The Annals of thoracic surgery
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Cardiopulmonary bypass reduces platelet number and function, increases postoperative bleeding time, and is the major, unsolved cause of nonsurgical bleeding after open heart operations. Temporary inhibition of platelet function during cardiopulmonary bypass (platelet anesthesia) protects platelets and reduces postoperative bleeding time and bleeding. ⋯ Integrilin alone or in combination with Iloprost significantly reduces platelet activation during cardiopulmonary bypass and produces normal or near-normal bleeding times at the time protamine is given.
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Randomized Controlled Trial Comparative Study Clinical Trial
Prospective, randomized comparison of extrapleural versus epidural analgesia for postthoracotomy pain.
Thoracic epidural analgesia is considered the method of choice for postthoracotomy analgesia, but it is not suitable for every patient and is associated with some risks and side effects. We therefore evaluated the effects of an extrapleural intercostal analgesia as an alternative to thoracic epidural analgesia. ⋯ These results led us to suggest that extrapleural intercostal analgesia might be a valuable alternative to thoracic epidural analgesia for pain control after thoracotomy and should particularly be considered in patients who do not qualify for thoracic epidural analgesia.
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An important factor in the management and outcome of patients with complex univentricular or partial biventricular repair is atrioventricular valve function. Cross-sectional and Doppler echocardiography are versatile tools for the evaluation of atrioventricular valve function. However, it is important to understand the physics and applications of this technology to appreciate the strengths and limitations of echocardiography in this application. ⋯ Cross-sectional and Doppler cardiac ultrasound is the optimal tool for evaluation of atrioventricular valve function in the current era. Although the issue of quantifying regurgitant jets is not yet fully resolved, echocardiography allows for complete qualitative assessment of the anatomic and functional features that influence the function of the atrioventricular valves.
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The aim of this study was to assess by angiography the late effects of both classic and modified Blalock-Taussig shunts in terms of growth and development of stenosis and distortion. ⋯ After a Blalock-Taussig shunt, growth of the pulmonary arteries occurred but did not exceed the normal growth of the pulmonary arterial tree. Moreover, a shunt procedure can cause distortion and stenosis of the pulmonary artery, which may have important implications for future corrective surgical intervention. All these findings support earlier complete surgical repair of correctable congenital cardiac defects.
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Case Reports
Cardiopulmonary bypass with danaparoid sodium and ancrod in heparin-induced thrombocytopenia.
Heparin is the standard anticoagulant for patients undergoing cardiopulmonary bypass. There are some patients for whom heparin is unsuitable and ancrod (a defibrinogenating enzyme) has been used as an alternative. ⋯ The addition of danaparoid sodium (a heparinoid) allowed safe cardiopulmonary bypass. We discuss the reasons for this and suggest that the combination of ancrod and danaparoid sodium is a logical one in such cases.