The Annals of thoracic surgery
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Case Reports
Left ventricular outflow tract obstruction and hemolytic anemia after mitral valve repair with a Duran ring.
We report a case of mitral valve repair with a Duran ring that was complicated by left ventricular outflow tract obstruction, mitral regurgitation, and hemolytic anemia. A 59-year-old man with severe mitral valve regurgitation underwent mitral valve repair, including a Duran ring annuloplasty. ⋯ The patient then underwent mitral valve replacement with a 29-mm St. Jude valve.
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Randomized Controlled Trial Clinical Trial
Heparin and antithrombin III levels during cardiopulmonary bypass: correlation with subclinical plasma coagulation.
The anticoagulant effect of heparin in the milieu of altered antithrombin III levels was investigated in adult (n = 7) and pediatric (n = 14) patients undergoing open heart operations. The pediatric patients were subdivided into a control group (n = 8) and an antithrombin III group (n = 6), which received 1,000 units of antithrombin III. The reduction in antithrombin III levels during cardiopulmonary bypass was obvious in patients of all ages, showing a greater reduction (although not statistically significant) in the pediatric patients. ⋯ This result may be related to the different actions of heparin when antithrombin III levels are reduced. Supplementation with antithrombin III succeeded in suppressing the activation of the coagulation cascade and resulted in no statistical change in fibrinopeptide A levels at any time. We conclude that heparin and (in some patients) antithrombin III levels are important variables for the inhibition of fibrin formation and the possible preservation of coagulation proteins.
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Gastrobronchial fistula is an extremely rare condition. A case of gastrobronchial fistula secondary to a benign gastric ulcer 9 years after esophagectomy and gastric pull-up for treatment of esophageal carcinoma is described. A review of the literature is provided.
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Physiologists could keep animals alive with an open chest long before surgeons set about doing the same thing in patients. Why was there not an orderly transfer of knowledge and technique?
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In 12 patients who had had composite replacement of the aortic valve and ascending aorta, infective endocarditis developed 2 months to 17 years after operation. Six patients had mechanical valves and 6 had biological ones (four homograft and two porcine valves). All patients needed operation because of shock, heart failure, persistent sepsis in spite of adequate antibiotic therapy, or the development of a paravalvular false aneurysm. ⋯ Operative survivors were followed up from 3 to 156 months (mean, 42 months). One patient died 35 months postoperatively due to bleeding complications of anticoagulation; 1 patient suffered a cardiac arrest at home 2 months after operation, sustained permanent cerebral damage, and died 4 months later. The remaining patients are asymptomatic from the cardiovascular viewpoint.(ABSTRACT TRUNCATED AT 250 WORDS)