Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jun 2007
Case ReportsCardiopulmonary bypass using nafamostat mesilate for patients with infective endocarditis and recent intracranial hemorrhage.
Infective endocarditis is a life threatening disease with high mortality and morbidity, including brain infarction concomitant with intracranial hemorrhage. Generally, patients with a recent intracranial hemorrhage are believed to be a contraindication to undergo cardiac surgery with cardiopulmonary bypass. However, some patients with infective endocarditis occasionally require an unavoidable emergent surgery because of uncontrollable heart failure or on-going thromboembolism even if complicated by intracranial hemorrhage. In this study, a cardiopulmonary bypass strategy using nafamostat mesilate as an anticoagulant for such patients is discussed based on three cases we experienced.
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Interact Cardiovasc Thorac Surg · Jun 2007
Correlates of thenar near-infrared spectroscopy-derived tissue O2 saturation after cardiac surgery.
We studied the significance of near-infrared spectroscopy (NIRS), for measuring tissue oxygenation (S(t)O(2)) and perfusion adequacy, and thus for haemodynamic monitoring of patients after cardiac surgery. We compared NIRS-derived S(t)O(2) of the thenar muscle to haemodynamic variables, oxygenation indices, temperature, lactate levels and urinary output, in 23 patients in the course of time after cardiac surgery and admission into the intensive care unit. Clinical variables, global haemodynamics and NIRS% total haemoglobin (%HT) and S(t)O(2) in the thenar for up to 18-22 h after admission were measured. ⋯ From all variables, changes in body-finger temperature difference best correlated to changes in S(t)O(2) (r(s)=-0.48, P<0.001). As judged from clinical and haemodynamic correlates, thenar NIRS S(t)O(2) is a non-invasive measure of peripheral rather than global perfusion adequacy, after cardiac surgery. This may help to define the role of thenar NIRS monitoring after cardiac surgery in future studies.
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Interact Cardiovasc Thorac Surg · Jun 2007
Comparative StudyComparison of lateral tunnel and extracardiac conduit Fontan procedure.
The purpose of this study was to compare the outcomes of lateral tunnel (LT) and extracardiac conduit (ECC) Fontan procedures at a single institution. From April 1995 to December 2006, 165 Fontan procedures were performed (67 LT, 98 ECC). Pre-, intra- and postoperative variable values were compared between two different techniques. ⋯ Actuarial survival at 10 years is 92% for LT, and 89% for ECC patients (P=0.796). The LT and ECC, both, showed comparable early and mid-term outcomes in operative morbidity and mortality, postoperative hemodynamics, survival. Use of ECC for modified Fontan operation reduces the risk of sinus node dysfunction and shows better outcome of immediate postoperative hemodynamics.
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Interact Cardiovasc Thorac Surg · Jun 2007
Case ReportsSurgical exclusion of a symptomatic circumflex coronary to right atrium fistula.
Coronary artery fistulas are rare and half of them are symptomatic. Diagnosis is confirmed by echocardiography and coronarography and can be precisely located by multislice CT-scan. ⋯ Surgical exclusion of the fistula was achieved by ligation of both extremities and a running suture on the aneurysmal vessel. Follow-up at 6 months was satisfactory with an asymptomatic patient and absence of recurrence of the fistula on echocardiography.