Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Oct 2009
ReviewIs reduction aortoplasty (with or without external wrap) an acceptable alternative to replacement of the dilated ascending aorta?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether reduction aortoplasty is an acceptable alternative to ascending aorta replacement. From 925 potential papers, 13 papers represented the best evidence to answer the clinical question. ⋯ In particular, an aortoplasty in elderly patients with post-stenotic dilatation, or in patients with significant co-morbidities is attractive. It should be acknowledged that only one study directly compares the technique with conventional replacement and that replacement remains the 'gold standard' technique. It should also be acknowledged that the external wrap is not without risk and wrap dislocation, erosion or fistula formation are recognised complications.
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Interact Cardiovasc Thorac Surg · Oct 2009
A retrospective analysis of terlipressin in bolus for the management of refractory vasoplegic hypotension after cardiac surgery.
Cardiac surgery performed with cardiopulmonary bypass (CPB) may be complicated by hypotension due to low systemic vascular resistance (SVR). Often in those cases, hypotension is resistant to pressor catecholamines. We report six cases of norepinephrine-resistant postcardiotomy hypotension, treated by terlipressin (TP), a potent vasopressor agent. ⋯ Subsequently, the effect on systemic blood pressure enhanced urine output. No major collateral effects were observed. The administration of TP in bolus may result as a useful alternative for treating refractory low SVR hypotension post CPB.
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Interact Cardiovasc Thorac Surg · Oct 2009
Case ReportsNon-operative management of tube thoracostomy induced pulmonary artery injury.
Tube thoracostomy insertion is a common procedure in the management of air and fluid collections in the pleural space. Pulmonary artery injury is a rare but serious complication following intercostal catheterisation. This complication is usually managed surgically. We report a case of successful non-operative management of a pulmonary artery injury after tube thoracostomy.