Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · May 2008
Use of tissue microdialysis to investigate hyperlactataemia following paediatric cardiac surgery.
We investigated tissue lactate, pyruvate and lactate:pyruvate (LP) ratio post cardiac surgery and the relationship of cardiac index and oxygen delivery to late onset hyperlactataemia in ICU. It involved a prospective study of 10 children, mean age 4.9 (0.4) years, post-Fontan operation admitted with normo-lactataemia. Tissue lactate, pyruvate and LP ratio were monitored postoperatively every 30 min for 12 h via subcutaneous microdialysis in the abdominal wall. ⋯ Cardiac index increased from 2.83 (0.63) to 3.77 (1.34) l min(-1) m(-2) over the same period (P=0.05), with a corresponding increase in oxygen delivery from 4556 (1094) to 6076 (2322) ml min(-1) (P=0.04). Tissue microdialysis provides near-continuous measurement of tissue lactate and pyruvate, post cardiac surgery. Blood lactate rise post-Fontan is mirrored by tissue lactate and pyruvate concentrations, and not associated with a low or falling cardiac index or with tissue oxygen debt.
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Interact Cardiovasc Thorac Surg · May 2008
ReviewIs blood cardioplegia superior to crystalloid cardioplegia?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether blood cardioplegia is clinically superior to crystalloid cardioplegia for myocardial protection. Altogether 501 papers were identified. ⋯ Of these, 10 reported some statistically significant clinical outcomes in favour of blood cardioplegia and five reported statistically significant differences in enzyme release in favour of blood cardioplegia. A recent survey of UK practice found that 56% of surgeons use cold blood cardioplegia, 14% use warm blood cardioplegia, 14% use crystalloid cardioplegia, 21% use retrograde infusion and 16% do not use any cardioplegia. The papers presented in our review support most of these practices!
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A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: does re-expansion pulmonary oedema exist? Altogether 233 papers were found using the reported search, of which 13 represented the best evidence to answer the clinical question. The authors, journal, date and country of publication, patient group studied, study type, relevant outcomes and results of these papers are tabulated. ⋯ The British Thoracic Society guidelines suggest <1.5 l pleural fluid should be drained at a time. Provided no respiratory symptoms occur it is not unreasonable to drain larger volumes to dryness: caution should be taken to avoid high negative intrapleural pressures. Patients who appear to be at higher risk, which may warrant more gradual evacuation, are: those who have had large pneumothoraces; young patients; patients in whom the lung has been down for >7 days; and possibly those who need >3 l of pleural fluid drained.
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Interact Cardiovasc Thorac Surg · May 2008
Papillary muscle realignment and mitral annuloplasty in patients with severe ischemic mitral regurgitation and dilated heart.
Chronic ischemic mitral regurgitation (IMR) is one of the leading causes of congestive heart failure and death. It is controversial whether mitral annuloplasty (MAP) per se can improve the long-term survival because IMR has been considered a disease of the left ventricle. We reviewed our experience of papillary muscle realignment in conjunction with MAP in patients with IMR. ⋯ Furthermore, a six-month echocardiographic examination demonstrated that these improvements remained unchanged. The combination of papillary muscle realignment and MAP seems to be effective in patients with IMR. The duration of the effect may be expected to be long-term with these methods.