Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Mar 2013
ReviewWhat is the optimum prophylaxis against gastrointestinal haemorrhage for patients undergoing adult cardiac surgery: histamine receptor antagonists, or proton-pump inhibitors?
A best evidence topic was written according to a structured protocol. The question addressed was what is the optimum prophylaxis against gastrointestinal haemorrhage for patients undergoing adult cardiac surgery: histamine receptor antagonists (H(2)RA) or proton-pump inhibitors? A total of 201 papers were found; of which, 8 represented the best evidence. The authors, date, journal, study type, population, main outcome measures and results were tabulated. ⋯ Two RCTs showed that H(2)RAs may augment the immune system and reducing stress following cardiac surgery. Proton-pump inhibitors appear to be the superior agent for prophylaxis against gastrointestinal bleed in patients undergoing cardiac surgery, although rigorous comparative data are sparse. Furthermore, level-I evidence would confirm this.
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Interact Cardiovasc Thorac Surg · Mar 2013
Comparative StudyThe effect of lung-size mismatch on mechanical ventilation tidal volumes after bilateral lung transplantation.
Mechanical ventilation tidal volumes are usually set according to an estimate of patient size in millilitres (ml) per kilogram (kg) body weight. We describe the relationship between donor-recipient lung-size mismatch and postoperative mechanical ventilation tidal volumes according to recipient- and donor-predicted body weights in a cohort of bilateral lung transplant patients. ⋯ During mechanical ventilation after bilateral lung transplantation, undersized allografts received relatively higher tidal volumes compared with oversized allografts when the tidal volumes were related to donor-predicted body weights.
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Interact Cardiovasc Thorac Surg · Mar 2013
Case ReportsLate ventriculo-atrial shunt migration leading to pericardial cerebrospinal fluid effusion and cardiac tamponade.
We present the case of a patient with cardiac tamponade secondary to late intrapericardial migration of a disrupted ventriculo-atrial shunt (VAS). A 48-year old woman was referred for cardiac tamponade. She had a history of congenital hydrocephalus with implantation of a VAS (Codman(®)) in 1994. ⋯ Surprisingly, cardiac tamponade was not related to bleeding but to the accumulation of translucid liquid whose gross aspect and biochemistry were very suggestive of cerebrospinal fluid (CSF). We hypothesize that a fibrin sheath had developed around the VAS at the time of its disconnection and acted as a fibrous tunnel allowing continued CSF drainage through its distal part. Surgical strategies to prevent late VAS disconnection should be considered at the time of implantation.
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Interact Cardiovasc Thorac Surg · Mar 2013
Case ReportsPseudoaneurysm of the mitral-aortic intervalvular fibrosa as a complication after minimally invasive mitral valve repair.
Pseudoaneurysm of the mitral-aortic intervalvular body is a rare condition, which has been reported as a result of endocarditis, chest trauma or cardiac surgery. We describe here the first case after minimally invasive mitral valve repair. Such a complication may be overlooked in the early postoperative echocardiographic study and may lead to fistula formation, compression of adjacent structures, infection, or rupture. Both computed tomography and echocardiography provide a detailed anatomy of the pseudoaneurysm and its communication with the left ventricular outflow tract.
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Interact Cardiovasc Thorac Surg · Mar 2013
Comparative Study Controlled Clinical TrialContinuous renal replacement therapy versus furosemide for management of kidney impairment in heart transplant recipients with volume overload.
It is unknown whether continuous renal replacement therapy or furosemide therapy is superior in heart transplant recipients who are in postoperative kidney insufficiency and volume overload. This prospective non-randomized, controlled trial investigated the efficacy of the two methods after transplantation. ⋯ In this study, continuous renal replacement therapy in heart transplant recipients with reduced kidney function was associated with an improvement in estimated glomerular filtration rate status in comparison with furosemide.