Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Oct 2009
ReviewIs reduction aortoplasty (with or without external wrap) an acceptable alternative to replacement of the dilated ascending aorta?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether reduction aortoplasty is an acceptable alternative to ascending aorta replacement. From 925 potential papers, 13 papers represented the best evidence to answer the clinical question. ⋯ In particular, an aortoplasty in elderly patients with post-stenotic dilatation, or in patients with significant co-morbidities is attractive. It should be acknowledged that only one study directly compares the technique with conventional replacement and that replacement remains the 'gold standard' technique. It should also be acknowledged that the external wrap is not without risk and wrap dislocation, erosion or fistula formation are recognised complications.
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Interact Cardiovasc Thorac Surg · Oct 2009
A retrospective analysis of terlipressin in bolus for the management of refractory vasoplegic hypotension after cardiac surgery.
Cardiac surgery performed with cardiopulmonary bypass (CPB) may be complicated by hypotension due to low systemic vascular resistance (SVR). Often in those cases, hypotension is resistant to pressor catecholamines. We report six cases of norepinephrine-resistant postcardiotomy hypotension, treated by terlipressin (TP), a potent vasopressor agent. ⋯ Subsequently, the effect on systemic blood pressure enhanced urine output. No major collateral effects were observed. The administration of TP in bolus may result as a useful alternative for treating refractory low SVR hypotension post CPB.
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Interact Cardiovasc Thorac Surg · Oct 2009
Case ReportsNon-operative management of tube thoracostomy induced pulmonary artery injury.
Tube thoracostomy insertion is a common procedure in the management of air and fluid collections in the pleural space. Pulmonary artery injury is a rare but serious complication following intercostal catheterisation. This complication is usually managed surgically. We report a case of successful non-operative management of a pulmonary artery injury after tube thoracostomy.
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Interact Cardiovasc Thorac Surg · Oct 2009
Experience and intermediate-term results using the Contegra heterograft for right ventricular outflow reconstruction in adults.
The Contegra bioprosthesis (valved heterologous bovine jugular vein) is used for reconstruction of the right ventricular outflow tract (RVOT) in congenital heart malformations and pulmonary valve replacement in different settings. Compared to pulmonary homografts, the Contegra conduit is readily available 'on the shelf'. So far, its use was mainly described in children. The aim of this study is to evaluate the feasibility and the outcome of Contegra graft implantation in the adult. ⋯ In this small review of 32 operations using the Contegra graft for RVOT reconstruction in adult cardiac surgery for different indications, we observed good postoperative mid-term results concerning conduit function. Mean transpulmonary pressure gradients remain low (13.3+/-6.6 mmHg postoperative, 14.5+/-7.9 mmHg at follow-up). The use of the Contegra graft seems to be a good alternative to the homograft with low operative mortality and morbidity. Long-term outcome data are not available and further investigations must be performed to evaluate results.