient survived the complication. However, he died 1 week later from multiple organ failure not associated with the CVC insertion.
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The heart surgery forum · Jan 2008
Case ReportsBullet embolism after gunshot injury: a case report.
We describe a case of gunshot injury presenting with cardiac tamponade in which a dummy bullet advanced through the aorta and caused embolization in the right renal interlobar artery after passing above the sternoclavicular joint and penetrating into the aorta. Emergency surgery with cardiopulmonary bypass was performed to repair the cardiac tamponade and aortic injury. ⋯ The procedure was successful, and the patient was discharged on postoperative day 8. In gunshot injuries, if all entrance points are not paired with exit points, the possibility of an organ or extremity embolism caused by the presence of a bullet or shrapnel fragments in circulation should be borne in mind, although such occurrences are rare.
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The heart surgery forum · Jan 2008
Retrospective analysis of surgically treated infective endocarditis cases.
Prosthetic valve endocarditis (PVE) and native valve endocarditis (NVE) both cause high rates of morbidity and mortality and are significant health problems in our community. Optimal timing of the surgical intervention depends on the hemodynamic stability of the patient. In the present study, we retrospectively evaluated the clinical status, bacteriology, morbidity, and mortality parameters of infective endocarditis cases that were treated surgically. ⋯ Despite significant medical and surgical advances, both NVE and PVE still continue to be causes of high mortality and morbidity rates in cardiac surgery.