Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Dec 2008
Controlled Clinical TrialFenoldopam in newborn patients undergoing cardiopulmonary bypass: controlled clinical trial.
We determined if low dose fenoldopam in neonates already receiving conventional diuretics improves urine output, fluid balance, acute kidney injury incidence (AKI) and time to extubation. A prospective controlled clinical trial in a pediatric cardiac intensive care unit on 40 neonates undergoing cardiac surgery with cardiopulmonary bypass, excluding simple ventricular septal defect and atrial septal defect. Fenoldopam was infused at a low dose of 0.1 microg/kg/min soon after anesthesia induction and infusion prolonged for 72 h in 20 patients. ⋯ The treatment did not significantly affect IS value, AKI incidence, fluid balance control, time to sternal closure, time to extubation and time to intensive care unit discharge. Low dose fenoldopam in neonates undergoing cardiac surgery with CPB did not produce effects on urine output, fluid balance and AKI incidence. Fenoldopam was well tolerated and did not negatively affect hemodynamics and vasopressor support.
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Interact Cardiovasc Thorac Surg · Dec 2008
Case ReportsTotal cavopulmonary connection for functionally single ventricle with pulmonary atresia and abnormal arborization of pulmonary arteries--exclusion of overwhelmed area by collateral arteries from Fontan circulation.
Functionally single ventricle with major aortopulmonary collateral arteries and pulmonary atresia is very rare. Surgical indication for this combination of abnormalities is still unclear and Fontan procedure is still a crucial challenge for the patient who has this anomaly. We report a case with asplenia, functionally single ventricle, pulmonary artesian and pulmonary abnormal arborization who successfully underwent staged Fontan operation. In this case, the left upper lobe area, where the flow from a Glenn shunt was overwhelmed by the collateral arterial blood flow, was excluded from the Fontan circulation by the ligation of the left upper pulmonary arterial branch at its most proximal side at the time of fenestrated extracardiac total cavopulmonary connection.
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Interact Cardiovasc Thorac Surg · Dec 2008
Case ReportsEndovascular repair after stent elephant trunk procedure for extensive thoracic aortic aneurysm.
Hybrid surgical-endovascular procedure was conducted in a 46-year-old male with extensive thoracic aortic aneurysm. Ascending aorta and arch replacement combined with stent elephant trunk implantation was performed first. ⋯ Postoperative CTA showed total coverage of the descending aorta by stent-grafts and the descending aortic aneurysm was totally thrombo-excluded. Stent elephant trunk may be a better alternative to conventional elephant trunk in hybrid surgical-endovascular approaches in treatment of extensive thoracic aortic aneurysm.
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Interact Cardiovasc Thorac Surg · Dec 2008
Case ReportsA rapid bail-out technique for reinsertion of a displaced tracheostomy tube in difficult situations.
Safe and rapid repositioning of a displaced tracheostomy tube is vital to protect the airway and to avoid a potentially life threatening situation. This article describes a simple bail-out technique to avert prolonged airway compromise. This is particularly useful in patients with obesity, large goitre or maxillofacial injuries.
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Interact Cardiovasc Thorac Surg · Dec 2008
Case ReportsLeft ventricular pseudoaneurysm after pericardiocentesis.
We present the case of a patient with recurrent episodes of pericardial effusion and fever. During approximately one month, the patient was treated with double pericardiocentesis for cardiac tamponade and the last of them was interrupted for the suspect of left ventricular puncture due to aspiration of arterial blood from the needle used for pericardiocentesis. Considering the suspect of infective pleuro-pericarditis and patient's symptoms, a surgical drainage of the pericardial effusion was performed via right thoracotomy. ⋯ Exclusion of the LV pseudoaneurysm was performed using a Prolene 0 running suture on two strips of bovine pericardium, avoiding ECC use. The patient was discharged on the 7th postoperative day. Iatrogenic pseudoaneurysm caused by pericardiocentesis represents a very rare complication and it should be prevented by identifying the high-risk patients.