General thoracic and cardiovascular surgery
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Gen Thorac Cardiovasc Surg · Feb 2011
Intraoperative direct hemoperfusion with a polymyxin-B immobilized fiber column for treatment of infective endocarditis.
Endotoxin adsorption treatment (direct hemoperfusion using a polymyxin-B immobilized fiber column, or PMX-DHP) is now considered a useful option for treating severe sepsis. However, the efficacy of PMX-DHP for infective endocarditis (IE), in which the causative microorganisms are usually gram-positive cocci, remains unclear. In the present study, we investigated the impact of intraoperative PMX-DHP on clinical parameters during the treatment of IE. ⋯ Intraoperative PMX-DHP demonstrated several positive effects, such as a drastic decrease in the doses of inotropic agents and shortening of the duration of mechanical ventilation, in patients who underwent emergent surgery for active IE. Intraoperative PMX-DHP can be a useful option for the treatment of critically ill patients with IE.
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The aim of our study was to describe our protocol of non-heart-beating-donor (NHBD) lung transplantation and discuss data regarding the situation of NHBD and lung transplantation in Spain. ⋯ NHBD is no longer just a promising source of organs for lung transplantations, it is a real one. We hope that in the near future many other units will develop similar protocols to improve the use of these grafts and decrease the mortality rate among those on the waiting lists.
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Gen Thorac Cardiovasc Surg · Jan 2011
Case ReportsModified Norwood procedure with a handmade down-sizing valved right ventricle-to-pulmonary artery conduit.
First-stage palliation of hypoplastic left heart syndrome has been revolutionized by the recent introduction of a right ventricle-to-pulmonary artery (RV-PA) conduit as an alternative to a systemic-to-pulmonary shunt. However, most conduits are unvalved, and the use of valved xenografts was abandoned during the early era of this operation. ⋯ The postoperative course was uneventful with well-balanced pulmonary and arterial perfusion. We believe that minimization of the regurgitant volume from an unvalved prosthetic conduit by utilizing this modification might be of benefit in this particular group of patients.
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Gen Thorac Cardiovasc Surg · Jan 2011
Case ReportsExtrapleural hematoma as a complication following thoracotomy for pulmonary lobectomy.
Extrapleural hematoma as a complication following thoracic surgery is rare. We report a case of an extrapleural hematoma following pleural lobectomy that resolved completely with nonsurgical treatment. A 63-year-old woman underwent left lower lobectomy for lung cancer through a left posterolateral thoracotomy. ⋯ She became symptomatic after rapid infusion. The hematoma resolved without an invasive intervention. The CT results 189 days after the onset showed almost complete regression of the hematoma.
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Gen Thorac Cardiovasc Surg · Jan 2011
Neurohumoral and inflammatory markers for prediction of right ventricular failure after implantation of a left ventricular assist device.
Implantation of a left ventricular assist device (LVAD) is an established treatment for end-stage heart failure. Right ventricular dysfunction develops in 20%-50% of patients after device implantation, leading to prolonged hospital stays and elevated mortality rates. However, prediction of right ventricular failure remains difficult. ⋯ Preoperative evaluation of markers of inflammation and neurohumoral activation may provide additional information for predicting right ventricular failure after implantation of an LVAD.