Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jun 2007
Case ReportsThe 'aortic rim' recount: embolization of interatrial septal occluder into the main pulmonary artery bifurcation after atrial septal defect closure.
Percutaneous device closure of atrial septal defect (ASD) has emerged as an alternative to traditional surgical closure. Although reduced hospital stay, decreased morbidity and absence of a surgical incision are beneficial, other procedure- or device-related complications are coming into light. We report a rare complication of early embolization of the Blockaid septal occluder into the main pulmonary artery bifurcation associated with 'aortic rim' erosion and present a brief review of literature pertaining to the high incidence of complications associated with deficient or eroded 'aortic rims' necessitating surgical intervention. ⋯ Strict selection criteria governing an 'adequate' aortic rim, the size of the device, and the choice of the device may help reduce the incidence of complications like the rare, but potentially fatal embolization of the device into the pulmonary artery following percutaneous device closure of an ASD.
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Interact Cardiovasc Thorac Surg · Jun 2007
Effects of cardiopulmonary bypass circuit reduction and residual volume salvage on allogeneic transfusion requirements in infants undergoing cardiac surgery.
Cardiopulmonary bypass in children may cause severe hemodilution and can lead to excessive perioperative blood loss and high transfusion requirements. Minimization of cardiopulmonary bypass circuit and salvage of red blood cells from the residual volume after the procedure are widely utilized to reduce allogeneic transfusion. We evaluated the effectiveness of those measures introduced in infant cardiac surgery in our institution. ⋯ Reduction of the circuit volume significantly diminished use of red blood cell concentrates from 1.6 units to 0.8 units (P<0.0001), and fresh frozen plasma from 1.3 units to 0.4 units (P<0.0001). Utilization of the cell salvage product reduced significantly (P=0.023) the postoperative need for homologous blood transfusion. Therefore, both measures proved to be effective in reducing homologous blood transfusion in infant cardiac surgery.
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Interact Cardiovasc Thorac Surg · Apr 2007
Clinical TrialDoes poor oxygenation during one-lung ventilation impair aerobic myocardial metabolism in patients with symptomatic coronary artery disease?
One-lung ventilation is used during a variety of surgical procedures, even in patients with pre-existing coronary artery disease. The study purpose was to elucidate if myocardial metabolism crosses the anaerobic threshold under hypoxemia during one-lung ventilation. Therefore, we determined myocardial metabolism as a marker for anaerobic myocardial metabolism in patients with significant multi-vessel coronary artery disease undergoing one-lung ventilation during minimally-invasive coronary artery bypass grafting. ⋯ No clinically significant signs of myocardial ischemia occurred in any patient. Aerobic myocardial metabolism was unaffected during one-lung ventilation in all patients. Therefore, one-lung ventilation can be applied to patients with multi-vessel coronary artery disease with an acceptable risk of turning myocardial metabolism to an anaerobic state.