The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Oct 1991
Early and late results of the modified Waterston shunt with PTFE grafts for palliation of complex congenital cyanotic heart disease in neonates.
During a 12 year period from 1978 to 1989, 35 infants under 4 weeks of age underwent palliative surgery for complex congenital cyanotic heart disease with a short (1-1.5 cm) PTFE graft between the ascending aorta and the right pulmonary artery (modified Waterston shunt). Twenty-three infants had pulmonary atresia and 14 had severe pulmonary stenosis. Underlying cardiac lesions were tetralogy of Fallot (n = 11), single ventricle (n = 7), transposition complexes (n = 6), and intact ventricular septum and hypoplastic right heart syndrome (n = 13). ⋯ We observed a significant difference in the shunt patency rate between 4 and 5 mm grafts: palliation was adequate after 2 years in 52% of the patients when a 4 mm graft was used and in 89% of the 5 mm graft group (p less than 0.005). Reshunting was necessary in 7 infants between 5 and 60 months after primary surgery. Recatheterization was performed in 17 infants for suspected shunt failure (n = 6) or diagnostic reasons (n = 11).(ABSTRACT TRUNCATED AT 250 WORDS)
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Thorac Cardiovasc Surg · Oct 1991
ReviewThe relevance of coronary sinus interventions in cardiac surgery.
The concept of arterialization of the coronary venous system was first discussed almost 100 years ago. Subsequently, those attracted by this approach have chosen the coronary veins as an alternative route for interventional and surgical therapy. Modern techniques of coronary sinus interventions (CSI) have been suggested mainly for temporary support and protection of ischemic myocardium. ⋯ Three major techniques have been suggested for different indications in cardiology and cardiac surgery: 1) ECG-synchronized retroperfusion of arterial blood, which is supposed to positively affect ischemic myocardium by phasic supply of oxygen to deprived areas mainly in cardiac emergencies, 2) retroinfusion of cardioplegia in the arrested heart, which is now a well-established clinical technique, and 3) intermittent coronary sinus occlusion during antegrade cardioplegic delivery in the arrested heart and in the early reperfusion period after surgical revascularization, or in cardiac emergencies. The beneficial effect of pressure-controlled intermittent coronary sinus occlusion is assumed to result from cyclic occlusion and release of the coronary sinus shifting venous blood to underperfused regions, thereby facilitating substrate delivery and subsequent washout of metabolites. Experimental studies and first clinical trials suggest that all methods of CSI are safe and feasible, and the ultimate goals of reduction of infarct size and preservation of jeopardized ischemic myocardium will be achieved.
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Thorac Cardiovasc Surg · Oct 1991
Experimental evaluation of heparin-coated cardiopulmonary bypass equipment with low systemic heparinization and high-dose aprotinin.
Cardiopulmonary bypass (n = 8 calves) with heparin-coated perfusion equipment, low-dose systemic heparinization (activated clotting time: ACT greater than 180 s) and high-dose aprotinin administration was evaluated in comparison to standard perfusion equipment with full-dose systemic heparinization (ACT greater than 480). All animals were perfused for 6 hours and similar values were observed for blood gases and mixed venous oxygen saturation in both groups. The heparin doses given in the study group before and during the 6 hours of perfusion totalized 14660 +/- 2553 IU as compared to 60833 +/- 5137 IU for the control group. ⋯ After mixing with the priming volume, plasma hemoglobine was 8.6 +/- 2.5 mumol/L in the study group versus 6.7 +/- 1.6 mumol/L in the control group. The highest value was observed in the study group after 2 hours of perfusion (8.2 +/- 2.1 mumol/L) versus 5 hours of perfusion in the control group (7.4 +/- 3.6 mumol/L). Prebypass LDH levels of 1610 +/- 150 IU in the study group versus 1740 +/- 210 IU in the control group moved to 1870 +/- 200 IU in the study group at 24 hours after perfusion versus 2650 +/- 400 IU in the control group at 24 hours and decreased thereafter.(ABSTRACT TRUNCATED AT 250 WORDS)