The Annals of thoracic surgery
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Successful reimplantation into the aorta of an anomalous left coronary artery arising from the right pulmonary artery is described in a 3-month-old child. Preoperative and postoperative angiograms are included, and serial echocardiography demonstrates the marked improvement in left ventricular function.
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A new method is described for the repair of a congenital tracheoesophageal fistula in an adult. This technique uses a fiberoptic bronchoscope and passes a flexible vascular guidewire across the tracheoesophageal fistula. This maneuver then simplifies the intraoperative identification of the tracheoesophageal fistula, which is exposed and repaired through a left transcervical approach.
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Airborne contamination of the wound area and the cardiopulmonary bypass circuit during sham open-heart operations on dogs was studied. The air of the operating room (OR) was contaminated with two typeable bacterial strains. It was found that the number of wounds, blood specimens, oxygenators, and cardiotomy reservoirs contaminated with Staphylococcus aureus was related to the number of S. aureus present in the air of the OR, but that contamination with Serratia marcescens was related to the type of suction used. ⋯ The oxygenator and cardiotomy reservoir were contaminated mainly by aspirating wound fluid from the airborne-contaminated wound area. The low number of sample sites positive for S. marcescens may be due to a better preserved host defense mechanism if only wound fluid is sucked. A rather high incidence of postoperative infections occurred even in dogs operated on in an OR with a low level of airborne contamination.
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Clinical Trial Controlled Clinical Trial
Cerebral blood flow and metabolism during cardiopulmonary bypass with special reference to effects of hypotension induced by prostacyclin.
Cerebral blood flow and metabolism of oxygen, glucose, and lactate were studied in 43 patients undergoing aortocoronary bypass. Twenty-five patients received prostacyclin infusion, 50 ng per kilogram of body weight per minute, during cardiopulmonary bypass (CPB), and 18 patients served as a control group. Regional cerebral blood flow (CBF) was studied by intraarterially injected xenon 133 and a single scintillation detector. ⋯ The cerebral arteriovenous oxygen pressure difference decreased more in the control group than in the prostacyclin group during hypothermia. The cerebral metabolic rate of oxygen decreased in both groups from approximately 2 ml/100 gm/min to about 1 ml/100 gm/min during hypothermia, increased again during rewarming, and after CPB was at the levels measured before bypass in both groups. There was no difference between the groups in regard to glucose and lactate metabolism.