Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jul 2009
Video-assisted right atrial surgery with a single two-stage femoral venous cannula.
In the present paper, we report our experience with a single two-stage femoral venous cannula, ideated to drain simultaneously both the superior and the inferior vena cava during minimally invasive cardiac surgery. This cannula has been used in 79 patients (mean age 66.2+/-11.3 years; mean body surface area 1.9+/-0.2 m2) who underwent limited access mitral and tricuspid valve surgery at our institution. In our experience, this cannula permits to obtain a safe venous drainage (mean arterial flow 4.7+/-0.6 l/min, 104+/-13.3% of the theoretical flow) and it allows for a correct functioning of the pump even when the right atrium is opened. ⋯ In all cases, insertion and positioning of the venous cannula was easily obtained and no patients required a conversion to an alternative perfusion strategy. In conclusion, during minimally invasive procedures requiring opening the right atrium, venous return can be safely accomplished with this two-stage femoral venous cannula. The use of this cannula permits the avoidance of the risk associated with the insertion of a second venous cannula and, in so doing, significantly simplifies the procedure.
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Interact Cardiovasc Thorac Surg · Jul 2009
Do we need fenestration when performing two-staged total cavopulmonary connection using an extracardiac conduit?
Between August 1999 and December 2007, 72 consecutive patients with single ventricle physiology underwent a modified Fontan procedure after a bidirectional Glenn shunt using an extracardiac polytetrafluoroethylene conduit without fenestration. Nitric oxide gas inhalation was commenced just after cardiopulmonary bypass together with intravenous phosphodiesterase III inhibitor administration. After oral intake was started, pulmonary vascular dilators such as beraprost, sildenafil, bosentan were given orally according to amount of chest drainage and patient's condition. ⋯ Arterial oxygen saturation (SaO(2)) at the latest outpatient visit was 94.4+/-3.8%. According to our clinical experience with two-staged total cavopulmonary connection using an extracardiac conduit without fenestration, fenestration in the Fontan circuit is not necessary when performing the Fontan completion. Two-staged extracardiac total cavopulmonary connection without fenestration can be satisfactorily completed with the aid of pulmonary vasodilation therapy.
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Interact Cardiovasc Thorac Surg · Jul 2009
Brain natriuretic peptide is removed by continuous veno-venous hemofiltration in pediatric patients.
We wanted to evaluate if brain natriuretic peptide (BNP) is cleared during continuous veno-venous hemofiltration (CVVH) sessions in children with congenital heart disease. A prospective observational single-center study was conducted in a post-cardiac surgery intensive care unit of the city children's hospital. Ten children requiring CVVH for acute kidney injury following cardiac surgery were enrolled. ⋯ BNP levels were significantly reduced after three and four days from CVVH start (P<0.05). During 80 ml/kg/h CVVH, utilizing polyacrylonitrile membranes, BNP is efficiently cleared from blood in a small cohort of pediatric post-cardiosurgical patients. In this situation, BNP absolute blood levels may be unpredictable.
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Interact Cardiovasc Thorac Surg · Jul 2009
Mini re-sternotomy for aortic valve replacement in patients with patent coronary bypass grafts.
As the population ages, an increasing number of patients with patent coronary grafts will require subsequent aortic valve replacement. Major operative problems include those associated with re-entry and, in particular, damage of the patent grafts. Between January 2007 and October 2008, 10 patients who had previous coronary bypass surgery underwent aortic valve replacement through upper j-shaped mini re-sternotomy. ⋯ The in-hospital mortality was 0%. Aortic valve replacement in previous coronary bypass grafting can be performed safely with a mini re-sternotomy. This approach avoids extensive dissection, decreasing the risk of injuries to heart chambers and previous patent coronary grafts with low morbidity and mortality.
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Interact Cardiovasc Thorac Surg · Jul 2009
Case ReportsThoracoscopic drainage of ascending mediastinitis arising from pancreatic pseudocyst.
Acute mediastinitis is a life-threatening disease. Common etiologies include surgical infection, esophageal perforation, and descending necrotizing mediastinitis from the oral cavity or pharynx. Mediastinitis caused by pancreatic disease is rare. ⋯ We report a case of acute mediastinitis and bilateral empyema thoracis arising from a pancreatic pseudocyst. We utilized thoracoscopy to drain the mediastinum without drainage of the intra-abdominal cyst. The patient recovered well after operation.