The Annals of thoracic surgery
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This study was done to answer the question, "What is the current risk of resection of ascending aortic aneurysms regardless of acuity or cause?" ⋯ The current risk for ascending aortic aneurysm repair is low (< 2%) whether or not the aortic root or valve also needs repair, regardless of the cause of the aneurysm.
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A 28-year-old woman presented with monthly returning thoracic pain and cough. Catamenial pneumothorax was diagnosed. Thoracoscopy showed multiple nodules on the diaphragm, parietal pleura and lung itself, which proved to be thoracic endometriosis. Thoracoscopy is a useful procedure for diagnosis and treatment of this rare condition.
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Comparative Study
In vitro effect of hemodilution on activated clotting time and high-dose thrombin time during cardiopulmonary bypass.
Extreme dilution of clotting factors, as may occur during pediatric or neonatal cardiopulmonary bypass, often leads to inadequate monitoring of anticoagulation with activated clotting time (ACT). In this study we postulate that the high-dose thrombin time (HiTT) is less influenced by extreme dilution of clotting factors because it stimulates clotting through the common pathway. ⋯ These results imply that when blood is extremely diluted during cardiopulmonary bypass with a clear prime without substituted clotting factors, HiTT is a better test than ACT for anticoagulation monitoring.
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The purposes of this study are to determine whether patients with severe left ventricular dysfunction benefit from prophylactic insertion of an intraaortic balloon pump and to evaluate its cost-effectiveness. ⋯ Our experience suggests that patients with severe left ventricular dysfunction undergoing coronary artery bypass grafting may benefit from preoperative intraaortic balloon pump insertion, especially patients in functional class III or IV. This approach improved survival significantly, reduced hospital stay, and was more cost-effective.
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Progressive metabolic acidosis, hypoxia, and hypercarbia develop rapidly after fetal cardiac bypass mainly as a result of an increase in placental vascular resistance and a decrease in placental blood flow. A number of factors including fetal stress, priming substances, and extracorporeal surfaces have been identified as possible stimuli causing this placental dysfunction. The purpose of this study was to examine the effects of avoiding priming volume and minimizing extracorporeal surface area on placental hemodynamics and function. ⋯ Reducing the extracorporeal surface area and avoiding external priming substances preserves placental hemodynamics after fetal cardiac bypass. An in-line axial-flow pump is useful in miniaturizing the bypass circuits for potential use in fetal cardiac surgery.