Circulation
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Subaortic obstruction is one of the risk factors for anatomic repair of double outlet right ventricles (DORV). A comprehensive approach to such lesions has been developed in our institution since 1981. This retrospective work analyzes the results of this approach. ⋯ Surgical relief of subaortic obstruction in DORV has to be adapted to VSD location and spatial arrangement of atrioventricular valves and great vessels.
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Randomized Controlled Trial Comparative Study Clinical Trial
Cyclosporine-induced hypertension. Efficacy of omega-3 fatty acids in patients after cardiac transplantation.
Cyclosporine-induced hypertension may be related to vasoconstriction of the afferent arterioles in the glomeruli caused by changes in the prostaglandin profile. omega-3 Fatty acids have demonstrated vasodilatory properties related to a favorable effect in the prostaglandin profile. The purpose of this study was to evaluate the antihypertensive effects of oral supplementation with omega-3 fatty acids in cyclosporine-treated cardiac transplant recipients. ⋯ omega-3 Fatty acids (3 g/d) reduce blood pressure by decreasing systemic vascular resistance and, therefore, can be used as an adjuvant for the treatment of hypertension in cyclosporine-treated cardiac transplant recipients. Their vasodilatory effect may be related to a beneficial change in the prostaglandin profile.
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Randomized Controlled Trial Comparative Study Clinical Trial
Nafamostat mesilate reduces blood loss during open heart surgery.
Nafamostat mesilate (FUT-175) is a protease inhibitor inactivating coagulation, fibrinolysis, and platelet aggregation. A prospective, randomized trial was performed to assess the efficacy of FUT-175 in the reduction of postoperative bleeding tendency. ⋯ FUT-175 inhibits fibrinolysis and preserves platelet counts and function during CPB and reduces blood loss during open heart surgery.
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Multicenter Study
Management of patients with intramural hematoma of the thoracic aorta.
Intramural hematoma of the thoracic aorta (IMH) is a diagnosis of exclusion and represents spontaneous, localized hemorrhage into the wall of the thoracic aorta in the absence of bona fide aortic dissection, intimal tear, or penetrating atherosclerotic ulcer. This process may arise from primary vasa vasorum hemorrhage within the aortic media or rupture of an atherosclerotic plaque. The clinical presentation of patients with IMH mimics that of acute aortic dissection; moreover, considerable diagnostic confusion exists despite the use of many different imaging modalities. The optimal mode of management of patients with IMH (medical versus medical plus surgical) remains problematic because of the paucity of information available. ⋯ IMH is a distinct pathological entity, should not be confused with aortic dissection, and probably will be identified more frequently in the future. All patients with IMH should be monitored carefully and treated with aggressive antihypertensive therapy. Frequent serial assessment is necessary using TEE or MRI/CT scans. Based on this small experience, patients with ascending/arch IMH, ongoing pain, or IMH expansion should probably undergo early graft replacement. Patients with IMH involving the descending thoracic aorta who have no evidence of progression and become pain free can probably be treated conservatively but require antihypertensive therapy and serial aortic imaging surveillance indefinitely.