The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Aug 1986
Performance of the Ionescu-Shiley pericardial valve in the aortic position: 100 months clinical experience.
From August 1977 through August 1984, 239 patients underwent aortic valve replacement (AVR) with the Ionescu-Shiley pericardial valve. Isolated AVR was performed in 112 patients and associated cardiac surgery in 127 patients (53.1%). One hundred twenty-eight patients were males and 111 females, with an average age of 50.6 years (range 15 to 78 years). ⋯ Twenty-five patients required reoperation (2.79% per patient-year): 6 for infective endocarditis, 3 for paravalvular leak, one for valve thrombosis, 3 for another valve explantation, and 12 for primary tissue failure (1.3% per patient-year). In conclusion, the Ionescu-Shiley valve has a satisfactory performance in the aortic position at long-term follow-up. In our experience, the higher rate of postoperative complications occurred among patients with concomitant cardiac surgery, so not necessarily related to this pericardial valve.
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Thorac Cardiovasc Surg · Jun 1986
Randomized Controlled Trial Clinical TrialA qualitative analysis of pulsatile perfusion: effects on cortisol response to cardiopulmonary bypass surgery.
Continuous analysis of pressure waveform has enabled quantitative assessment of pulsatile perfusion in a series of 51 patients randomly allocated to "pulsatile" (N = 37) and "non-pulsatile" (N = 14) groups. Cortisol and hematocrit (PCV) were measured preoperatively, at 2 minutes and 30 minutes after the start of bypass and just prior to the end of bypass. ⋯ Multiple regression analysis of cortisol and change in cortisol with pulse pressure dp/dt and mean arterial pressure failed to show any correlation. We found a normal cortisol response to surgery irrespective of the quality of pulsation.
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Thorac Cardiovasc Surg · Apr 1986
The influence of extracorporeal circulation on extravascular lung water in coronary surgery patients.
The influence of extracorporeal circulation (ECC) on extravascular lung water (EVLW) was investigated in a total of 45 consenting patients undergoing coronary artery bypass surgery. The patients were subdivided into 3 groups according to positive fluid balance during ECC: 1. less than 500 ml; 2. 500 to 1500 ml; 3. 1500 to 3000 ml. ⋯ Extravascular lung water increase was accompanied by a deterioration of pulmonary gas exchange demonstrated by the greatest decrease of paO2 in group 3 (490 mmHg----243 mmHg). No significant relationship of lung water changes to various hemodynamic parameters was observed in this study.
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Thorac Cardiovasc Surg · Oct 1985
Case ReportsPulmonary arteriovenous fistula in association with recurrent cerebral abscess.
Cerebral abscess secondary to a pulmonary arteriovenous malformation is rare, but a definite entity. A case is reported of a woman treated for a cerebral abscess on 2 separate occasions, where a right lower lobectomy and removal of a pulmonary arteriovenous fistula has resulted in cure.
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Thorac Cardiovasc Surg · Aug 1985
Hemodynamic changes during mechanical ventilation in infants and small children after open heart surgery.
The study was undertaken to clarify the hemodynamic effects of intermittent positive pressure ventilation (IPPV) and intermittent mandatory ventilation (IMV) with variation of the positive end-expiratory pressure (PEEP) from 5 to 15 mbar. The cardiac index (CI) was measured with thermodilation techniques in 30 infants who underwent open-heart surgery with extracorporeal circulation for various congenital heart lesions. The age of the patients varied from 6 to 28 months and body weight from 4 to 15 kg. ⋯ The oxygen consumption (VO2) did not change significantly (135 ml.min-1.m-2 to 128 l.min-1.m-2, p greater than 0.5). A positive end-expiratory pressure exceeding 5 mbar caused a decrease of intrapulmonary veno-arterial blood shunting (QS/QT) from 12.3 to 7.1%; p less than 0.01), while PEEP at the level of 5 mbar did not affect this parameter. The alveolo-arterial oxygen gradient (AsDO2) also decreased from 182 to 135 torr (p less than 0.01) when PEEP was 10 and 15 mbar.(ABSTRACT TRUNCATED AT 250 WORDS)