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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Severe pulmonary regurgitation (PR) and associated right ventricular (RV) dilatation are late complications of surgical repair of tetralogy of Fallot (TOF). For the past several years, we have restored pulmonary valve competence with the exclusive use of cryopreserved allografts. ⋯ Thus, restoration of the pulmonary valve with cryopreserved allografts improved exercise tolerance and diminished RV volume overload in patients with severe PR after previous repair of TOF. Optimal results were achieved in patients who did not have significant residual pulmonary artery distortion.
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Comparative Study
Significance of gaseous microemboli in the cerebral circulation during cardiopulmonary bypass in dogs.
Gaseous microemboli during cardiac surgery may damage the brain by reducing cerebral blood flow (CBF). We examined whether the incidence of gaseous microemboli during 150-minute hypothermic (28 degrees C) cardiopulmonary bypass (CPB) adversely affects CBF (radioactive microspheres). ⋯ These results indicate that: (1) the incidence of gaseous microemboli during hypothermia increases when a bubble oxygenator is used, and (2) global CBF and regional brain perfusion are not adversely affected by numerous gaseous microemboli.
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Comparative Study
The effects of warm versus cold blood cardioplegia on endothelial function, myocardial function, and energetics.
Recent interest in the use of normothermic blood cardioplegia is based on theoretical advantages over the traditional method of hypothermic myocardial protection. This study was designed to compare the effects of warm and cold blood cardioplegia on left ventricular functions and energetics and coronary responsiveness. ⋯ For 30 minutes of aortic cross-clamp time, continuous warm cardioplegia did not provide any benefit over a single injection of cold cardioplegia in coronary endothelial and smooth muscle function, myocardial function, and energetics.
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This study was undertaken to determine if a newly developed synthetic peptide thrombin inhibitor (DuP 714; DuPont-Merck, Wilmington, Del) could be used as an anticoagulant in cardiopulmonary bypass (CPB) surgery. ⋯ This study reveals that the peptide inhibitor DuP 714 can effectively function as an anticoagulant in a canine CPB model. The efficacy and safety, even when overdosed, are demonstrated by reduced blood loss and lack of platelet count reduction. Clinical monitoring can be achieved by the use of ACT levels. No evidence of hemodynamic compromise was noted with the drug administration.