Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Feb 2010
ReviewIs pH-stat or alpha-stat the best technique to follow in patients undergoing deep hypothermic circulatory arrest?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether pH-stat or alpha-stat is the best technique to follow in patients undergoing deep hypothermic circulatory arrest. Altogether 206 papers were found using the reported search, of which 16 represent the best evidence to answer the clinical question. ⋯ Conversely, all seven papers that suggested alpha-stat method is associated with better intraoperative and postoperative outcome were based on studies done on adult patients. The remaining four papers suggested no significant difference between the pH-stat group and alpha-stat group. In conclusion, there is evidence to suggest that the best technique to follow in the management of acid-base in patients undergoing deep hypothermic circulatory arrest during cardiac surgery is dependent upon the age of the patient with better results using pH-stat in the paediatric patient and alpha-stat in the adult patient.
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Interact Cardiovasc Thorac Surg · Feb 2010
Impact of preoperative anemia on cardiac surgery in octogenarians.
Preoperative anemia has been related with adverse outcomes in elective valve replacement and CABG surgery. Impact of preoperative anemia on outcome in octogenarians submitted to cardiopulmonary bypass (CPB) has not yet been precisely described. ⋯ Mortality and adverse postoperative outcome increase in anemic octogenarians undergoing cardiac surgery. Although mortality is directly related to immediate postoperative anemia, adverse outcomes mainly depend on associated co-morbidities.
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Interact Cardiovasc Thorac Surg · Feb 2010
Case ReportsFailed closure of a ventricular septal defect with an Amplatzer occluder.
A 74-year-old man was diagnosed to have a ventricular septal defect (VSD), which was detected shortly following transvenous pacemaker implantation. Transoesophageal echocardiography suggested the presence of two VSDs, one of which was closed with a device. At surgery, a single large VSD was seen, with the implanted device having embolised into the left ventricle. The defect was successfully closed using a pericardial patch, and the embolised device explanted.
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Osseous metastases of renal cell carcinoma (RCC) are the second most frequent location after lung metastases. They rarely present as isolated location. When isolated, resection may offer five-year survival rates of 30-60%. ⋯ The overall five and ten-year survival rates were respectively, 83 and 66.7%. IRM of RCC are rare and remain not well-known. Surgical wide resection is a safe and effective treatment.
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Interact Cardiovasc Thorac Surg · Feb 2010
ReviewVolume load paradox while preparing for the Fontan: not too much for the ventricle, not too little for the lungs.
Ventricular dysfunction is frequently encountered in Fontan patients. Cardiologists and cardiac surgeons have, therefore, mainly focused on preservation of cardiac function, limiting the early volume overload as much as possible both in magnitude and duration. ⋯ The volume requirements for optimal growth and development of the ventricle and the lungs are different and divergent. Avoiding overload of the ventricle is important, but excessive protection from volume overload may not be necessary and may result in PA hypoplasia, which in turn will severely affect the Fontan circuit.