The Annals of thoracic surgery
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Neurocognitive deficits after open heart operations have been correlated to jugular venous oxygen desaturation on rewarming from hypothermic cardiopulmonary bypass (CPB). Using a porcine model, we looked for evidence of cerebral hypoxia by magnetic resonance imaging during CPB. Brain oxygenation was assessed by T2*-weighted imaging, based on the blood oxygenation level-dependent effect (decreased T2*-weighted signal intensity with increased tissue concentrations of deoxyhemoglobin). ⋯ Decreased T2* signal intensity in a diffuse spatial distribution indicates that a large proportion of cerebral parenchyma is hypoxic (evidenced by an increased proportion of tissue deoxyhemoglobin) during CPB in this porcine model. Neuronal damage secondary to parenchymal hypoxia may explain the postoperative neuropsychological dysfunction after cardiac operations.
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A new emphasis has been directed toward "off-pump" coronary artery bypass grafting to avoid the morbidity of cardiopulmonary bypass and further reduce the postoperative hospital length of stay. With the intent of achieving a hospital discharge for "on-pump" coronary artery bypass grafting procedures comparable with the same procedures "off pump," we applied a rapid-recovery protocol with particular attention paid to patients eligible for discharge on the third postoperative day. ⋯ With the application of a rapid-recovery protocol to patients undergoing "on-pump" coronary artery bypass grafting, discharge home within 3 days postoperatively is attainable and safe for patients who have minimal comorbid conditions.
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Regurgitation of the common atrioventricular valve in patients with univentricular atrioventricular connection has a negative impact on outcome in the Fontan operation. Because severe regurgitation of the common atrioventricular valve may not be sufficiently reduced by a volume-reducing operation alone, the addition of a valvuloplasty may be a necessary adjunct to achieve competence of the common atrioventricular valve. A modified technique of valvuloplasty of the common atrioventricular valve and its medium-term results are presented. ⋯ Pericardial patch augmentation of the bridging leaflets may be a valuable adjunctive technique in the reconstruction of the regurgitant common atrioventricular valve in hearts with univentricular atrioventricular connection, especially if a volume-reducing operation alone does not result in competence of the valve.
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The latissimus dorsi is usually left unstimulated for 2 weeks after cardiomyoplasty to allow the muscle to recover from the loss of the collateral circulation. To determine whether the 2-week delay may cause muscle atrophy, we randomized 15 mongrel dogs to a control group or a disuse atrophy group. ⋯ Delayed electrical stimulation of the latissimus dorsi may result in atrophy and loss of function.
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Mature lobar transplantation will increase the pediatric donor organ pool; however, issues regarding size discrepancy between donor grafts and recipient lungs remain unresolved. We hypothesized that an oversized mature pulmonary lobar allograft implanted into an immature recipient would provide adequate longterm pulmonary function versus a size-matched mature lobar graft or an immature whole lung. ⋯ Over-sized mature lobar grafts provide improved hemodynamics as compared with size-matched grafts. Mature left lower lobe grafts are superior to size-matched upper lobe grafts in this model, probably as a result of an augmented vascular bed.