The Annals of thoracic surgery
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Randomized Controlled Trial Clinical Trial
Completely heparinized cardiopulmonary bypass and reduced systemic heparin: clinical and hemostatic effects.
When heparinized circuits are used for cardiopulmonary bypass, the amounts of heparin and protamine administered systemically can be reduced. However, it is not entirely known what effects this reduction in systemic anticoagulation has on clinical performance and on the coagulation and fibrinolytic systems. ⋯ The combination of complete heparin-coated cardiopulmonary bypass circuits and low systemic heparinization is safe for patients undergoing elective coronary artery bypass procedures and reduces the perioperative blood loss. There was no evidence of increased thrombogenicity, fibrinolytic activity, or consumption of coagulation factors. No clinical or technical side effects were observed.
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Extracorporeal membrane oxygenation (ECMO) has emerged as an effective technique for the mechanical support of many pediatric postcardiotomy patients with medically refractory cardiac failure. ⋯ Extracorporeal membrane oxygenation is most effective in salvaging pediatric cardiac surgical patients who demonstrate medically refractory hemodynamic deterioration at some interval after being successfully weaned from cardiopulmonary bypass. The right atrial pressure after extracorporeal membrane oxygenation decannulation is an independent predictor of hospital death.
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Pulmonary arterial anastomotic stenosis is an unusual complication after single-lung transplantation. Intravascular ultrasound, performed at the bedside with an introducer sheath and guidewire, is a new technique that provides high-resolution tomographic images of the anastomotic site. This modality was used early in the postoperative course of a 58-year-old man to exclude significant pulmonary arterial anastomotic narrowing after right single-lung transplantation for primary pulmonary hypertension.
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Protamine sulfate, which is used for heparin neutralization, has been reported to induce catastrophic pulmonary vasoconstriction after infusion. However, in the systemic circulation, protamine infusion induces hypotension due to peripheral vasodilation. ⋯ Protamine-mediated pulmonary vasodilatation could be an important mechanism to protect against the constrictive effects of autocoids generated during heparin neutralization. Such a mechanism might be dysfunctional in certain persons and put them at risk for pulmonary vasoconstriction after protamine infusion.