The Annals of thoracic surgery
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Infants with single ventricle and transposition of the great arteries with or without aortic arch obstruction have a poor prognosis due in large part to the development of systemic outflow obstruction, a frequent consequence of pulmonary artery banding. Thus, the initial palliation and long-term treatment options are critical in terms of surgical choices and timing. We report our experience with 9 patients managed by neonatal pulmonary artery banding and early debanding, a Damus-Kaye-Stansel procedure, and either a modified Glenn shunt or a modified Fontan procedure. ⋯ There is trivial or mild pulmonic insufficiency in 5 patients, which is not progressing. One patient had mild to moderate pulmonic insufficiency but died late presumably of an arrhythmia. We conclude that neonatal pulmonary artery banding coupled with planned early debanding, a Damus-Kaye-Stansel procedure, and cavopulmonary anastomosis is a relatively low-risk course for patients with this complex physiology.
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A case of postcardiotomy cardiogenic shock after repair of a congenital ventricular septal defect in a 5-year-old boy is reported. Mechanical circulatory support, instituted with a centrifugal left ventricular assist device, adequately supported the patient for 50 hours until recovery of native left ventricular function occurred. Transesophageal echocardiography proved to be useful in assessment of left ventricular function, allowing for timely institution and withdrawal of mechanical circulatory support.
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Prosthetic valve thrombosis is associated with high mortality. The treatment of choice remains operation. This is a case report of the successful combination therapy of tissue plasminogen activator and urokinase for an isolated thrombosed prosthetic mitral valve in a postpartum patient in whom operation was thought to carry an unacceptable risk. Combined thrombolytic therapy or therapy with a single agent with a long half-life and a prolonged infusion time is suggested as an emergent treatment option for prosthetic mitral valve thrombosis.
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Case Reports
Distal aortic arch aneurysmectomy and coronary revascularization through a left thoracotomy.
A successful single operation of a distal aortic arch aneurysm and coronary artery disease through a left lateral thoracotomy using a simple hypothermic retrograde cerebral perfusion technique for cerebral protection in a 64-year-old man is reported. During ventricular fibrillation accompanying cooling to 15 degrees C, a left internal thoracic artery was anastomosed with the left anterior descending coronary artery, and the aneurysm was replaced with a patch during hypothermic retrograde cerebral perfusion.
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Randomized Controlled Trial Clinical Trial
Platelet protection by low-dose aprotinin in cardiopulmonary bypass: electron microscopic study.
To evaluate the effect of low-dose aprotinin during cardiopulmonary bypass on platelet function and clinical hemostasis, 30 patients undergoing various cardiopulmonary bypass procedures employing bubble oxygenators were randomized to receive either low-dose aprotinin (2 x 10(6) KIU in the cardiopulmonary bypass priming solution, 15 patients [group A]) or placebo (15 patients [group B]). Blood samples were collected before and after cardiopulmonary bypass to assess platelet count and aggregation on extracellular matrix, which was studied by a scanning electron microscope. On a scale of 1 to 4 preoperative mean platelet aggregation grades were similar in both groups (3.8 +/- 0.5 and 3.5 +/- 0.5 for groups A and B, respectively). ⋯ Platelet count was similar in both groups preoperatively and postoperatively. Total 24-hour postoperative bleeding and blood requirement were lower in the aprotinin group (487 +/- 121 mL and 2.3 +/- 1.0 units) than in the placebo group (752 +/- 404 mL and 6.8 +/- 5.1 units; p < 0.01). These results show that the use of low-dose aprotinin during cardiopulmonary bypass provides improved postoperative hemostasis, which might be related to the protection of the platelet aggregating capacity.