The Annals of thoracic surgery
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The case of a 21-year-old woman without previous cervical pathology in whom irreversible tetraplegia developed after operation for tracheal stenosis is reported. After tracheal resection the neck was kept in extreme flexion and after extubation she was moved to a sitting position. The different causal agents that could produce the neurologic damage remain unclear, although we think that the combination of relative arterial hypotension secondary to the sitting position and disturbed autorregulation, caused by extreme neck flexion, could result in ischemic spinal cord injury.
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The treatment of infants with hypoplastic left heart syndrome has been challenging and controversial. ⋯ Both the Norwood procedure and heart transplantation have encouraging early to intermediate results in infants with hypoplastic left heart syndrome. Hypoplastic left heart syndrome should be managed selectively on the basis of cardiac morphology, donor availability, and family wishes. Development of a flexible program involving the use of both procedures may aid in the successful management of infants with hypoplastic left heart syndrome.
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The purpose of this study was to determine whether cerebral cortical microvascular responses to platelet-derived vasoactive substances are altered after normothermic cardiopulmonary bypass (CPB), and whether these alterations are modified by moderate hypothermia. ⋯ This study demonstrates that normothermic extracorporeal circulation reduces endothelium-dependent relaxation responses to products of platelet activation in the cerebral microcirculation. Moderate hypothermia attenuates the CPB-induced impairment of endothelium-dependent relaxation, but has no effect on baseline cerebral blood flow after rewarming.
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Significant right ventricular (RV) dysfunction as measured by increased end-diastolic volume and reduced ejection fraction has been documented in the postoperative period after pulmonary resection. We hypothesized that changes in RV contractile state or afterload may contribute to this RV pump dysfunction. ⋯ The present study suggests that RV dysfunction after pulmonary resection is not caused by primary alterations in contractility or immediate changes in afterload. Better control of heart rate with minimal effect on inotropy may enhance RV pump function.