The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Apr 1994
Review Case ReportsAnomalous origin of the right coronary artery from the pulmonary artery.
Isolated anomalous origin of the right coronary artery (RCA) is a very rare congenital malformation. The case of a 15-month-old boy with anomalous origin of the RCA from the pulmonary artery is presented. The RCA was reimplanted into the aorta. The anatomical correction was uneventful and its success demonstrates that diagnosis and surgical correction are possible at a very young age.
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Thorac Cardiovasc Surg · Feb 1994
Case ReportsFalse aneurysm of the ascending aorta with fistula to the right atrium. Noninvasive diagnosis by computed tomographic scan and two-dimensional echocardiography with successful repair.
A 57-year-old Japanese man presented with symptoms of congestive heart failure 9 years after aortic valve replacement. On auscultation, a continuous murmur was heard at the left lower sternal border. Chest radiograph showed moderate cardiomegaly and a widened upper mediastinum. ⋯ The fistula was closed with pledgeted sutures, and the ascending aorta was replaced with a collagen-coated double woven velour dacron graft. The patient recovered uneventfully. Computed tomographic scan and two-dimensional echocardiography are complementary techniques for reliable non-invasive assessment of the complexity of an aortic aneurysm.
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Thorac Cardiovasc Surg · Feb 1994
Comparative StudyContinuous thermodilution measurement of cardiac output: in-vitro and in-vivo evaluation.
The current study was designed to evaluate a method for continuous measurement of cardiac output. The system consists of a modified pulmonary artery catheter that uses the thermodilution principle for determination of cardiac output. The evaluation was performed in vitro and in vivo. ⋯ The results from this study suggest that the new continuous thermodilution measurement system for cardiac output provides accurate data in vitro and in vivo. Continuous monitoring of cardiac output adds a new dimension for evaluation of the patient's hemodynamic profile. Furthermore, significant volume load due to bolus thermodilution measurements can be avoided.
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Thorac Cardiovasc Surg · Oct 1993
Comparative StudyCoronary artery resistance and oxygen uptake during reperfusion: is there any difference between warm and cold cardioplegia?
To evaluate the effects of warm continuous versus cold intermittent blood cardioplegia on coronary blood flow patterns after prolonged cardioplegic arrest, nine pigs underwent cardiopulmonary bypass with 210 minutes of aortic cross-clamping. Antegrade blood cardioplegia was administered either cold intermittent (n = 4) or warm continuous (n = 5). During the first 30 minutes of reperfusion, there was decreased coronary blood flow with higher coronary vascular resistance in the cold group (mean +/- standard error; warm vs. cold: 30 min: flow: left anterior descending artery (LAD): 66 +/- 6 vs 36 +/- 4 ml/min, right coronary artery (RCA): 88 +/- 2 vs 61 +/- 4, p < 0.05, resistance: LAD: 33 +/- 3 vs 69 +/- 5 dyn.s.cm-5 x 10(3), RCA: 41 +/- 3 vs 58 +/- 8, p < 0.05). ⋯ Arterio-venous oxygen difference was higher in the cold group after 15 min (3.1 +/- 0.5 vs 4.8 +/- 0.3 ml O2/100 ml, p < 0.05) and 30 min (4.2 +/- 0.5 vs 6.2 +/- 0.7, p < 0.05) with equal values after 1 hour. During reperfusion there is reduced myocardial blood flow after cold intermittent blood cardioplegia. This may reflect superior myocardial protection with warm continuous cardioplegia.
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Thorac Cardiovasc Surg · Oct 1993
Protection of the ischemic immature heart--effect of perfusate reinfusion and composition.
We determined the influence of perfusate composition and reinfusion during ischemia upon myocardial protection in the immature rabbit heart. Isolated "working" hearts (n = 6 per group) from 7-10-day-old New Zealand White rabbits were perfused with Krebs bicarbonate buffer and function measured. Hearts were then arrested with 3 minutes cold (14 degrees C) perfusion with bicarbonate buffer (as hypothermia-alone group) or St. ⋯ There were no differences in post-ischemic creatine kinase leakage or myocardial water content between groups. These results suggest (i) that reinfusion itself, regardless of the composition of the perfusate, caused decreased recovery of function after an extended period of ischemia, and (ii) protection of the ischemic immature heart with St. Thomas' II solution remains inadequate and requires improvement.