The Annals of thoracic surgery
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Randomized Controlled Trial Clinical Trial
Monitoring of anticoagulation in aprotinin-treated patients during heart operation.
Since aprotinin has become extensively used during cardiopulmonary bypass the maintenance of safe anticoagulation is a concern. Aprotinin affects anticoagulation measurement by the activated clotting time. Therefore, a reliable new measurement is needed to monitor anticoagulation during cardiopulmonary bypass. ⋯ However, the activated clotting time measurement was prolonged more by heparin when aprotinin was present (p < 0.05), whereas high-dose thromboplastin and high-dose thrombin measurements were not. Moreover, these measurements were faster and more dependable than the activated clotting time. Therefore, high-dose thromboplastin time and high-dose thrombin time seem to be reliable for monitoring anticoagulation when aprotinin is used during cardiopulmonary bypass.
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Comparative Study Clinical Trial
Airway management during bilateral sequential lung transplantation for cystic fibrosis.
Bilateral sequential lung transplantation is now an accepted therapy for patients with end-stage cystic fibrosis. In our experience, the use of a standard double-lumen endotracheal tube to establish one-lung ventilation during bilateral lung transplantation has been associated with difficulty in clearing the airway of the thick, tenacious secretions characteristically seen in these patients. Intraoperatively, retained secretions have resulted in inadequate ventilation with subsequent hypercarbia, hypoxia, and the need for cardiopulmonary bypass support. ⋯ The lumen of a single-lumen tube accommodates larger suction catheters and an adult bronchoscope, which has a larger suction port. We have used this technique in our last five transplantations, finding easier clearing of airway secretions along with markedly improved ventilation compared with management with a double-lumen tube. We recommend this technique of airway management when performing a bilateral single-lung transplantation for end-stage cystic fibrosis.
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A young woman of the Jehovah's Witness faith presented with a rupturing aneurysm of the ascending aorta and transverse aortic arch. She had Marfan syndrome and previous aortic valve replacement. Despite reoperation conditions, successful operation via median sternotomy was carried out using deep hypothermia and circulatory arrest.
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Case Reports
Drug infusion through a branch of the aortocoronary vein graft for refractory coronary spasm.
We describe two cases of coronary artery spasm that occurred during open heart operations and were treated by coronary artery bypass grafting. Vasodilators and calcium antagonists were infused directly into the right coronary artery via the side branch of the saphenous vein graft. Both patients were weaned successfully from cardiopulmonary bypass.
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Case Reports
Left ventricular outflow tract obstruction and hemolytic anemia after mitral valve repair with a Duran ring.
We report a case of mitral valve repair with a Duran ring that was complicated by left ventricular outflow tract obstruction, mitral regurgitation, and hemolytic anemia. A 59-year-old man with severe mitral valve regurgitation underwent mitral valve repair, including a Duran ring annuloplasty. ⋯ The patient then underwent mitral valve replacement with a 29-mm St. Jude valve.