Right-to-Left Shunting after Lobectomy through a Patent Foramen Ovale

Hypoxia and dyspnea after lung resection may be caused by a variety of factors. One entity that has been rarely described is right-to-left shunting across an interatrial communication in the absence of elevated right-sided pressures. We describe the occurrence of clinically evident right-to-left shunting after lobectomy in a patient with a patent foramen ovale and suggest that two-dimensional contrast echocardiography is a useful and minimally invasive means of diagnosing what may be a more common entity than was previously recognized.     

Massive Pulmonary Embolism Complicated by a Patent Foramen Ovale with Straddling Thrombus: Report of a Case

We report a case of massive right pulmonary embolism with a patent foramen ovale and straddling thrombus, occurring a few days after cesarean section in a 31-year-old woman. Preoperatively, a mass was seen echocardiographically in four cardiac cavities. We performed emergency surgery because of the patient's acute hemodynamic deterioration. Intraoperatively, we found a thrombus entrapped in the patent foramen ovale. Most of the thrombus was floating in the right atrium and a long end was found in the left atrium, in addition to the pulmonary emboli. We removed the thrombus, closed the patent foramen ovale by direct suturing, and performed pulmonary embolectomy. Histological examination confirmed thrombi. Doppler examination of the venous system did not reveal any possible source of the thrombus. The patient is now well and free from recurrence of embolic disease 1 year after surgery. We review the literature on this relatively unusual thromboembolic disease.     

Association of Double-J Stenting in Renal Transplant Patients With Urinary Tract Colonization and Infections in a Multidrug-resistant Microbe Endemic Nosocomial Environment

Purpose

We investigated the association of ureteral stenting after kidney transplantation with the development of urinary tract infections (UTIs) and/or urinary tract colonization, in a hospital environment considered endemic for multidrug resistant (MDR) Gram-negative Enterobacteriaceae.

New-Onset Diabetes After Transplantation: Comparison Between a Cyclosporine-Based and a Tacrolimus-Based Immunosuppressive Regimen

Introduction

New-onset diabetes after transplantation (NODAT) is a complication of renal transplantation (RT) with an adverse effect on graft survival.

Extracorporeal Membrane Oxygenation for Massive Pulmonary Thromboembolism

This study was undertaken to determine whether extracorporeal membrane oxygenation (ECMO) could modify the effects of massive lethal thromboembolism and prevent death. Twenty anesthetized dogs were prepared for venoarterial perfusion with a demand pump and membrane lung and were perfused slowly for 1 1/2 hours to lessen homologous blood shock; 1 ml per kilogram of 24-hour-old tantalum-impregnated thrombus was injected intravenously. The dogs had profound systemic hypotension with an elevated mean pulmonary artery pressure (62.9 ± 4.5 mm Hg) immediately after embolization. Control animals generally died within 15 minutes. Four of the 10 ECMO-supported animals lived for six days, at which time they were restudied and killed.Not only can ECMO maintain an animal that would otherwise die quickly of massive pulmonary thromboembolism, but such support, even though temporary, can greatly improve the chances of survival.     

Critical Pulmonary Stenosis in Infants Less than Three Months of Age: A Reappraisal of Closed Transventricular Pulmonary Valvotomy

Sixteen patients less than 3 months of age underwent closed transventricular pulmonary valvotomy for critical pulmonary stenosis with intact ventricular septum. There were 14 survivors; the 2 deaths were unrelated to the technique. Early and late results reveal good hemodynamics in all but 1 patient who underwent open valvotomy four years later for restenosis. We have used this technique exclusively, as it is safe, requires little preparation for operative relief in the very sick infant, and the early and late results are excellent.     

Repair of Atrial Septal Defect with Partial Anomalous Pulmonary Venous Return from the Left Upper Lobe

A patient with partial anomalous venous return from the left upper lobe in the presence of a large atrial septal defect is presented. The diagnosis was confirmed by selective angiographic studies. Two technical points are emphasized: first, that the exposure through a midsternal incision is excellent, and second, that the anomalous vein must be detached from its connection to the innominate or subclavian artery as high into the left chest as it is technically possible to reach. Postoperative cardiac catheterization and angiograms confirm the completeness of the repair.     

Sinus Venosus Atrial Septal Defect Associated with Partial Anomalous Pulmonary Venous Drainage: Surgical Repair

This report describes a new technique for the repair of sinus venosus atrial septal defect associated with partial anomalous pulmonary venous drainage. A right atrial wall flap is used both to deflect the anomalous venous blood into the left atrium and to close the atrial septal defect. Then an atrioplasty is performed. This method does not employ any foreign materials, avoids injury to the sinoatrial node and internodal tracts, and minimizes the risk of obstruction of the ostia of the anomalous pulmonary veins and superior vena cava.     

Massive Pulmonary Embolism Permitting Paradoxical Systemic Arterial Embolism: Successful Surgical Management

The case of a young woman, receiving oral contraceptives, who developed massive pulmonary embolism producing circulatory collapse and paradoxical arterial embolism through a patent foramen ovale is documented. Limb viability was threatened. Emergency management included removal of arterial and pulmonary emboli, surgical closure of the patent foramen ovale, inferior caval partitioning, ovarian vein ligation, and short-term anticoagulation. Recovery was rapid and complete.     

Influence of Pulmonary Hypertension on Intrahospital Mortality in Lung Transplantation for Interstitial Lung Disease

Background

Pulmonary hypertension (PH) is a comorbidity associated with interstitial lung disease (ILD). The purpose of this study was to evaluate the influence of PH on intrahospital mortality in lung transplantation (LT) for ILD.