Penetrating bullet wound of chest with bronchoscopic removal of bullet.

A case history is presented of a patient with a penetrating bullet wound of the chest in whom the 0.38 caliber bullet was unexpectedly found entirely within the lumen of the right lower lobe bronchus at bronchoscopy. A second bullet penetrating the abdomen necessitated an extensive abdominal operation and delayed removal of the intrabronchial bullet by 1 day. During the 1 day interval, distal migration of the intrabronchial bullet caused technical problems in removal which are discussed. The bullet was successfully removed with a rigid bronchoscope without subsequent complications. The limited literature on this rare occurrence is reviewed, and suggestions are made concerning management.

Preservation of anterior and posterior leaflet in mitral valve replacement with a tilting-disc valve.

An operative technique for mitral valve replacement with preservation of chordae tendineae to both the anterior and posterior leaflets is described. The anterior mitral valve leaflet is completely detached from the annulus and divided into three to four islands of tissue, each with attached chordae tendineae. These islands are transposed under the posterior leaflet and secured with 4-0 polypropylene sutures. The posterior leaflet is completely preserved with no division or manipulation. This technique allows safe implantation of tilting-disc or bileaflet prostheses with excellent preservation of left ventricular function.

Parasternal intrapleural colon interposition: an alternative pathway for the colon graft.

A new pathway for the placement of the interposed colon in esophagocolonoplasty is described. In a patient with a peptic stricture and a history of previous coronary artery bypass operation and multiple thoracotomies, the interposed colon was placed in the parasternal right intrapleural space successfully. This avoided a thoracotomy as well as the areas of adhesion. Technical details are described.

Pulmonary preservation effect of nitroglycerine in isolated rat lung reperfusion model.

PURPOSE: Though nitric oxide has many favorable protective effects on donor lungs, it may also have cytotoxic side effects. In this regard, we investigated whether administration of nitroglycerine, a nitric oxide donor, could minimize ischemia-reperfusion injury in an isolated rat lung reperfusion model. MATERIALS AND METHODS: Thirty-five Sprague-Dawley rats were used for this experiment. The nitroglycerine (NTG) group (n = 18) received the drug intravenously and the 17 control group hosts were treated with the same amount of normal saline. The heart-lung block was retrieved, weighed, and maintained in University of Wisconsin solution for 24 hours at 10 degrees C. Reperfusion was performed using human blood diluted in Krebs-Hensleit solution for 60 minutes. Peak inspiratory pressure, pulmonary artery pressure, and blood gas analysis were performed. After 60 minutes of reperfusion, the amount of protein in bronchoalveolar lavage (BAL) fluid and the myeloperoxidase (MPO) activity in the lung were measured. RESULTS: There were no major statistical differences between the two groups in peak inspiratory pressure and pulmonary artery pressure, but the NTG group maintained lower pulmonary artery pressure during the whole period of reperfusion. Oxygen tension in the NTG group was significantly higher, whereas there were no differences in carbon dioxide tension, BAL fluid, protein, or MPO activity. CONCLUSION: Administration of NTG before donor lung preservation resulted in better lung protection, a possible strategy for clinical application.

Catheter induced pulmonary arterial perforation during open heart surgery.

Four cases of the pulmonary artery perforation induced by the flow directed pulmonary artery catheter (Swan-Ganz Catheter) are reported. These cases were experienced in approximately 1500 major cardiac procedures over a four year period in the cardiothoracic surgical service at a community cardiac center. Their clinical manifestations, management and eventual outcomes are discussed. Based on this clinical experience and review of the literature, current management plans are discussed. We suggest preventative measures to avoid similar complications.

Survival with total occlusion of left main coronary artery.

Complete occlusion of the left main coronary artery is considered to be a terminal event in most cases. We describe two patients with this lesion who underwent successful coronary bypass surgery with complete relief of symptoms and long-term survival. The angiographic findings and clinical management of the two patients are discussed.

Leiomyosarcoma of the esophagus: report of a case and review of the literature.

Leiomyosarcoma of the esophagus is a very rare neoplasm, the total number of reported cases in the English literature being 44 patients. We describe another case of the esophageal leiomyosarcoma to add to the recorded experience of this rare tumor. The therapeutic and prognostic implications of the tumor are discussed, and the related literature is reviewed. In spite of the progress in the thoracic surgical care of patients and the progress in the field of oncology, overall prognosis of patients with leiomyosarcoma of the esophagus remains unchanged. Patients with polypoid lesions and well-differentiated histologic features appear to show better chance of survival. Simple excision of the lesion can be as effective as radical excision, especially in well-localized lesions.

Anomalous origin of the left coronary artery from the pulmonary trunk: its clinical spectrum and current surgical management.

An anomalous left coronary artery arising from the pulmonary artery is a rare congenital anomaly which carries a serious prognosis with a high mortality in infants. Our experience in the surgical treatment of 9 patients with this condition during the last 5 years is discussed. The majority of patients were under the age of 2 years and presented with left ventricular failure. Surgical procedures included simple ligation of the left coronary artery, left subclavian to left coronary artery anastomosis, interposition vein graft, and direct reimplantation of the left coronary artery into the aorta. Patients treated by simple ligation survived the procedure but did not show improvement. Results with the subclavian artery to left coronary artery anastomosis were disappointing. Direct reimplantation or interposition of a saphenous vein graft appears to be the method of choice.