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Table of Contents
Year : 2020  |  Volume : 10  |  Issue : 1  |  Page : 42-43

Complex re-operative surgery: A good physical exam could be critical

1 Departement of Cardiothoracic and Vascular Surgery, The Medical Center of Aurora, Aurora, CO, USA
2 Department Surgery, University of Tennessee Health Sciences, Memphis, TN, USA
3 Center-Global Surgery Institute, William Novick Global Cardiac Alliance, Memphis, TN, USA

Date of Submission31-Aug-2019
Date of Acceptance02-Dec-2019
Date of Web Publication9-Mar-2020

Correspondence Address:
Dr. Michael S Firstenberg
The Medical Center of Aurora, 1444 S. Potomac Street, Suite 200, Aurora, CO 80012
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/IJCIIS.IJCIIS_73_19

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How to cite this article:
Firstenberg MS, Novick W, Hanna J, McCallister D. Complex re-operative surgery: A good physical exam could be critical. Int J Crit Illn Inj Sci 2020;10:42-3

How to cite this URL:
Firstenberg MS, Novick W, Hanna J, McCallister D. Complex re-operative surgery: A good physical exam could be critical. Int J Crit Illn Inj Sci [serial online] 2020 [cited 2023 Mar 30];10:42-3. Available from: https://www.ijciis.org/text.asp?2020/10/1/42/280229

Our patient was a 26-year-old male who presented with worsening shortness of breath and a heart murmur. An echocardiogram demonstrated critical aortic stenosis in the setting of a bicuspid valve and what appeared to be a small aortic root. His past surgical history was significant for previous open cardiac surgery when he was young. He did not recall the specific details other than it had been performed “somewhere in England when I was a child.” However, he commented that he once had a copy of his operative note and thought the picture of his heart from surgery was “really cool” and as such, had a tattoo made on his chest [Figure 1]. Further inspection of the tattoo suggested that his initial surgery appeared to have been consistent with repair of an interrupted aortic arch – a key piece of clinical information that was vital in terms of explaining his cardiovascular anatomy and planning the technical aspects of his complex re-operative surgery. Several weeks later, he underwent uncomplicated peripheral cannulation for cardiopulmonary bypass, re-operative median sternotomy, and aortic valve replacement, with pericardial patch root and proximal aortic enlargement.
Figure 1: Tattoo outlining cardiac anatomy and previous surgical repair

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If nothing else, this case illustrates that despite all of the advances in diagnostic and therapeutic technologies in health care, sometimes, it is a basic examination of the patient that provides the most clear and important information. The value of a good, even simple, physical exam cannot be underappreciated.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

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Conflicts of interest

There are no conflicts of interest.


  [Figure 1]


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