The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Jun 1998
Randomized Controlled Trial Comparative Study Clinical TrialStenosis of the right coronary artery and retrograde cardioplegia predispose patients to atrial fibrillation after coronary artery bypass grafting.
It is assumed that stenosis of the right coronary artery (RCA) predisposes CABG patients, by way of incomplete atrial myocardial protection, to postoperative atrial fibrillation (AF). Sixty patients with high-grade RCA lesion were randomized into four groups according to the technique of delivery of cold blood cardioplegia: antegrade, retrograde, retrograde without catheter cuff, and combined antegrade and retrograde. As controls, 34 patients without RCA lesion were randomized to receive antegrade or retrograde cardioplegia. ⋯ Prolonged stay in the intensive care unit (p < 0.001) and occurrence of postoperative ventricular tachycardia (p < 0.05) were associated with AF. RCA stenosis and retrograde cardioplegia delivery in RCA-affected patients were risk factors for postoperative atrial fibrillation. Retrograde cardioplegia may offer poorer protection at the atrial level.
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Thorac Cardiovasc Surg · Jun 1998
ReviewNear-infrared spectrophotometry of the brain in cardiovascular surgery.
Neuropsychological and neurological deficits are still major causes of mortality and morbidity after cardiac operations and are thought to be caused by embolism and cerebral hypoxia. Near-infrared spectrophotometry (NIRS) is a promising method for non-invasive monitoring of cerebral oxygenation and hemodynamics. Different devices provide information on changes of oxygenated (HbO2) and deoxygenated hemoglobin (Hb), oxidized cytochrome aa3 (CytOx) or regional oxygen saturation (rSO2). ⋯ Therefore, the CytOx signal is of great interest for future studies. NIRS must prove its ability to diagnose cerebral hypoxia consistently during cardiac surgery in a large patient study before this method is brought into routine clinical practice. Absolute quantification and definitions of critical oxygenation margins will be helpful for this goal.
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Thorac Cardiovasc Surg · Jun 1998
Clinical Trial Controlled Clinical TrialArterial hypertension in adults after surgical treatment of aortic coarctation.
Despite primarily successful surgical repair of aortic coarctation (CoA), postoperative persistent, recurring, or newly developing hypertension is regarded as a risk factor of earlier mortality compared with a normal population. The present study shows that even after surgical correction of CoA many patients have hypertension at rest or during exercise. Out of 44 patients, 72% had a pathological profile at rest, 20% during exercise, and 53% during ambulatory blood pressure measurement. ⋯ Since these processes yield very different answers they should be combined and evaluated critically for a proper assessment of the blood pressure situation and effective treatment. Ambulatory blood pressure measurement allows the recognition of round-the-clock behavior of blood pressure and of patients with 'occult' or 'white-coat' hypertension, and furthermore it helps to control the effectiveness of the treatment. It thus makes an essential contribution to the postoperative care of patients after surgical treatment of CoA.
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Thorac Cardiovasc Surg · Jun 1998
Case ReportsChronic herniation of the lung in a patient with chronic obstructive pulmonary disease. Case report and review of the literature.
Lung herniation is a rare condition and can be classified by both anatomical site and etiology. A 70-year-old man was referred with dyspnea, productive cough, and right-sided chest pain. ⋯ Two years after surgical repair the patient is free of complaints. Treatment can be conservative or surgical, but as experience is limited no long-term results have been reported.
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In contrast to its use in other surgical disciplines, intraoperative sonography has so far been of minor importance in thoracic surgery. The technique of intrathoracic, intraoperative, ultrasonic examination was applied in 85 patients with different indications: in 61 patients during thoracoscopy, in 24 patients during open thoracic surgery. 6 patients eventually underwent a combination of both procedures. In order to improve the intrathoracic maneuverability of the sonographic probe we developed an electrically controllable handle for the probe. ⋯ The sound frequency available so far for intraoperative application allows a safe distinction of non-infiltrating tumors from vascular structures; the reliable identification of an infiltration mostly requires a higher resolution. If our experiences are confirmed by further application of the method, explorative thoracotomies will surely be partly replaced by explorative thoracoscopic interventions. Ultrasonography has also proved to be useful in visualisation of mediastinal lymph-nodes and tumors, with the possibility of assessing their size.