The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Dec 2000
Case ReportsAbsence of hemodynamic and ECG changes in a patient with traumatic left ventricular injury and puncture of the left anterior descending branch.
Patients with penetrating cardiac injury usually present with cardiac tamponade and shock upon hospital arrival. However, absence of hemodynamic depression does not exclude a potentially fatal injury of the heart. This article reports on a patient who developed neither hemodynamic depression nor ECG changes for several hours, despite two left ventricular lacerations with puncture of the LAD. Echocardiography is advocated as the diagnostic tool of choice, and it is emphasized that no penetrating objects should be removed from the wound before surgical access to the heart is established, as this may result in the sudden development of cardiac tamponade.
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Thorac Cardiovasc Surg · Dec 2000
Role of electrophysiological studies and arrhythmia intervention in repairing Ebstein's anomaly.
Repairing Ebstein's anomaly without correction of associated arrhythmia may result in sudden death. Catheter or surgical ablation is indicated for various symptomatic tachyarrhythmias in Ebstein's anomaly. ⋯ We conclude that detailed preoperative electrophysiological evaluation in patients with Ebstein's anomaly is mandatory. Aggressive surgical intervention of the associated arrhythmias in addition to anatomic correction can reduce the sudden death in Ebstein's anomaly.
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Thorac Cardiovasc Surg · Oct 2000
Comparative StudyUncontrolled reoxygenation by initiating cardiopulmonary bypass is associated with higher protein S100 in cyanotic versus acyanotic patients.
The systemic reoxygenation injury produced by initiating cardiopulmonary bypass (CPB) in infants with cyanotic heart disease may be associated with cerebral dysfunction and injury. Increased protein S100 (S100) serum levels may indicate cerebral and blood brain barrier damage as well as inflammatory changes, therefore serving to quantify these changes. The present clinical study assessed S100 in cyanotic patients undergoing CPB with normoxic versus hyperoxic paO2 in acyanotic cases and in controls without CPB. ⋯ Uncontrolled hyperoxic reoxygenation on CPB for surgical correction of congenital heart defects is associated with higher S100 levels in cyanotic infants as compared to acyanotic patients undergoing comparable operations.
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Thorac Cardiovasc Surg · Oct 2000
Comparative StudyComplete arterial revascularization using T-graft technique in diabetics with coronary three-vessel disease.
Coronary revascularization using exclusively arterial grafts holds the promise of improved long-term patency. The T-graft approach achieves this goal with only two arterial grafts in coronary 3-vessel disease. Arterial grafts in diabetics, however, exhibit more frequently atherosclerotic wall abnormalities, and higher levels of endothelin-1 were found in diabetic arterial grafts, which may be associated with a higher incidence of vasoconstriction. The objective of this prospective study was to compare functional und angiographic parameters of arterial T-grafts in diabetics and nondiabetics. ⋯ Baseline parameters (graft diameter and quantitative graft flow), patency and CFR are identical in diabetics and non-diabetics. Our results suggest that diabetic patients with coronary 3-vessel disease take comparable profit from complete arterial revascularization using the T-graft technique as non-diabetics.
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Thorac Cardiovasc Surg · Oct 2000
Case ReportsRe-opened foramen ovale--a rare cause of postoperative dyspnea following pneumonectomy.
Dyspnea and hypoxemia are common postoperative problems following pneumonectomy. Platypnea, the increased dyspnea in the erect position relieved by assuming a prone position, has been reported as a result of right to left inter-atrial shunt. ⋯ Given the rarity of the diagnosis, we think interatrial shunt, based on an open foramen ovale, should be taken into consideration when platypnea occurs in patients as a postoperative complication following lung surgery. Transesophageal echocardiography may be helpful in detecting patients with "anatomical closed but functional open" foramen ovale or genuine inter-atrial septal defect prior to lung surgery.