The Annals of thoracic surgery
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Long-term support on the implantable left ventricular assist device (LVAD) produces structural changes in the recipient's heart. To assess the possibility of heart "recovery" we reviewed the records of 19 HeartMate LVAD recipients to determine structural and left ventricular histologic changes during LVAD support. Intraoperative transesophageal echocardiographic studies were performed in the operating room before LVAD insertion, immediately after LVAD insertion, and at explantation and heart transplantation (mean duration of support, 76 +/- 34 days). ⋯ We conclude that implantable LVAD support is associated with immediate changes in ventricular structure. Histologic markers of acute myocyte damage improve, but fibrosis increases. Because the structural changes occur immediately, they do not indicate "recovery" of left ventricular function, but merely changes in loading conditions.
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Case Reports
Intraoperative prosthetic valve dysfunction: detection by transesophageal echocardiography.
We describe the valuable role of intraoperative transesophageal echocardiography in the detection of immediate prosthetic valve dysfunction. Transesophageal echocardiography accurately diagnosed one leaflet of a St. Jude Medical mitral valve to be stuck. We recommend routine transesophageal echocardiography for mitral valve operations.
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Orthotopic cardiac transplantation was performed in a 42-year-old woman with idiopathic cardiomyopathy. Postoperative right ventricular failure developed and a transesophageal echocardiogram demonstrated acquired cor triatriatum with marked obstruction to mitral valve inflow and severe right ventricular dilatation. At reexploration, redundant donor atrial tissue was excised correcting the cor triatriatum. She was alive and well with normal hemodynamic parameters 12 months after transplantation.
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Editorial Comment Comparative Study
Cerebral blood flow values during cardiopulmonary bypass: relatively absolute or absolutely relative?