The Annals of thoracic surgery
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After witnessing the death of a patient following pulmonary embolectomy, John H. Gibbon, Jr, developed the idea of a device for extracorporeal oxygenation and circulation. What followed has led to the present-day method of extracorporeal membrane oxygenation as an effective method of cardiorespiratory support. In this case of massive acute pulmonary embolism, its use in a conscious patient completes the circle from the first ideas of Gibbon.
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Comparative Study
High and low heparin dose with heparin-coated cardiopulmonary bypass: activation of complement and granulocytes.
Cardiopulmonary bypass with heparin-coated circuits allows reduced amounts of systemic heparin. Heparin inhibits activation of the complement cascade experimentally, but the effects of different levels of systemic heparin on activation of complement and granulocytes in patients have remained unknown. ⋯ Complement activation was significantly reduced in both heparin-coated groups and was independent of the level of systemic heparinization, whereas granulocyte activation was reduced only in patients who received low doses of systemically administered heparin. The results indicate that a moderate reduction of the systemic heparin dose may be an advantage with regard to improved biocompatibility when using heparin-coated cardiopulmonary bypass circuits.
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Arrhythmias occur frequently after Fontan operations, and are related in part to high atrial pressure, wall distention, and scarring caused by extensive suture lines. These arrhythmic factors may be avoided by an extracardiac total cavopulmonary anastomosis. We have embarked on a program of conversion of the hemi-Fontan operation to a fenestrated extracardiac Fontan procedure with a relatively simple operation. ⋯ An extracardiac fenestrated Fontan procedure can safely and successfully be performed after a hemi-Fontan operation, and may have both hemodynamic and arrhythmic benefits.