The Annals of thoracic surgery
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Patients with congenital aortic stenosis are subject to sudden death without prior symptoms. Indications for operation are based on pressure gradients, but intraoperative evaluation of results after relief of obstruction can be subjective and arbitrary. Between September, 1981, and October, 1983, 21 patients underwent operation for relief of congenital aortic stenosis. ⋯ Immediate reexploration and incision of the rudimentary commissure in 2 and excision of redundant valvular tissue in the other resulted in a more satisfactory pressure gradient without substantial aortic insufficiency. We suggest that measurement of intraoperative pressure gradients can accurately assess the results of therapy and allow the surgeon the option of reexploration for further intervention. Moreover, the high correlation between intraoperative and postoperative pressure gradients can help in planning postoperative management and future cardiac catheterizations.
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Sixty-four consecutive patients with penetrating cardiac injuries were treated between January, 1977, and January, 1983, at the University of Maryland Hospital. Twenty-eight patients had major associated injuries of other organs. The patients were divided into groups according to their clinical status on arrival. ⋯ None of the survivors sustained severe neurological sequelae. Five patients underwent late reoperations for closure of a ventricular septal defect (2), mitral valve replacement (1), and pericardiectomy (2) with no deaths. Though repair of penetrating cardiac injuries should preferably be carried out in the OR, immediate thoracotomy for "lifeless" or deteriorating patients can be performed in the ER with a low incidence of direct surgical complications and with high patient survival.
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Comparative Study
A comparison of Blalock-Taussig, Waterston, and polytetrafluoroethylene shunts in children less than two weeks of age.
Results obtained with Blalock-Taussig, Waterston, and polytetrafluoroethylene (PTFE) shunts were compared in 67 cyanotic infants less than 2 weeks of age. A different shunt was preferably used at each of three institutions. The incidences of early shunt failure (3 out of 21, 14%), mortality after revision of early shunt failure (0 out of 3), and overall hospital mortality (1 out of 21, 5%) were all lowest for the PTFE shunt. ⋯ At 1 year, all shunts provided comparable adequate palliation (greater than 80%). Probability of late shunt failure was significantly higher (p = 0.04) for the PTFE shunt at 3.5 years. Results suggest that the PTFE shunt may be the safest and most effective shunt in neonates, but that elective shunt replacement or total repair may be warranted in the first or second year of life.
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Randomized Controlled Trial Clinical Trial
Avoidance of blood transfusion in coronary artery surgery: a trial of hydroxyethyl starch.
Banked blood transfusion, with its attendant hazards, may be avoided in certain instances. A search for an acceptable plasma substitute was made. A randomized prospective trial of hydroxyethyl starch (HES) versus plasma for postoperative volume replacement is described. ⋯ Colloid osmotic pressure was significantly higher at one week in the HES group (p less than 0.001) and was correlated with the volume of HES given (r = 0.525; p less than 0.01). There were no untoward effects attributable to HES. It is concluded that HES is a safe, cheap, and effective plasma substitute for volume replacement following cardiac surgical procedures.