The Annals of thoracic surgery
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A woman pregnant for 21 weeks underwent an emergency operation because of an aortic arch aneurysm that had ruptured into her left lung. Cardiopulmonary bypass and deep hypothermia were used and she needed 37 minutes of circulatory arrest at a core temperature of 19 degrees C. Both the mother and fetus survived, and a normal baby was delivered by cesarean section at the 39th week of gestation.
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We report the case of a 24-year-old man in whom a clinical syndrome developed while he was on active military duty in Saudi Arabia that was subsequently diagnosed as constrictive pericarditis. Phrenic nerve to phrenic nerve pericardiectomy and posterior pericardial release successfully relieved the ventricular constriction with a resultant increase in the cardiac index from 1.9 to 3.8 L.min-1.m-2. Transesophageal echocardiographic monitoring during the operation disclosed trace mitral regurgitation before median sternotomy. ⋯ This echocardiographic finding had improved 1 week later, but the regurgitation still was greater than baseline. Mitral valve function had returned to baseline by 4 weeks after the operation. Possible mechanisms of this evolving pattern of perioperative mitral valve dysfunction are discussed.
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The effects of different cardioplegia temperatures on myocardial protection with continuous aerobic blood cardioplegia were studied in a canine model of acute regional injury after left anterior descending coronary artery occlusion and subsequent revascularization. Twenty-five animals underwent 90 minutes of occlusion followed by revascularization during 60 minutes of electromechanical arrest with continuous retrograde blood cardioplegia delivered at one of three temperatures: 18 degrees C (n = 8), 28 degrees C (n = 8), and 37 degrees C (n = 9). Left ventricular protection was assessed in a right heart bypass model in terms of the left ventricular pressure-volume relationships, myocardial oxygen consumption, regional myocardial blood flow, adenosine trisphosphate concentration, and water content. ⋯ The maximum elastance and stress-strain relationships showed there were no significant differences between the groups at 90 minutes. The myocardial oxygen consumption was greatest in the 37 degrees C group during the first hour after reperfusion (18 degrees C, 5.4 +/- 1.4 mL O2.min-1.100 g-1; 28 degrees C, 4.7 +/- 1.1 mL O2.min-1.100 g-1; 37 degrees C, 6.3 +/- 1.6 mL O2.min-1.100 g-1; p < 0.05). The regional myocardial blood flow, adenosine triphosphate concentration, and myocardial water content were similar in the three groups.(ABSTRACT TRUNCATED AT 250 WORDS)
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During a 15-month period, a subxiphoid pericardial window was performed as a diagnostic method to rule out cardiac injury in 76 patients with penetrating wounds near the heart. Patients with an obvious diagnosis of cardiac tamponade or patients in severe shock were excluded. Seventy-four patients were male, and 2 were female. ⋯ In 16 patients (21%), the procedure identified hemopericardium. In our hands, the subxiphoid pericardial window has proved to be a rapid, precise, and safe method for the diagnosis of wounds of the heart. Until a less invasive procedure proves more precise, we recommend it as the standard diagnostic approach for cardiac injuries in patients in stable condition.
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Randomized Controlled Trial Clinical Trial
Aprotinin preserves hemostasis in aspirin-treated patients undergoing cardiopulmonary bypass.
Various clinical trials have shown that hemostasis is improved by the administration of aprotinin during cardiopulmonary bypass. However, this effect has not been proved for those patients treated preoperatively with aspirin. Therefore, a double-blind, placebo-controlled study was conducted to test the efficacy of low-dose aprotinin (2 x 10(6) KIU in the pump prime solution) in preserving hemostasis in 40 aspirin-treated (325 mg) patients undergoing coronary artery bypass grafting. ⋯ The inhibitory effects of aspirin on collagen-induced platelet aggregation and thromboxane production were not influenced by aprotinin treatment. The findings from the present study indicate that aprotinin preserves hemostasis in aspirin-treated patients during cardiopulmonary bypass, but aspirin's effect on platelets is maintained. Therefore, aprotinin seems to be a useful adjunct treatment in aspirin-treated patients undergoing coronary artery bypass grafting.