European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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This review discusses the phenomenon of ischaemic preconditioning and its potential application to cardiac surgery. The biology of ischaemic preconditioning is explained and the more limited evidence suggesting that the human heart can be preconditioned is discussed. ⋯ Preconditioning is a powerful and reproducible method of protecting the myocardium from irreversible ischaemic injury. There is now evidence indicating that the human heart can be preconditioned. However, more trials are necessary in patients undergoing cardiac surgery before the role of preconditioning as a means of myocardial protection can be assessed.
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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
Comparative StudySurgery for ruptured thoracic and thoraco-abdominal aortic aneurysms.
To assess the outcome of patients with ruptured descending thoracic and thoracoabdominal aortic aneurysms undergoing emergency repair, in comparison to elective surgery for chronic lesions. ⋯ Emergency repair of ruptured descending thoracic and thoracoabdominal aortic aneurysms can be achieved with acceptable results.
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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%.