European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jan 1996
Case ReportsMultilevel somatosensory evoked potentials (SEPs) for spinal cord monitoring in descending thoracic and thoraco-abdominal aortic surgery.
The usefulness of somatosensory evoked potential (SEP) monitoring as a means of preventing paraplegia in descending aorta surgery was evaluated in 47 consecutive cases operated on for isthmic (14 cases), thoracic (22 cases), or thoraco-abdominal (11 cases) repair. An aortic dissection was found in 11 cases (acute in 6). Somatosensory evoked potentials were obtained by unilateral left and right posterior tibial nerve (PTN) stimulation at the ankle and recordings were performed on four channels: peripheral nerve, lumbar spinal, brain-stem, and cortical recordings. ⋯ Somatosensory evoked potential specificity was also 100%, but only 58% of the abnormalities found were actually consequent to spinal cord ischemia, the rest of the abnormalities being consequent to peripheral nerve or brain ischemia. Finally, SEP monitoring had a significant impact on surgical strategy in 19% of the cases. It is concluded that distal aortic perfusion and multilevel SEP monitoring play a significant role in preventing paraplegia in descending aorta surgery.
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Eur J Cardiothorac Surg · Jan 1996
Case ReportsLeft ventricular false aneurysm after previous repair of acquired ventricular septal defect.
We report a novel case of a 69-year-old woman who was treated surgically for a postinfarction inferior ventricular septal defect and presented 3 years postoperatively with a large left ventricular false aneurysm. This was successfully repaired.
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Eur J Cardiothorac Surg · Jan 1996
Upper and lower extremity somatosensory evoked potential recording during surgery for aneurysms of the descending thoracic aorta.
Since tibial nerve somatosensory evoked potentials (SEPs) recording is influenced by hemodynamic changes and anesthetics, alterations cannot always be attributed to spinal cord ischemia, so causing false positive results. Additional recording of median nerve SEPs facilitates interpretation. From January 1988 to July 1993, 60 consecutive patients (44 men, 16 women, mean age 66 years, ranging from 26 to 83 years) underwent surgery for an aneurysm of the descending thoracic aorta using a non-heparinized left heart bypass (Biomedicus pump). ⋯ In two patients (5%) isolated loss of the tibial nerve SEP was due to ischemia in the spinal pathway of the tibial nerve. The tibial nerve SEP signal returned to normal: in one patient after reperfusion of intercostal arteries localized within the aneurysm, in the other patient after drainage of cerebrospinal fluid (CSF). Continuous recording of both tibial and median nerve SEPs gives consistent information on spinal cord ischemia, reducing the false positive rate of the lower extremity SEP to 7.5%.
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Eur J Cardiothorac Surg · Jan 1996
Surgery for aortic dissection with intimal tear in the transverse aortic arch.
This study reports surgical experience of 72 cases of aortic dissection with intimal tear in the transverse aortic arch. ⋯ Early and late surgical result for arch dissection was satisfactory with a surgical principle of resecting the aortic segment that contains the initial intimal tear and graft replacement.
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Eur J Cardiothorac Surg · Jan 1996
Pharyngo-oesophageal dysphagia: surgery based on clinical and manometric data.
High or pharyngo-oesophageal dysphagia (PD) is defined as difficulty in initiating the act of swallowing within 1s. It involves the mechanisms controlling the tongue, pharynx and upper oesophageal sphincter (UOS) and is associated with a wide variety of local, neurologic and muscular disorders, and can also occur after surgery in the area and in response to gastro-oesophageal reflux (GOR). Our study aims at defining the criteria for surgery in PD and to evaluate the clinical results of such treatment. ⋯ In conclusion, pharyngo-oesophageal motility measurement is mandatory in PD, especially when a diverticulum is absent. Cricopharyngeal myotomy with or without diverticulectomy as indicated produces excellent results. Associated oesophageal problems have to be dealt with appropriately.