Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Dec 2011
Postoperative non-invasive assessment of pulmonary vascular resistance using Doppler echocardiography.
Non-invasive monitoring of pulmonary vascular resistance (PVR) in postoperative cardiac surgery patients might be useful, particularly for management of pulmonary hypertension. For this purpose, we sought to assess Doppler echocardiography in the intensive care setting. In 73 patients, hemodynamics was measured using both, invasive gold standard (pulmonary artery catheter), and non-invasively by Doppler echocardiography. ⋯ Strain correlated with PVR in group 2 patients only. TRV/VTI(RVOT) and tricuspid annular systolic velocity (S'), are useful for non-invasive monitoring of PVR in postoperative cardiac surgery patients with or without elevated left ventricular filling pressure. Strain may be used in patients with elevated filling pressure.
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Interact Cardiovasc Thorac Surg · Nov 2011
ReviewDoes prophylactic inhaled nitric oxide reduce morbidity and mortality after lung transplantation?
A best evidence topic in thoracic surgery was written according to a structured protocol. The question addressed was does prophylactic inhaled nitric oxide (NO) reduce morbidity and mortality after lung transplantation? Altogether 232 papers were found using the reported search, of which six 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 were tabulated. ⋯ Nonetheless, despite their limitations, there are currently, no randomised controlled studies that demonstrate a reduction in morbidity [time to extubation, length of intensive care unit (ICU) or hospital stay] or mortality. As such it is difficult to currently, recommend the routine use of prophylactic inhaled NO in lung transplant surgery. Further studies may outline a benefit in certain types of surgeries, e.g. single-lung transplants or double-lung requiring cardiopulmonary bypass.
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Interact Cardiovasc Thorac Surg · Nov 2011
Multicenter Study Comparative StudyMechanical versus chemical pleurodesis for management of primary spontaneous pneumothorax evaluated with thoracic echography.
The current study is designed to compare the effectiveness of brushing the pleura vs. instillation of minocycline for the management of primary spontaneous pneumothorax, and to assess the sensitivity of echography in defining areas of defects. Blebectomy and pleurodesis were carried out thoracoscopically on 84 patients. In group A (42 patients), abrasions were induced using a sponge on a long ring forceps. ⋯ The patients in group B demonstrated a trend towards a decreased rate of prolonged air leaks (2% vs. 5%; P=0.100). Thus, pleurodesis by instillation of minocycline as a part of thoracoscopy is more effective than brushing the pleura. Thoracic echography is a highly sensitive method for assessing the effectiveness of pleurodesis.
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Interact Cardiovasc Thorac Surg · Nov 2011
Case ReportsMinimally-invasive resection of a scapular osteochondroma.
Osteochondroma of the scapula is a rare benign tumour that produces pain and mechanical dysfunction of the joint when settled on the ventral surface of the scapula. Surgical resection is the treatment of choice in symptomatic cases. ⋯ We present a case of video-assisted surgical resection of a large osteochondroma from the ventral surface of the scapula in a young male patient with the snapping scapula syndrome. The technique and the postoperatory outcome are described.