The Annals of thoracic surgery
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Comparative Study Clinical Trial
Aprotinin in pediatric cardiac operations: a benefit in complex malformations and with high-dose regimen only.
The benefits and the current indications of aprotinin in congenital operations are not well defined. At present there are only a few studies available that have investigated a small number of patients in several heterogeneous groups of malformations. ⋯ High-dose aprotinin reduces blood loss and transfusion requirement only in complex congenital cardiac operations; therefore aprotinin cannot be recommended as a blood conservation agent in routine pediatric operations.
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The surgical treatment of mitral regurgitation associated with Marfan's syndrome remains controversial because of the underlying degenerative process. ⋯ Mitral valve repair for mitral regurgitation in patients with Marfan's syndrome can be performed safely in almost all instances. This technique provided stable midterm results comparable with those obtained for other degenerative mitral valve diseases.
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A surgically treated case of absent pulmonary valve syndrome associated with type B interrupted aortic arch is presented. The presence of a restrictive ductus arteriosus promoted the development of a collateral circulation between ascending and descending thoracic aorta, allowing the child to remain clinically stable after birth.
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As the extracardiac Fontan operation evolves, a reliable method for creating and subsequently closing communications between the systemic and pulmonary venous chambers would be useful. We describe a surgical technique for creating this "fenestration" and a complementary transcatheter technique that allows safe and reliable closure of these communications regardless of size and position.
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Left ventricular thrombus is a complication of myocardial infarction, ventricular aneurysm, cardiomyopathy, and myocarditis. Left ventriculotomy has been the standard approach for removal of left ventricular thrombus. ⋯ We describe a case of left ventricular thrombus with systemic embolization in a patient with myocarditis. Video-assisted cardioscopy allowed visualization and removal of the thrombus via an aortotomy, thereby avoiding a left ventriculotomy.