Michael D. Horowitz

Late complications of plombage

Plombage was used commonly in the management of tuberculosis before the early 1950s. From 1977 through 1990, 4 patients were seen with complications of plombage performed decades previously. Lucite spheres were used in 3 patients and paraffin in 1. One patient had bilateral apical plombage. In all cases, complications were related to infection or migration of the foreign material. Two patients had extrusion of foreign material or fluid into the chest wall. One patient had hemoptysis and infection due to erosion of a Lucite sphere into the lung. Another had intestinal obstruction subsequent to erosion into the esophagus. The patient with bilateral plombage had development of asynchronous complications on both sides. Treatment consisted of removal of the foreign material and individualized management of the remaining space. There were no operative deaths and the outcome was good in all cases.

Pulmonary Artery Banding: Analysis of a 25-Year Experience

A 25-year experience (May 1962 through April 1987) with pulmonary artery banding in 183 patients was reviewed and analyzed. Pulmonary artery banding was performed in a heterogeneous group of patients aged two days to 60 months (median, 10 weeks; mean, 21.8 weeks) and weighing 1.4 to 13.8 kg (mean, 4.2 kg). Diagnosis was ventricular septal defect in 76 (41.5%) and atrioventricular communis in 41 (22.4%). Pulmonary artery banding was also used in patients with d-transposition of the great vessels with ventricular septal defect, double-outlet right ventricle, univentricular heart, tricuspid atresia, and truncus arteriosus. Early death occurred in 39 of 175 patients who underwent pulmonary artery banding at Ochsner Foundation Hospital (22.3%). Definitive operation has been performed in 37 of the patients who underwent pulmonary artery banding since 1979 with excellent outcome in 32 (86.5%). Pulmonary artery banding is a useful palliative procedure for a diverse group of patients with congenital cardiac anomalies and unrestricted pulmonary blood flow. With improved results of primary repair of intracardiac anomalies in small infants, however, pulmonary artery banding should be reserved for severely ill patients with complex lesions not amenable to early definitive correction. Currently, pulmonary artery banding is indicated in patients with excessive pulmonary blood flow and single ventricle or tricuspid atresia. Pulmonary artery banding is also appropriate in certain patients with atrioventricular communis and in patients with muscular or multiple ventricular septal defects. Pulmonary artery banding is an option in patients with ventricular septal defect and coarctation of the aorta.

Cor triatriatum in adults

with echocardiographically detected right-sided heart thrombi: a metaanalysis. AM HEART J 1989;118:569-73. 4. Kronik G, for European Working Group on Echocardiography. The European cooperative study on the clinical significance of right heart thrombi. Eur Heart J 1989;10:1046-59. 5. Kasper W, Meinertz T, Henkel B, Eissner D, Hahn K, Hofmann T, Zeiher A, Just H. Echocardiographic findings in patients with proved pulmonary embolism. AM HEART J 1986;112:1284-90. 6. Franzoni P, Cuccia C, Zappa C, Volpini M, Gel P, Visioli O. Tromboembolo migrante nelle cavit~ cardiache destre in corso di embolia polmonare. G Ital Cardiol 1989;19:7-16. 7. Chakko S, Richards F. Right-sided cardiac thrombi and pulmonary embolism. Am J Cardiol 1987;59:195. 8. Goldhaber SZ, Heit J, Sharma GVRK, Friedenberg WR, Heiselman DE, Wilson DB, Parker JA, Bennet D, Feldstein ML, Selwyn AP, Kim D, Sharma GVRK, Nagel JS, Meyerovitz MF. Randomized controlled trial of recombinant tissue plasminogen activator versus urokinase in the treatment of acute pulmonary embolism. Lancet 1988;2:293-8. 9. Goldhaber SZ, Kessler CM, Heir JA, Elliot CG, et al. Recombinant tissue-type plasminogen activator versus a novel dosing regimen of urokinase in acute pulmonary embolism: a randomized controlled multicenter trial. J Am Coll Cardiol 1992;20:24-30. 10. Levine MN, Hirsh J, Weitz J, Cruikshank M, Neemeh J, Turpie AG, Gent M. A randomized trial of a single bolus dosage regimen of recombinant tissue plasminogen activator in patients with acute pulmonary embolism. Chest 1990;98: 1473-9.

Resection of right atrial lymphoma in a patient with AIDS

Although cardiac problems are common in acquired immunodeficiency syndrome, there is limited experience with heart surgery in this group of patients. We report a case in which a right atrial lymphoma was resected to alleviate tricuspid valve obstruction in a patient with AIDS. The patient did well for approximately 7 months. At that time, he developed multiple complications of AIDS and deteriorated rapidly; he died 8 months after operation. Cardiac surgery can be successfully performed in AIDS patients. However, the late outcome is compromised by the nature of the underlying viral infection.

Intraaortic balloon entrapment

A review of intraaortic balloon pump use at the University of Miami/Jackson Memorial Medical Center over the past 21 years identified 2 cases where a balloon was found to be entrapped. The balloon catheters had been in place for approximately 10 days when this complication occurred. The retained balloons were torn, filled with clotted blood, and impacted in the vasculature. In our first case, forceful removal of the intraaortic balloon was complicated by unintentional extraction of the external iliac and common femoral arteries. In the second case, clot within the balloon was dissolved with tissue plasminogen activator injected into the drive lumen of the catheter before removal. The prevention and management of this rare but serious complication of intraaortic balloon pumping is reviewed.

Coronary-subclavian steal: A cause of recurrent myocardial ischemia

Coronary-subclavian steal through an internal mammary artery (IMA) graft is a rare cause of myocardial ischemia in patients who have previously undergone coronary artery bypass surgery. Two patients presented with upper extremity ischemic symptoms and recurrent angina pectoris 3 to 4 years following coronary artery bypass with in situ IMA grafts. Diagnosis of coronary-subclavian steal was confirmed by brachiocephalic arteriography, which showed tight stenosis or occlusion of the proximal subclavian artery. Coronary arteriography showed retrograde filling of the IMA with steal from the coronary circulation. Both patients were successfully treated by carotid-subclavian bypass.

A Venous Reservoir for Cardiopulmonary Bypass in Newborns and Small Infants

A venous reservoir has been designed for cardiopulmonary bypass in newborns and small infants that prevents undesirable volume shifts and thus permits precise control of perfusion.

Surgical Tourism: The Role of Cardiothoracic Surgery Societies in Evaluating International Surgery Centers

In the end, ethical principles of autonomy (respect for the individual), beneficence (doing good for the patient), non-maleficence (avoiding harm), and justice (treat all patients fairly) support the patient in doing what she wants to do with her own life. However, thoracic surgical societies are under no obligation to facilitate this practice, given the potential negative consequences to our health care structure, our culture, and our economic well-being.

Hyperbaric oxygen: Value in management of nonhealing saphenectomy wounds

The greater saphenous vein is commonly used as a conduit for arterial bypass in both cardiac and peripheral vascular operations. Although saphenectomy wound complications occur infrequently, such problems may be quite serious. We report a case in which hyperbaric oxygen therapy was extremely valuable in the management of a very difficult saphenectomy wound.