PMC3902439_01
Pre and postoperative CT images. A. Preoperative axial computed tomogram with intravenous contrast demonstrating near-total obstruction of the SVC at the level of the right pulmonary artery (arrow). B. Postoperative coronal computed tomogram with intravenous contrast demonstrating wide patency of the cryopreserved thoracic aortic allograft-reconstructed SVC (arrows on proximal and distal anastomoses).
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F1
Contrast computed tomography (CT) demonstrated near total obliteration of the SVC at the level of the right pulmonary artery with an area of soft tissue calcification consistent with remote granulomatous infection. (Figure 1A) The obstruction was felt unamenable to percutaneous intervention therefore SVC resection and reconstruction planned through a median sternotomy approach. A CT scan with contrast was obtained 6 months after the initial operation confirming patency of the thoracic aortic allograft (Figure 1B).
Intraoperative photograph of allograft conduit in the anatomic SVC position (arrows on proximal and distal anastomoses, RA = right atrial appendage, IV = left innominate vein, PN = phrenic nerve and pedicle).
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F2
Clamps were removed after de-airing to reestablish flow through the homograft. (Figure 2) Subcutaneous heparin (5,000 U) three times daily for DVT prophylaxis and aspirin were begun on the second postoperative day.