The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Oct 1999
Randomized Controlled Trial Clinical TrialHemostasis management by use of Hepcon/HMS: increased bleeding without increased need for blood transfusion.
Extracorporeal circulation forces complete anticoagulation, most frequently achieved by complete heparinization. Activated clotting time (ACT) is the gold standard for monitoring, although there is a lack of correlation between heparin plasma level and ACT. Several systems for the estimation of free heparin have been developed: in this study we focused investigating on the influence of the Hepcon/HMS system on postoperative bleeding and transfusion requirements. ⋯ Use of the Hepcon/HMS-system for monitoring of heparinization during extracorporeal circulation is possible without increased risk of thromboembolism. Postoperative blood loss was slightly but significantly increased but there was no need for more heterogenous transfusion.
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Thorac Cardiovasc Surg · Aug 1999
ReviewCatheter ablation of pulmonary vein foci for atrial fibrillation: PV foci ablation for atrial fibrillation.
While experimental and human mapping studies have documented multiple wavelet reentry as the electrophysiological mechanism maintaining atrial fibrillation, recent evidence shows that nearly all paroxysms of atrial fibrillation are initiated by trains of rapid discharges from the pulmonary veins. Radiofrequency catheter ablation targeting these initiating triggers has resulted in an overall 69% freedom from atrial fibrillation at a follow-up of 8 +/- 4 months in a population of 110 patients with paroxysmal atrial fibrillation. Six of the targeted pulmonary veins (4%) developed pulmonary vein stenosis; none requiring specific treatment. Catheter ablation of pulmonary vein foci initiating atrial fibrillation is therefore an effective curative modality for paroxysmal atrial fibrillation.
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Thorac Cardiovasc Surg · Aug 1999
Case ReportsValue of video-assisted thoracic surgery in traumatic extrapleural hematoma.
The current article reports on a rare case recently experienced, in which a medially displaced extrapleural fat layer with parietal pleura, revealed by CT scan of the chest, was a sign of traumatic extrapleural hematoma. Video-assisted thoracic surgery was not suited to approaching and managing the extrapleural hematoma, so that a limited thoracotomy was mandatory. Extrapleural hematoma should be considered a relative major contraindication to video-assisted thoracic surgery.
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Thorac Cardiovasc Surg · Aug 1999
Time-dependent efficacy of initial reperfusion with 2,3 butanedione monoxime (BDM) on release of cytosolic enzymes and ultrastructural damage in isolated hearts.
Reperfusion injury after cardioplegia may not be sufficiently addressed by conventional cardioplegic techniques in open heart surgery. 2,3-butanedione monoxime (BDM) has the potential to reduce myocardial reperfusion injury by uncoupling myocyte contraction from the intracellular calcium concentration, thus reducing reperfusion contracture. The aim of this study was to investigate the effects of different application periods of BDM during initial reperfusion on myocardial tissue injury after cardioplegia. ⋯ Both 20 and 40 min of initial reperfusion effectively protected the hearts from reperfusion damage as indicated by cytosolic enzyme release, while 5 min of treatment were clearly insufficient. Toxic effects of BDM during the longer treatment period of 40 min or induction of edema by the long-term perfusion of non-beating hearts in this group may account for the worse preservation of myocardial ultrastructure in BDM-40 hearts. Thus, contraction uncoupling during initial reperfusion by BDM or similarly acting drugs may prove a viable principle for reduction of myocardial reperfusion injury. However, the ideal duration of treatment for the best therapeutic effect must be carefully evaluated.
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Thorac Cardiovasc Surg · Apr 1999
Case ReportsMinimally invasive extirpation of a left-ventricular myxoma.
As myxomas usually are benign neoplasms a minimally invasive technique would be an interesting alternative for their extirpation because the surgical trauma is reduced. In one male patient with a diagnosed left-ventricular myxoma minimally invasive surgery was carried out using the Port-Access method. 2D echocardiography, EBT, and MRI were performed preoperatively to obtain exact information about topography, calcifications, and malignity. ⋯ Histopathological examination revealed a cardiac myxoma extirpated in toto. At one-year follow-up there was no recurrence of the tumor.