The Thoracic and cardiovascular surgeon
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A case report is described of a 33-years-old male who suffered a bullet pulmonary embolus following an abdominal gunshot injury. The literature of this rare occurrence is discussed together with the role of surgery in its treatment. Operative removal is advocated in all cases and the optimal time for removal is 1-2 weeks following the initial embolus to allow pulmonary induration, which can prevent peroperative embolus migration.
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Thorac Cardiovasc Surg · Dec 1991
The arterial switch-operation: early and midterm (6 years) results with particular reference to technical problems.
Since February 1985 the arterial switch operation (ASO) has become the surgical treatment of choice for newborns with simple TGA, appropriate forms of complex TGA and double outlet right ventricle (DORV) as well at our institution. Between 1985 and 1990 a total of 87 patients underwent surgery. In 60 patients with simple TGA and 8 patients with complex TGA or DORV, respectively, an arterial switch-operation was performed. ⋯ Late after surgery there was one death due to chylothorax after thrombotic obstruction of the SVC, and 3 more deaths secondary to intraoperative infarct, progressive LV dysfunction and meningitis, respectively. Among the long-term survivors 2 patients developed a severe supravalvulary pulmonary stenosis. There were no significant arrhythmias, supravalvulary pulmonary aortic stenoses, aortic insufficiency or myocardial perfusion disturbances.(ABSTRACT TRUNCATED AT 250 WORDS)
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Thorac Cardiovasc Surg · Dec 1991
The arterial switch repair and the obstructive right ventricular outflow tract: does it matter?
Right ventricular outflow tract obstruction (RVOTO) was resected in 5 of 78 neonates (6.4%) with complete transposition of the great arteries (TGA) and in 10 of 26 neonates and infants (38.5%) with double outlet right ventricle (DORV) or TGA associated with ventricular septal defect (VSD). The early mortality in the combined series was 7.7%. ⋯ Sizing of the RVOT and the aortic valve annulus should confirm the diagnosis and establish the indication for resection. Right ventricular outflow tract obstruction is important for the outcome of arterial switch operation (ASO) in neonates and infants with simple and complex TGA: if subaortic obstruction is anticipated and properly dealt with, the surgical risk of anatomic correction is not increased.
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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)
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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.