Interactive cardiovascular and thoracic surgery
-
Interact Cardiovasc Thorac Surg · Jan 2009
ReviewDoes surgical correction of coarctation of the aorta in adults reduce established hypertension?
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether surgical correction of coarctation of the aorta in adults (>16 years) results in reduction in established hypertension. Altogether 484 relevant papers were identified using the below mentioned search, 11 papers represented the best evidence to answer the question. ⋯ The reduction in blood pressure postoperatively has been demonstrated consistently, with most patients reported as normotensive without medication and the remainder having reduced requirements for antihypertensive medications. In all the papers included here (except one), there was no early mortality and no procedure-related late mortality during mean follow-up ranging from 2 to 14 years. Thus, surgical correction of aortic coarctation is a relatively safe procedure.
-
Interact Cardiovasc Thorac Surg · Jan 2009
Case ReportsPossibilities and limitations of a miniaturized long-term extracorporeal life support system as bridge to transplantation in a case with biventricular heart failure.
In cardiac surgery extracorporeal life support systems (ECLS), also known as extracorporeal membrane oxygenation systems (ECMO), are often placed in case of postcardiotomy shock, until the patient's myocardial pump function recovers. Patients under ECLS are typically intubated and immobilized. We present a 57-year-old man suffering from severe ischemic cardiomyopathy in biventricular failure and intractable cardiogenic shock, who was supported with a miniaturized cardiopulmonary bypass system (MECC((R))) installed as venoarterial ECLS for 37 days. ⋯ He then required intubation for pneumonia, but later underwent successful transplantation. In conclusion, this case demonstrates that ECLS with miniaturized heart-lung machines offer the possibility of prolonged and safe support, ideal as a bridge to decision in patients with cardiogenic shock. On the other side, this report also indicates that ECLS is not recommended as a bridge to transplantation on a routine basis.
-
Interact Cardiovasc Thorac Surg · Jan 2009
Case ReportsNon-invasive positive pressure ventilation for bilateral diaphragm paralysis after pediatric cardiac surgery.
We present the case histories of two children having respiratory failure due to bilateral diaphragm paralysis after cardiac surgery. In both children non-invasive positive pressure ventilation alleviated respiratory distress, improved gas exchange, and prevented the need for endotracheal intubation. Following unilateral recovery of diaphragmatic function both children were successfully weaned from non-invasive positive pressure ventilation.