The Annals of thoracic surgery
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The accumulation of intracellular sodium during myocardial ischemia couples an inappropriate calcium influx and depressed cardiac recovery during subsequent reperfusion. The effects of the selective sodium/ hydrogen exchange inhibitor HOE 694 are evaluated during myocardial ischemia and reperfusion. ⋯ The addition of 1 mumol/L HOE 694 to cardioplegic solution attenuates the increase of intracellular sodium during myocardial ischemia and early reperfusion. This is coupled with an improved recovery of contractile function, possibly as a result of decreased sodium and calcium overload of ischemic myocardium.
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The concepts of minimally invasive coronary artery bypass grafting have gained increasing attention and interest from cardiac surgeons. Operations through small incisions are mostly applied to patients with less extensive coronary disease, mostly single-vessel disease. The aim of this study was to identify a baseline level of conventional coronary bypass grafting for this group of patients, particularly with regard to surgical complications and immediate results. ⋯ For this highly selected group of patients, coronary artery bypass grafting based on median sternotomy, cardiopulmonary bypass, and cardioplegic arrest carries a very high rate of immediate success. Such data may be useful as a baseline when considering the costs and benefits of new surgical procedures.
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The method of replacing the aortic valve via a minithoracotomy has been reported in the recent literature. Although this strategy has clear advantages, further refinements of the process make the procedure even less invasive. ⋯ The advantages of this method include further reduction of surgical trauma, early mobilization, and rehabilitation of the patient. Surgical technical improvements include avoidance of groin cannulation, simpler equipment, safe venting of the left ventricle, and preservation of chest wall integrity.
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The management of patients with acute pulmonary embolism remains difficult, particularly when cardiogenic shock is involved. The preoperative incidence of cardiac arrest compromises the results of emergency pulmonary embolectomy. In an attempt to reduce the operative mortality rate, we applied percutaneous cardiopulmonary bypass support to restore vital organ perfusion before the surgical intervention. ⋯ The use of percutaneous cardiopulmonary bypass support immediately resuscitated and stabilized the cardiopulmonary function and allowed for successful emergency pulmonary embolectomy. In each patient, transesophageal echocardiography was useful for prompt and noninvasive diagnosis.
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Ebstein's anomaly of the tricuspid valve is a complex malformation. Various operations have been undertaken with varying results. Because valve replacement yielded poor results, surgical treatment has focused on valvuloplasties. ⋯ Valvuloplasty using the single-stitch technique is a rewarding operation. It yields good long-term results with substantial improvement in functional performance and clinical status.