Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Nov 2009
Multicenter StudyAnomalous left coronary artery from the pulmonary artery: intermediate results of coronary elongation.
A two coronary system is preferred for correcting anomalous left coronary artery from the pulmonary artery (ALCAPA); however, translocation is not always possible. In countries where neonatal arterial switch operations have not been perfected coronary transfer can be difficult. The purpose of this report is to describe the intermediate results using the coronary elongation and translocation technique in developing countries. ⋯ Color Doppler showed a patent left coronary artery; echocardiography estimated a normal left ventricular ejection fraction and improved mitral regurgitation in all patients. The technique provides an alternative approach to translocation for ALCAPA in countries where routine neonatal coronary transfer techniques may not be perfected. Intermediate results are comparable to translocation.
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Interact Cardiovasc Thorac Surg · Nov 2009
ReviewIn patients with acute aortic intramural haematoma is open surgical repair superior to conservative management?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was: in patients with acute aortic intramural haematoma (IMH) is open surgical repair superior to conservative management. IMH is defined as a clinical condition related to but pathologically distinct from aortic dissection. ⋯ We conclude that surgical treatment of aortic IMH involving the ascending aorta with open distal replacement of ascending aorta results in lower mortality and longer survival compared to conservative management. IMH affecting the descending aorta can be managed with medical or endovascular interventional approach. In this latter group, serial imaging of the aorta is recommended, as aneurysm formation is not uncommon.
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Interact Cardiovasc Thorac Surg · Nov 2009
The effect of diabetic medications on creatine kinase-myocardial band levels in patients undergoing coronary artery bypass surgery.
Ischemic preconditioning has been shown to attenuate the rise in creatine kinase-myocardial band levels that occur with coronary artery bypass surgery (CABG). Recently, concerns have been raised that some sulfonylureas particularly glibenclamide may block ischemic preconditioning. The purpose of this study was to determine the effect of various diabetic medicines on creatine kinase-myocardial band levels after CABG. ⋯ After univariable comparisons, linear regression was used to determine the statistically significant predictors of creatine kinase-myocardial band levels. After correction for other factors, none of the diabetic medicines was a statistically significant predictor of creatine kinase-myocardial band levels. We found that the use of glibenclamide or other diabetic medications had no effect on creatine kinase-myocardial band levels the morning after patients underwent CABG.
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Interact Cardiovasc Thorac Surg · Nov 2009
Case ReportsHeartmate XVE destination therapy for end-stage heart failure in a patient with human immunodeficiency virus.
Cardiac dysfunction is a known predictor of survival in patients with acquired immunodeficiency syndrome. In this report, we describe a human immunodeficiency virus (HIV)-infected patient with worsening heart failure who was managed successfully for 16 months with placement of a left ventricular assist device.
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Interact Cardiovasc Thorac Surg · Nov 2009
Case ReportsA strategy for safe sternal reentry in patients with pseudoaneurysms of the ascending aorta using the PORT-ACCESS EndoCPB system.
Pseudoaneurysms of the ascending aorta developing after previous aortic or aortic valve surgery pose a high risk of exsanguination upon sternal reentry. In the past, femorofemoral bypass and hypothermic circulatory arrest before sternotomy was the preferred approach. Today, however, availability of the PORT-ACCESS EndoCPB system (Edwards Lifesciences, Irvine, CA, USA) allows for endovascular clamping and cardioplegia before sternotomy, avoiding circulatory arrest.