Ali Khoynezhad

Total Mediastinal Traverse with Isolated Internal Mammary Artery Transection

Abstract  Transmediastinal gunshot wounds are infrequent but life‐threatening injuries. The course of the projectile and the bullet track often is unpredictable. Prompt and specific diagnostic and therapeutic interventions are necessary to quickly identify and repair potentially life‐threatening injuries to the heart, great vessels, and the aerodigestive tract. Multiple diagnostic algorithms exist for work‐up of these injuries, and the therapeutic interventions are diverse and challenging. We describe a patient with total mediastinal traverse, who presented with right‐sided hemopneumothorax. The work‐up revealed surprisingly an isolated left internal mammary artery transection with a significant hemorrhage that mandated surgical intervention in left chest. (J Card Surg 2004;19:136‐138)

Aortic Hemiarch Replacement through a J-Shaped Lower Partial Sternotomy.

Minimally invasive cardiac surgical techniques include the use of partial sternotomy for aortic valve and mitral valve replacement. Partial sternotomy is associated with less pain, better chest and upper-sternal stability, shorter hospital stays, and faster recoveries. However, aortic arch operations are still typically performed through median sternotomies. We describe the case of a 77-year-old woman who underwent elective hemiarch replacement because of an asymptomatic ascending aortic aneurysm. She requested a minimal incision. Our J-shaped partial lower sternotomy adequately exposed the proximal aorta and enabled all cannulations to be performed through the sternotomy. The patient had an uncomplicated postoperative course. We think that a partial sternotomy for ascending aortic and hemiarch replacement can be considered in selected patients for whom the procedures benefits are important.

Perioperative Hemodynamic Management and Pharmacotherapeutics of Patients Undergoing Thoracic Endovascular Aortic Repair

Thoracic endovascular aortic repair (TEVAR) has become an attractive alternative treatment option for many patients with specific thoracic aortic disease. New devices and advanced image-guided procedures are continuously expanding the indications and improve neurological outcomes. Hemodynamic management of these patients is a critical aspect in reducing neurological deficit and it is different compared to patients undergoing open thoracic aortic operations. There are two different phases of blood pressure management for patients with thoracic aortic disease. Before and during the critical steps of TEVAR anti-impulsive therapy facilitates safe positioning and stent deployment. After stent grafts are deployed, controlled hypertensive blood pressure levels are achieved to avoid spinal cord ischemia. This precise blood pressure strategy is essential to ensure a safe procedure and good long-term results.