The Annals of thoracic surgery
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One of the dilemmas in the management of lung allotransplant recipients is our inability to precisely determine the cause of graft dysfunction. Differentiating between lung allograft infection, rejection, atelectasis, or ischemic injury remains a difficult task. ⋯ Transbronchial biopsy and bronchoalveolar lavage have emerged as two methods with the most potential for aiding in the establishment of diagnosis. This review attempts to provide the readers with a current knowledge of the cellular events in lung allograft and the status of bronchoalveolar lavage in experimental and clinical lung transplantation.
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Myocardial hypothermia is an essential component of myocardial preservation for most cardiac operations. Because of multiple causes of rewarming, it is necessary to monitor temperatures at specific sites (right and left ventricular epicardium and endocardium or cavity). ⋯ Consequently, metallic probes do not have sufficient accuracy to detect transmural temperature gradients because of "stem effect." Using the plastic probes to evaluate temperature changes in porcine hearts after cardioplegia-induced hypothermia revealed a temperature rise of 1 degree C/min at all sites if control of systemic and venous return and local myocardial cooling are not provided. The use of temperature monitoring at multiple sites permits identification and prevention of various causes of myocardial rewarming and is facilitated by the use of plastic probes described herein which contain dual thermocouples.
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The transcranial Doppler technique enabled the detection of cerebral air emboli in 10 of 10 patients during open-heart valve operations despite standard deairing procedures. With this technique, the occurrence of emboli in the right middle cerebral artery was followed continuously in patients undergoing aortic or mitral valve replacement. Membrane oxygenators were used. ⋯ Meticulous deairing before declamping the aorta is strongly advocated. In addition, a short period of filling of the beating heart before final closure of the aortic incision or vent may decrease the incidence of cerebral emboli. A concomitant reduction in cerebral blood flow by hyperventilation or anesthetics or both during filling of the empty beating heart may also be beneficial.