Heart and vessels
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The human aorta is a curved conduit with a complex three-dimensional geometry. The curvature influences axial velocity distribution and introduces transverse velocity components. Rotational flow in the aorta can be demonstrated during normal pulsatile flow using transesophageal echocardiography. ⋯ The geometry of the aorta, which is fairly constant in all patients, imposes handedness to aortic flow before cardiopulmonary bypass. However, during cardiopulmonary bypass, other extrinsic factors such as aortic cannula orientation may influence the direction of rotation. The change in direction of rotational flow and increase in its transverse velocity component during cardiopulmonary bypass may have implications for atheroembolism and arterial branch perfusion during extended periods of non-pulsatile flow.
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Prolonged mechanical ventilation increases hospitalization costs, airway and lung trauma, and stress. The objective of this study was to elucidate patient characteristics and operative variables that predict delayed extubation in patients undergoing coronary artery bypass grafting (CABG). The records of 167 patients who underwent CABG between 1994 and 1998 were examined retrospectively. ⋯ Excellent prediction was provided by a model consisting of six variables: age, duration of surgery, perioperative heart failure, glucose level, postoperative transfusion, and the PaO2/FiO2 ratio. These results suggest that decreasing the cardiopulmonary bypass time, maintaining a low glucose level during cardiopulmonary bypass, and ensuring adequate perioperative hemostasis may help to avoid pulmonary dysfunction and delayed extubation. Moreover, the PaO2/FiO2 ratio may be a useful predictor of delayed extubation in patients undergoing CABG.
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Clinical Trial
Strategies for CABG patients with carotid artery disease and perioperative neurological complications.
Postoperative neurological complications not only increase morbidity and mortality, but also prolong hospital stay and elevate hospital costs. From 1995, carotid artery duplex scanning (CADS) has been performed in our hospital as screening for cerebrovascular disease in patients undergoing nonemergency coronary artery bypass grafting (CABG). This study was designed to evaluate the usefulness of our strategy for preventing stroke during CABG. ⋯ Three patients who underwent the combined CEA/CABG procedure did not suffer from any neurological complications. Preoperative screening by CADS is helpful for evaluating the presence of carotid artery disease in patients undergoing CABG. Further investigations to clarify the carotid hemodynamics are important, and synthetic assessment will be required to determine the most appropriate operative strategy.
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Color M-mode Doppler echocardiography (CMD) has been utilized in assessing left ventricular (LV) filling dynamics. We tested a novel CMD index, the depth of the spatiotemporal maximum of early diastolic inflow (D-maxV) in the left ventricle, to clarify its significance in assessing LV diastolic function. In 26 normal subjects and 32 patients with ischemic heart disease, D-maxV was determined with CMD as the distance from the mitral valve opening point to the center of the aliasing area in early diastole. ⋯ Moreover, Kaplan-Meier analysis focusing on the patients with myocardial infarction revealed that the group with D-maxV < 10.4 mm (n = 13) exhibited a lower cumulative cardiac event-free rate than that with D-maxV > or = 10.4mm (n = 14) (49.4% vs 92.9% at 5 years, P < 0.05). The depth of the spatiotemporal maximum of early diastolic LV inflow velocity reflects LV relaxation and is free of pseudonormalization. Evaluation of the LV relaxation separately from preload may have a prognostic value for myocardial infarction.
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Case Reports
Isolated periarteritis nodosa of the spermatic cord presenting as a scrotal mass: report of a case.
We report a 57-year-old man who visited a local hospital because of a fist-sized swelling and pain in his right scrotum. Surgically resected tissue revealed necrotizing arteritis in a small spermatic artery. As systemic symptoms for angiitis were not present, this is thought to be the second case of isolated angiitis occurring in the spermatic cord.