Reimplantation of a left internal thoracic artery during repeat coronary artery revascularization: early and midterm results.
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PURPOSE: To evaluate the outcome and potential reversibility of the changes induced in keratoconic eyes after intracorneal ring segment explantation. DESIGN: Retrospective, interventional case series. PARTICIPANTS: Five eyes of 4 patients who underwent uneventful implantation of one or two intracorneal ring segment segments for the correction of clear corneal keratoconus and who required explantation of one segment due to complications. MAIN OUTCOME MEASURES: Visual acuity, refraction, keratometric readings, and corneal topography. The follow-up was up to 1 year from the primary implantation procedure in all cases. RESULTS: Explantation was performed easily in all cases without intraoperative or postoperative complications. The segments were extracted due to migration and local melting. The visual, refractive, and topographic map findings regressed to approximate the original clinical situation before segment implantation. CONCLUSIONS: Intracorneal ring segments are safely and easily explanted from keratoconic eyes. Most of the visual, refractive, and topographic findings return to near the preimplantation levels.
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Urologic complications are common in renal transplant surgery. Numerous innovations have been developed to circumvent ureterovesical anastomotic failure. In addition to the popular modified Lich-Gregoir technique, we evaluated Taguchi's method which is both quick and easy to perform. One hundred forty four patients were prospectively compared using Taguchi (n = 44) or the modified Lich-Gregoir (n = 100) for anastomotic time, which differed significantly (10.2 minutes for Taguchi, vs. 24.6 minutes to Lich-Gregoir; P < .005). Minor complications, however, were less among Lich-Gregoir patients (P < .02). We concluded to continue using the modified Lich-Gregoir ureteroneocystostomy despite taking longer time to perform.
A method for replacing the entire ascending aorta and aortic valve is described that employs direct anastomosis of the coronary ostia to the graft, facilitated by appropriately time periods of hypothermic ischemic cardiac arrest. The advantages of this technique are that proper placement of sutures around the coronary ostia is simplified and that hemostasis at the aortic annulus and coronary anastomosis can be evaluated before the aortic clamp is removed and suture lines become inaccessible.
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BACKGROUND: We compared two repair techniques for pulmonary artery sling. The first comprised detachment of the aberrant left pulmonary artery from the right pulmonary artery and its implantation into the main pulmonary artery, and the second, translocation of the left pulmonary artery anterior to the trachea (without implanting it into the main pulmonary artery), resection of tracheal stenosis, and end-to-end reconstruction of the trachea. METHODS: Five symptomatic infants (3 boys and 2 girls; median age 5 months; range, 3 weeks to 11 months) with pulmonary artery sling were operated on through a median sternotomy with aid of cardiopulmonary bypass. In 3 patients, the left pulmonary artery was transected from the right pulmonary artery and implanted into the main pulmonary artery. In addition, the anterior trachea was augmented with a pericardial patch (n = 2). In the remaining 2 patients, associated tracheal stenosis was resected, the left pulmonary artery was translocated anterior to the trachea, and the trachea was reconstructed. RESULTS: All 5 infants survived the operation. The 3 patients in whom the left pulmonary artery was implanted into the main pulmonary artery had an uncomplicated postoperative course. All 3 patients, at a follow-up of 10 months to 7.9 years, were free of symptoms; the left pulmonary artery was documented to be widely patent. The remaining 2 patients in whom the left pulmonary artery was translocated anterior to the trachea could not be extubated. In both patients the distal trachea was compressed anteriorly by the left pulmonary artery. One of these patients died at 1 week postoperatively secondary to tracheal dehiscence. In the other patient, the left pulmonary artery was implanted into the main pulmonary artery with good result; at a follow-up of 3.9 years, mild residual stridor has persisted. CONCLUSIONS: In pulmonary artery sling, implantation of the aberrant left pulmonary artery into the main pulmonary artery, if necessary combined with anterior tracheoplasty, reliably eliminates tracheal and esophageal compression and maintains antegrade flow into the left pulmonary artery. Translocation of the left pulmonary artery anterior to the trachea without implanting it into the main pulmonary artery is not favored because that might result in anterior compression of the trachea. In addition, we are concerned about growth of the circumferential tracheal anastomosis in neonates and infants.
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