The Annals of thoracic surgery
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The records for 162 lung transplantations performed in 158 patients were reviewed with regard to the predictors for, frequency of, and indications for using cardiopulmonary bypass during the procedure. There were a total of 8 en bloc double-lung transplantations, 83 single-lung transplantations, and 71 bilateral single-lung transplantations. ⋯ No preoperative predictors for the need of bypass could be identified. Among the bilateral sequential lung recipients, the use of bypass did not seem to adversely affect outcome, as expressed in terms of the time until extubation, the time spent in the intensive care unit, and the time required to reach a room air oxygen tension greater than 60 mm Hg.
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Preoperative and postoperative pulmonary function of 109 sleeve lobectomy patients (90 right upper lobe, 10 left upper lobe, and 9 left lower lobe) were evaluated over a period of 30 years. Ninety-eight men and 11 women, with a mean age of 60 years, were reviewed. The diagnosis was lung cancer in 97 patients and carcinoid tumors in 12 patients. ⋯ Correlation between the predicted (mean, 2,097 mL) and measured FEV1 (mean, 2,067 mL) was good (linear regression and correlation test; r = 0.72). These values did not differ significantly (Wilcoxon signed rank test; p = 0.81). Our findings indicated a complete recovery of the reimplanted lung lobes after sleeve lobectomy.
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Studies documenting rises in endotoxin after cardiopulmonary bypass (CPB) have postulated gut mucosal hypoperfusion. We have investigated alterations in jejunal blood flow by laser Doppler flow measurement, intramucosal pH (pHi) by tonometry, and oxygen utilization in a canine model of hypothermic CPB (n = 11 dogs). After 10 minutes of hypothermic CPB, despite no major reduction in superior mesenteric artery flow, mucosal laser Doppler flow decreased to -38.2% +/- 9.3% of levels obtained before bypass (p = 0.008) and serosal laser Doppler flow, to -47.3% +/- 11.4% (p = 0.006). ⋯ These changes coincided with a surge in oxygen consumption (0.33 +/- 0.042 mL.min-1.kg-1; p = 0.009), while mesenteric oxygen delivery remained depressed at 1.09 +/- 0.12 mL.min-1.kg-1 (p = 0.04). Jejunal pHi fell from a value of 7.36 +/- 0.04 before CPB to 7.12 +/- 0.07 (p = 0.02), thus indicating mucosal hypoxia. During the rewarming phase of hypothermic CPB, there is a disparity between mesenteric oxygen consumption and oxygen delivery with villus tip ischemia; these findings may explain the pathophysiology of endotoxemia during CPB.
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Coronary artery fistula is a rare abnormality but one with substantial surgical importance, as operation abolishes the fistulous shunt volume, progressive coronary dilatation, and potential coronary steal. Prior reports emphasize the utility of direct inspection on cardiopulmonary bypass, with visualization of drainage of blood or cardioplegia from the fistulous connection, to define the drainage site. ⋯ In addition, the technique provides for continuous monitoring of ventricular function, providing the opportunity to detect inadvertent ischemic effects of ligation. This approach appears to have considerable utility.
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Case Reports
Systolic anterior motion of mitral valve after the posterior leaflet sliding advancement procedure.
The posterior leaflet sliding advancement procedure was developed to prevent the occurrence of systolic anterior motion of mitral valve and consequently outflow obstruction after mitral annuloplasty. We present a patient with extremely redundant posterior mitral leaflet in whom outflow obstruction developed despite employment of this procedure. This case underscores the utility of preoperative and intraoperative echocardiography in surgical decision making. Systolic anterior motion can develop in some patients despite this new surgical technique.