The Annals of thoracic surgery
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Comparative Study
Utility of a clinical practice guideline in treatment of chylothorax in the postoperative congenital heart patient.
Chylothorax after congenital heart surgery is a common complication with associated morbidities, but consensus treatment guidelines are lacking. Variability exists in the duration of medical treatment and timing for surgical intervention. ⋯ Institution of a clinical practice guideline for treatment of chylothorax after congenital heart surgery was associated with earlier diagnosis, reduced hospital length of stay, mechanical ventilation, and device utilization for these patients.
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Comparative Study
Course, predictors of diaphragm recovery after phrenic nerve injury during pediatric cardiac surgery.
Hemidiaphragm paralysis from phrenic nerve injury is a known complication of congenital cardiac surgery. Return of diaphragm function has been reported; however, prior studies on this subject have been limited by small numbers, static assessment methods, or observation of plicated or non-plicated patients alone. To describe return of function, we reviewed fluoroscopy and ultrasonography in all diagnosed cases of diaphragmatic paralysis. ⋯ In the current era, return of diaphragm function after phrenic nerve injury sustained during congenital cardiac surgery is a known occurrence; however, predicting recovery continues to be difficult.
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We evaluated the current results and the predictors of in-hospital complications for a pericardiectomy procedure for constrictive pericarditis in Japan. ⋯ Pericardiectomy is associated with high morbidity and mortality rates. Careful consideration should be given to these risk factors in the process of patient selection and perioperative management.
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Ischemia-reperfusion injury occurs during coronary artery bypass graft operations. Strategies are needed to lower the extent of damage. ⋯ This review provides a look at potential mechanisms involved in remote ischemic preconditioning, experimental evidence supporting it, clinical studies that support and negate it, and potential reasons for differences between clinical studies. With remote ischemic preconditioning having the potential to better clinical outcomes in patients undergoing coronary artery bypass graft operations, a large clinical trial needs to be undertaken to better assess its practical clinical application.