The Annals of thoracic surgery
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Comparative Study Observational Study
Elevated procalcitonin in patients after cardiac surgery: a hint to nonocclusive mesenteric ischemia.
Nonocclusive mesenteric ischemia (NOMI) can occur after cardiac surgery, commonly in conjunction with use of cardiopulmonary bypass. Some evidence suggests that serum procalcitonin (PCT) levels are increased in patients with mesenteric ischemia; however, an association between PCT and NOMI has not yet been studied. The current study investigates whether elevated serum PCT levels are found in patients exhibiting NOMI. ⋯ Postoperative measurement of PCT seems useful to improve the clinical and noninvasive identification of patients with NOMI after cardiac surgery.
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Clinical practice in the United States has no restrictions in allocating lungs from adult donors to pediatric recipients. ⋯ Adult donor lung allografts appear not to negatively affect survival in pediatric lung transplant recipients when considering confounders, and do not influence survival through an increased hazard for the development of BOS.
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Pulmonary alveolar proteinosis (PAP) is characterized by accumulation of lipoproteinaceous material in the terminal airways. Whole lung lavage (WLL) remains the gold standard treatment but may be particularly challenging in cases of severe hypoxemia. We present a 3-step strategy that was used in a patient with PAP-associated refractory hypoxemia and that combined venovenous extracorporeal membrane oxygenation (vvECMO), double-lumen orotracheal intubation, and bilateral multisegmental sequential lavage (MSL). The procedure was well tolerated and permitted weaning from the ventilator.
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Although periprocedural myocardial infarction frequently occurs with the robustness of percutaneous coronary intervention, the prognosis of the periprocedural myocardial infarction has been known to be relatively good compared with that of spontaneous myocardial infarction. We present a patient with a postinfarction ventricular septal defect, with cardiogenic shock, that developed 7 days after a percutaneous coronary intervention. Emergency surgical repair combined with coronary artery bypass grafting saved the patient, without complications.
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Comparative Study
Tricuspid valve regurgitation in congenitally corrected transposition of the great arteries and a left ventricle to pulmonary artery conduit.
The configuration of the interventricular septum can affect the function of the tricuspid valve in patients with congenitally corrected transposition of the great arteries who have a systemically functioning right ventricle. Altering septal configuration by addressing a dysfunctional conduit placed between the left ventricle (LV) and the pulmonary artery (PA) in these patients can impact septal configuration and competency of the tricuspid valve. ⋯ Intervention for LV to PA conduit dysfunction may result in worsening TR and right ventricular function, likely due in part to altered septal shift due to changes in the interventricular pressure ratio. Management of LV to PA conduit dysfunction should take these findings into account.