European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
-
Eur J Cardiothorac Surg · Jul 2005
Multicenter StudyDoes size matter? Larger Blalock-Taussig shunt in the modified Norwood operation correlates with better hemodynamics.
Excess pulmonary to systemic blood flow ratio (Qp/Qs) correlates with hemodynamic instability and mortality after modified Norwood operation. Studies suggest that maximal oxygen delivery occurs at a Qp/Qs of around 1. The use of a rather small modified Blalock-Taussig shunt (MBTS) is believed to achieve this goal. However, optimal MBTS size with respect to postoperative hemodynamics remains unclear. ⋯ Monitoring of the central venous oxygen saturations and application of afterload reduction in cases of high Qp/Qs allows the insertion of a larger MBTS without association with lower oxygen delivery. In fact, better hemodynamic status with less inotropic support was noted with a larger MBTS early after Norwood operation.
-
Eur J Cardiothorac Surg · Jul 2005
Thoracic epidural anesthesia does not improve the incidence of arrhythmias after transthoracic esophagectomy.
The incidence of arrhythmias related to an esophagectomy is high, and its clinical significance has been well accepted. Thoracic epidural anesthesia (TEA) can modulate the sympathetic tone and neuroendocrine responses associated with major operation. This study was aimed to evaluate the effects of TEA on the incidence of arrhythmias in transthoracic esophagectomy patients. ⋯ This result shows that TEA was not beneficial to reduce the incidence of arrhythmias in the transthoracic esophagectomy patients.
-
Eur J Cardiothorac Surg · Jul 2005
Can chest ultrasonography assess pleurodesis after VATS for spontaneous pneumothorax?
Thoracic echography easily detects the sign of 'pleural sliding', due to the movement of the visceral pleura on the parietal pleura. This sign is absent when pleurodesis is present. This study was designed to test thoracic echography in the assessment of difference in pleurodesis obtained after abrasion or pleurectomy performed for spontaneous pneumothorax, mainly based on the presence or absence of the 'pleural sliding' sign. ⋯ Thoracic echography for the postoperative evaluation of pleurodesis is feasible and simple. An ideal pleurodesis is more likely after pleurectomy than after pleural abrasion. Areas of persisting pleural sliding are probably at risk of recurrence.
-
Eur J Cardiothorac Surg · Jul 2005
Case ReportsUse of the Arndt wire-guided endobronchial blocker via nasal for one-lung ventilation in patient with anticipated restricted mouth opening for esophagectomy.
Functional separation of the lungs may be accomplished by several methods. Patient with restricted mouth opening has limited options for one-lung ventilation. We report the use of wire-guided endobronchial blockade, a new tool for achieving one-lung ventilation in a patient with restricted mouth opening requiring nasotracheal, fiberoptic intubation for esophagectomy and reconstruction with gastric tube substitution.
-
Eur J Cardiothorac Surg · Jul 2005
Antiphospholipid syndrome in cardiac surgery-an underestimated coagulation disorder?
Antiphospholipid syndrome (APS) is a rare coagulation disorder associated with recurrent arterial and venous thrombotic events. We analysed our experience with five APS patients who underwent cardiac surgery. In three of them the diagnosis of APS had been established before surgery, two patients were diagnosed after surgery. ⋯ Patients with APS undergoing cardiac surgery belong to a high risk subgroup. Thus, though rare, APS can be a critical issue in cardiac surgery. Some of the cardiac patients with unexplained perioperative thromboembolic complications, such as graft occlusion, may turn out to have an undiagnosed APS.