Subject(s)
Atrial Fibrillation/surgery , Catheter Ablation , Cryosurgery , Endocardium/surgery , Pulmonary Veins/surgery , Aged , Atrial Fibrillation/diagnosis , Atrial Fibrillation/physiopathology , Catheter Ablation/adverse effects , Cryosurgery/adverse effects , Endocardium/physiopathology , Female , Humans , Male , Middle Aged , Pulmonary Veins/physiopathology , Recurrence , Registries , Retrospective Studies , Risk Factors , Time Factors , Treatment OutcomeABSTRACT
Left internal mammary artery (LIMA) harvesting for coronary artery bypass grafting often complicates future thoracic procedures because of adhesion formation in the left chest and to the left upper lobe. We describe an adjuvant approach to left upper lobectomy for bronchogenic carcinoma in a patient with previous LIMA harvesting and grafting in which we preserved the LIMA pedicle, while still providing near complete lobe resection.
Subject(s)
Carcinoma, Non-Small-Cell Lung/surgery , Coronary Artery Bypass/methods , Internal Mammary-Coronary Artery Anastomosis , Lung Neoplasms/surgery , Pneumonectomy/methods , Aged , Aged, 80 and over , Carcinoma, Non-Small-Cell Lung/complications , Carcinoma, Non-Small-Cell Lung/pathology , Coronary Stenosis/complications , Coronary Stenosis/diagnosis , Coronary Stenosis/surgery , Follow-Up Studies , Humans , Lung Neoplasms/complications , Lung Neoplasms/pathology , Male , Preservation, Biological , Risk Assessment , Thoracotomy , Treatment OutcomeABSTRACT
OBJECTIVE: To determine whether delay of the repair of the ruptured thoracic aorta in patients with other major injuries is safe and has a potential positive impact on survival. SUMMARY BACKGROUND DATA: The accepted treatment for acute traumatic rupture of the thoracic aorta has been repair of the injury as soon as possible. This form of management, however, has been accompanied by a death rate of 0% to 54% mortality, often related to the presence of other injuries. METHODS: The records of 30 consecutive patients with rupture of the thoracic aorta from blunt trauma treated from 1995 to 2001 were retrospectively reviewed. Two of them died shortly after admission and were excluded from further consideration. The remaining 28 patients were divided according to the time of the repair of the rupture into two groups. Group 1 patients underwent repair of the rupture immediately after the diagnosis was made. Group 2 patients, who had associated injuries that were likely to increase the risk of surgical death, had either repair more than 48 hours after injury (subgroup 2A) or had no repair (subgroup 2B). The patients in group 2 had their mean arterial pressure maintained at less than 70 mm Hg with medication to eliminate shear stress on the aortic tear while being observed. RESULTS: Twenty-eight patients (22 men, 6 women) with an average age of 36 years (range 19-76) were treated. Twenty-five had rupture of the descending thoracic aorta and three had rupture in the ascending thoracic aorta. Group 1 comprised 14 patients, 5 of whom died during surgery or in the early postoperative period. Group 2 comprised 14 patients, 9 in subgroup 2A and 5 in subgroup 2B. Two patients in subgroup 2A and three patients in subgroup 2B died of associated injuries or illnesses. Rupture of the traumatic pseudoaneurysm of the thoracic aorta did not occur in any of the patients in group 2. CONCLUSIONS: Delayed repair of acute traumatic aortic rupture is safe under appropriate treatment and should be considered in selected patients.