Circulation
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Thrombosis is a serious complication of heart valve replacement, and management is often difficult. In recent years, thrombolytic therapy has been used as the primary technique by some investigators. ⋯ Fibrinolytic treatment appears to be an attractive nonsurgical alternative for prosthetic heart valve thrombosis, but because of the risk of cerebral embolism, its use should be reserved for tricuspid valve thrombosis or critically ill patients with mitral or aortic valve thrombosis. The use of a fibrinolytic agent in cases of small, nonobstructive paravalvular thrombosis demonstrated with transesophageal echocardiography needs further studies.
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From August 1982 to May 1991, 65 children (32 boys), 1 day to 14 years old, received extracorporeal membrane oxygenation (ECMO) 0-50 hours after cardiac surgery. Forty-four (67.7%) were weaned, with 23 (35.4%) survivors. ⋯ ECMO allows for myocardial recovery in the majority of patients with refractory postcardiotomy failure and permits some patients to survive who would not have otherwise.
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Acute bacterial endocarditis continues to be a condition with high morbidity. Although the majority of patients are treated by high-dose antibiotics, a high-risk patient group requires surgical intervention, which is the subject of this article. ⋯ The morbidity and mortality after surgical treatment of acute endocarditis depend on the site, the severity, and the subject infected. Early aggressive surgical intervention is indicated to optimize surgical results, especially in patients with nonstreptococcal infection or PVE.
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Comparative Study
Effect of normothermic blood cardioplegia on postoperative conduction abnormalities and supraventricular arrhythmias.
Conduction defects and supraventricular tachycardia (SVT) are common after myocardial revascularization using current methods of cold hyperkalemic blood or crystalloid cardioplegia. The current retrospective study was undertaken to assess the influence of normothermic blood cardioplegia on conduction defects and SVT. ⋯ Normothermic cardioplegia is associated with a marked decrease in new and permanent conduction disturbances and postoperative CK-MB release. This suggests that a significant factor in the pathogenesis of conduction blocks is cold-related injury. Supraventricular arrhythmias were not affected by the type of cardioplegia given.
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Several operations (most commonly ventricular septal myotomy-myectomy and also mitral valve replacement) have been performed to relieve symptoms and obstruction to left ventricular outflow in patients with hypertrophic cardiomyopathy (HCM). ⋯ Mitral valve plication combined with myotomy-myectomy in obstructive HCM 1) can be performed safely and does not adversely alter mitral valve function, 2) relieves symptoms and outflow obstruction under basal and provocable conditions, and 3) may represent an alternative to mitral valve replacement in selected patients with elongated and enlarged mitral leaflets.