The Annals of thoracic surgery
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For many years, valvulitis in systemic lupus erythematosus has been known to occur. Our patient was a 17-year-old girl who presented with severe mitral incompetence and renal insufficiency due to lupus valvulitis. ⋯ A reconstructive mitral valve operation would seem to be preferable. However, a conservative operation does not alter the natural history of the disease and the progression of valve thickening and calcification.
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Aprotinin use in adults is increasing, and its use in children has recently been reported. ⋯ We conclude aprotinin is an effective means of reducing bleeding, operating time, and donor exposure in infants and children. An increased rate of thrombosis and possibly mediastinitis are potential problems.
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Our institution has adopted a protocol of primary repair for all patients with double-outlet right ventricle. ⋯ An institutional protocol of early anatomic biventricular repair of double-outlet right ventricle in infants and neonates achieves excellent survival, making palliative operations unnecessary. Associated lesions should be repaired simultaneously. The complexity of these malformations requires a highly individualized and flexible surgical approach.
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Previous acute studies in immature piglets at our institution have demonstrated improved recovery of cerebral blood flow, intracellular pH, and high-energy phosphates with the administration of multidose University of Wisconsin solution as cerebroplegia during a period of deep hypothermic circulatory arrest (HCA). In an effort to define further the clinical applicability of this technique, we have developed a survival model of swine cardiopulmonary bypass (CPB) and HCA. ⋯ A clinically relevant survival model of CPB with HCA in immature swine is feasible. Cold UW solution as single-dose cerebroplegia is not beneficial, and may be injurious to the immature swine brain subjected to CPB and HCA. Further studies are indicated to determine optimal composition and administration of cerebroplegic solutions.
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Leukocyte filters have been used in cardiopulmonary bypass circuits to decrease potentially deleterious consequences of white blood cell product release in adults undergoing cardiac operations. Studies in animal models have also demonstrated benefits of white blood cell depletion during cardiopulmonary bypass. We sought to examine the efficacy of a leukocyte filter placed in the bypass circuit of infants undergoing operation for correction of congenital heart disease. ⋯ Although these data suggest that the leukocyte filter offers little clinical benefit, a prospective, randomized study should be undertaken to further elucidate the efficacy of leukocyte depletion for infants undergoing cardiopulmonary bypass for correction of congenital heart disease.