Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Dec 2007
Management of complicated postoperative air-leak - a new indication for the Asherman chest seal.
Postoperative air-leak is a problem which is frequently encountered in thoracic surgery. We describe the utility of the Asherman chest seal, a device used in primary trauma care in the successful management of a complicated postoperative air-leak. The Asherman Chest Seal is a sterile occlusive dressing with a one-way Heimlich valve for treating open pneumothorax in acute settings. ⋯ All six patients had satisfactory expansion of the lungs with cessation of the air-leak. This was achieved without the pain and morbidity of a chest drain and inpatient stay. The Asherman chest seal is a simple but very useful device that has a role in management of complex air-leaks.
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Interact Cardiovasc Thorac Surg · Dec 2007
Arginine vasopressin is an ideal drug after cardiac surgery for the management of low systemic vascular resistant hypotension concomitant with pulmonary hypertension.
Low systemic vascular resistance (SVR) hypotension concomitant with pulmonary hypertension (PH) is difficult to manage postoperatively because they are often catecholamine-resistant. So, we applied arginine vasopressin (AVP), which is a potent vasoconstrictor in a specific condition, for post-cardiotomy refractory low SVR hypotension concomitant with PH. We treated nine cases of postoperative refractory vasodilatory hypotension concomitant with PH even after conventional treatment that included nitric oxide inhalation and/or intraaortic balloon pump. ⋯ AVP improved systemic circulation (increased systemic blood pressure with maintaining cardiac output) without deterioration of pulmonary hypertension. AVP is an ideal drug for treating refractory low SVR hypotension concomitant with PH. But its indication must be limited.
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Interact Cardiovasc Thorac Surg · Dec 2007
Case ReportsSuccessful interventional closure of a patent foramen ovale in a pediatric patient supported with a biventricular assist device.
We report on a 16-year-old boy after an event of cardiac arrest and initial treatment with a veno-arterial extracorporeal membrane oxygenator (ECMO). After a short stabilisation period a biventricular assist device (BVAD, Thoratec) was implanted. Although the BVAD was functioning well, the patient showed persisting hypoxemia. ⋯ PFO has to be considered as a cause of arterial hypoxemia in patients supported with ventricular assist devices. The diagnosis of a PFO may be missed under ECMO-treatment. Interventional closure of a PFO can successfully be performed even if the patient is supported with a BVAD.
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Interact Cardiovasc Thorac Surg · Dec 2007
Randomized Controlled TrialFibrinolysis in coronary artery surgery: detection by thromboelastography.
Sixty-five patients scheduled for coronary surgery were randomized into three groups: A - conventional coronary artery bypass grafting, B - off-pump surgery, C - coronary artery bypass grafting with modified, rheoparin coated cardiopulmonary bypass with the avoidance of re-infusion of cardiotomy blood into the circuit. On the completion of peripheral bypass anastomoses, highly significant inter-group differences were found in the thromboelastographic parameter lysis of set time at 60 min of assessment (P=0.003) and at 150 min of assessment (P<0.001), the mean values of these parameters were significantly lower in group A as compared with both groups B and C, which were statistically indistinguishable. ⋯ In group A no significant correlations between lysis on set time, postoperative blood loss and D-dimer levels were found. Based on our results, thromboelastographic signs of fibrinolysis were clearly detectable during cardiopulmonary bypass in group A, but not at any time in groups B and C.
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Interact Cardiovasc Thorac Surg · Dec 2007
Diabetes is not a risk factor for hospital mortality following contemporary coronary artery bypass grafting.
The outcome of coronary artery bypass grafting (CABG) in diabetic patients has traditionally been worse than in non-diabetic patients. Recent studies have suggested an improvement in outcome in diabetic patients undergoing contemporary CABG. However, the direct impact of diabetes on mortality and morbidities following CABG remains unclear. ⋯ Excellent results following contemporary CABG can be expected in diabetics with a similar mortality compared to non-diabetics. Therefore, our data suggest that diabetes may, in fact, not be a risk factor for adverse outcome following CABG. However, long-term survival in diabetics remains significantly inferior compared to non-diabetics.