Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · May 2009
Case ReportsAsymptomatic bronchial aspiration of a video capsule.
Aspiration is a rare complication of video-capsule endoscopy. We report a case of asymptomatic aspiration of the capsule in a 90-year-old man. ⋯ Recommendations to prevent this complication are: (1) Patients with swallowing disorders should have the capsule placed into the duodenum at the time of upper endoscopy. The capsule should never be placed in the stomach because of prolonged emptying times following endoscopy and IV sedation. (2) If a patient appears to have difficulty swallowing the capsule after two or three attempts, the capsule should be placed endoscopically. (3) When real-time capsule location is more readily available, the abdomen can be scanned after the initial ingestion to be sure that the capsule reached the stomach.
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Following the acute changes of lung resection surgery, does the ratio of intrathoracic blood volume (ITBV) to global end diastolic volume (GEDV) remain constant? If it does this could validate a single thermo dilution (STD) technique in the measurement of extravascular lung water index (EVLWI) in patients undergoing lung resection surgery. EVLWI was derived using both double dye technique (DDT) and single thermo dilution technique (STD) in four patients undergoing thoracotomy selected for major lung resection surgery. Regular measurements were made for up to 12 h after surgery. ⋯ EVLWI measurements measured by STD correlate well with those of DDT. This preliminary study suggests that EVLWI measurements by STD could be used to measure changes in EVLW following major lung resection. An assessment of EVLW could be useful in early diagnosis, management and treatments of the devastating condition of postoperative acute lung injury.
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Interact Cardiovasc Thorac Surg · Apr 2009
Randomized Controlled TrialPrevention of atrial fibrillation after coronary artery bypass grafting via atrial electromechanical interval and use of amiodarone prophylaxis.
In our previous study, we defined a cut-off point of 120 ms for atrial electromechanical interval (AEMi) to determine the risk of atrial fibrillation (AF) occurrence. Accordingly, the present study sought to investigate whether or not a prophylactic perioperative administration of amiodarone could reduce the incidence of AF in a high-risk group (AEMi >120 ms) undergoing coronary artery bypass grafting (CABG). In this prospective, randomized study, 100 patients with AEMi >120 ms received either amiodarone (n=50) or placebo (n=50). ⋯ The incidence of postoperative AF was significantly higher in the placebo group than that of the amiodarone group (88% of patients in control group vs. 16% of patients in amiodarone group, P<0.0001). The prophylactic therapy with amiodarone significantly reduced the ICU length of stay (2.28+/-1.00 vs. 3.60+/-0.90 days, P<0.0001) and hospital length of stay (5.64+/-2.35 vs. 7.78+/-1.46 days, P<0.0001). The incidence of postoperative AF among patients with high AEMi was significantly reduced by a prophylactic amiodarone treatment, resulting in shorter ICU and hospital stays.
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Interact Cardiovasc Thorac Surg · Apr 2009
Randomized Controlled Trial Comparative StudyProspective randomized evaluation of stentless vs. stented aortic biologic prosthetic valves in the elderly at five years.
Randomized trials comparing stentless to stented bioprostheses for aortic valve replacement in elderly are scarce. The aim of this study was early and mid-term evaluation of these bioprostheses, with regards to clinical outcome and hemodynamic performance. ⋯ At five years, stentless valves were not superior to the stented valves, with regards to hemodynamic performance, regression of left ventricular mass and clinical outcome.