Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Dec 2011
Preserved consciousness in general anesthesia during carotid endarterectomy: a six-year experience.
We prospectively evaluated safety and efficacy from our six-year results of general anesthesia (GA) using remifentanil conscious sedation in carotid endarterectomy (CEA). ⋯ The six-year results for GA using remifentanil conscious sedation were very satisfactory and highlighted the advantages of both GA (hemodynamic stability and excellent control of ventilation) and local anesthesia (ease of evaluation of neurological status) in a calm and relaxed environment for both patient and surgeon.
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Interact Cardiovasc Thorac Surg · Dec 2011
Case ReportsVascular antispastic medication should take priority over other antihypertensives after coronary artery bypass grafting using a radial artery conduit.
Radial artery conduits have recently been used more often in coronary artery bypass grafting because of their potentially better long-term patency than saphenous vein conduits. However, vasospasm of the radial artery conduit due to its nature as a muscular artery has always been of concern and a variety of vasodilators have empirically been used to reduce the risk of spasm. ⋯ We report a case of a patient with a radial artery graft who did not receive vasodilators after surgery due to hypotension. The patient developed vasospasm of the radial artery conduit which did not respond to direct injection of vasodilators into the conduit but recovered after taking oral vasodilators for four weeks.
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Interact Cardiovasc Thorac Surg · Dec 2011
Valve prosthesis-patient mismatch: hemodynamic, echocardiographic and clinical consequences.
The purpose is to evaluate in vivo at rest and under stress conditions hemodynamic performance of the small size St. Jude Medical Regent (SJMR) prosthetic valve in patients with a body surface area (BSA) of 1.8 ± 0.11 m(2) and to define the role of valve prosthesis- patient mismatch on left ventricular mass regression following aortic valve replacement. ⋯ Aortic valve replacement with 17 mm SJMR or 19 mm SJMR prostheses appear to provide satisfactory clinical and hemodynamic results at rest and under DSE, even in those patients with BSA of 1.8 ± 0.11 m(2) where it was not possible to enlarge the aortic annulus. Prosthesis-patient mismatch is not associated with lesser regression of left ventricular mass. Dobutamine stress echocardiography should be a useful and effective means for evaluating prosthesis hemodynamic aspects.