The Annals of thoracic surgery
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Comparative Study
Risk factors associated with cardiac surgery during pregnancy.
This study is aimed at analyzing risk factors for fetal and maternal mortality in cardiac surgery during pregnancy. ⋯ Cardiac surgery during pregnancy is associated with acceptable maternal and fetal mortality rates. These rates may be even lower if the factors mentioned above are maintained under control.
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Comparative Study
Open heart surgery: one-year self-assessment of quality of life and functional outcome.
The aim of this prospective study, based on the completion of the short form health survey questionnaire (SF36) before and 1-year after open heart surgery, was threefold: to evaluate the changes in quality of life (QOL) after open heart surgery, to determine the factors influencing QOL, and to assess the relation between preoperative QOL and 1-year cardiac functional status. ⋯ Preoperative QOL determined by the SF36 is predictive of 1-year cardiac functional status. Coronary artery bypass patients do not recover as well as patients having undergone heart valve surgery.
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Comparative Study
The incidence of dysphagia in pediatric patients after open heart procedures with transesophageal echocardiography.
Pediatric patients who undergo open heart operations may be at risk for the development of dysphagia because of interventions such as intubation and transesophageal echocardiography. Although the occurrence of dysphagia after cardiac surgical procedures in adults is reported to be 3% to 4%, the incidence in children and adolescents has not been documented. This study was undertaken to determine the incidence of and risk factors contributing to dysphagia in pediatric patients after open heart procedures. ⋯ Eighteen percent of patients had dysphagia after an open heart operation with transesophageal echocardiography. Age of less than 3 years, preoperative patient acuity status, longer intubation times, and operation for left-sided obstructions are risk factors for dysphagia in this cohort of pediatric patients. The size of the transesophageal echocardiography probe in relation to the patient's weight was predictive of dysphagia. Physicians should consider using the new mini-multiplane transesophageal echocardiographic probes in patients weighing less than 5.5 kg. Vigilance in monitoring for the signs of preoperative and postoperative dysphagia with prompt referral to a speech therapist can substantially reduce patient morbidity, length of hospital stay, and requirement of prolonged nasogastric tube use.
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Comparative Study
Coronary artery and myocardial inflammatory reaction induced by intracoronary stent.
Intracoronary stents have been extensively used in percutaneous coronary revascularization. However, despite the breakthroughs and developments associated with this new technology, novel complications and findings have emerged compelling the cardiac surgeon to cope with this new scenario. The presence of an intracoronary foreign body (stent) might induce an inflammatory reaction to the coronary artery and surrounding cardiac muscle. ⋯ The presence of an intracoronary stent induces a persistent, acute and chronic inflammatory reaction, with involvement of the distal coronary artery and surrounding myocardium. This may have implications when choosing the optimal site distal to the stent for coronary artery bypass grafting.
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Aortic stenosis (AS) is encountered in approximately 5% of children with heart disease. The indications for surgery and the surgical techniques for AS are well established. This report focuses on the early and long-term outcomes in children with AS over a 40-year period. ⋯ Surgical relief of LVOTO in infants and children can be accomplished with low mortality and morbidity. Neonates with critical AS have significantly higher mortality and morbidity due to their complex anatomy and their critical presentation that affects outcome. Aortic valvotomy delays valve replacement in a significant percentage of children. The Ross procedure and mechanical aortic valve replacements have had a low mortality and morbidity in our series. Valve replacement will eventually be required in most children presenting with valvar AS and multilevel LVOTO while repair of discrete subaortic stenosis and supravalvar AS may not require reoperation in most patients. Children with LVOTO should have lifetime follow-up.