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 2012
Case ReportsRight atrial thrombosis and pulmonary embolism after atrial septal defect repair.
A 3-year-old boy underwent surgical closure of a large ostium secundum atrial septal defect. This was complicated with extensive right atrial thrombus formation and pulmonary thromboembolism immediately following surgery. He was managed with emergency surgical thromboembolectomy and anticoagulation. ⋯ This prompted us to add thrombolysis to his treatment, but with no effect. He died on the fifth postoperative day. A postmortem study confirmed extensive thromboembolism.
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Eur J Cardiothorac Surg · Jan 2012
Assessment of a right-ventricular infundibulum-sparing approach in transatrial-transpulmonary repair of tetralogy of Fallot.
The study aimed to evaluate the outcome of transatrial-transpulmonary repair of tetralogy of Fallot in relation to a right-ventricular outflow tract (RVOT)-sparing surgery. ⋯ In a 15-year's experience with transatrial-transpulmonary correction of tetralogy of Fallot, a valve- and infundibulum-sparing approach has been advanced by lowering the age for elective repair. This change has been performed without compromising immediate clinical outcome, despite an increased early re-operation rate for residual obstruction. However, longer follow-up will disclose whether this approach is protective against progressive and late RV dysfunction.
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Eur J Cardiothorac Surg · Jan 2012
Mild-to-moderate hypothermia in aortic arch surgery using circulatory arrest: a change of paradigm?
Antegrade cerebral perfusion makes deep hypothermia non-essential for neuroprotection; therefore, there is a growing tendency to increase the body temperature during circulatory arrest with selective brain perfusion. However, very little is known about the clinical efficacy of mild-to-moderate hypothermia for ischemic organ protection during circulatory arrest. The aim of this study was to evaluate the safety and efficiency of mild-to-moderate hypothermia for lower-body protection during aortic arch surgery with circulatory arrest and antegrade cerebral perfusion. ⋯ Systemic mild-to-moderate hypothermia that is adapted to the duration of circulatory arrest is a simple, safe, and effective method of organ protection and can be recommended in routine aortic arch surgery with circulatory arrest and cerebral perfusion.
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Anti-platelet therapy with aspirin is the cornerstone of treatment after coronary artery bypass grafting (CABG). Aspirin resistance describes the clinical observation of the inability of aspirin to prevent thrombotic complications or the laboratory phenomenon of absence of the effect of aspirin on platelet inhibition tests. Off-pump CABG (OPCAB) is associated with reduced platelet activation and turnover compared to on-pump surgery which may indicate that aspirin is more effective after OPCAB. Our aim was to evaluate the efficacy of aspirin and incidence of aspirin resistance in patients undergoing OPCAB. ⋯ Aspirin resistance is a transient phenomenon during the early postoperative period in approximately 30% of patients undergoing OPCAB.
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Eur J Cardiothorac Surg · Jan 2012
Preoperative hemoglobin A1c predicts atrial fibrillation after off-pump coronary bypass surgery.
Diabetes mellitus has been recognized as a risk factor for mortality and morbidity after coronary bypass grafting, but a significant association between diabetes mellitus and postoperative atrial fibrillation (AF) has not been found. Although a recent study demonstrated a potential link between preoperative hemoglobin A1c level and risk of postoperative AF, there has not been sufficient examination of this relationship. We aimed to investigate the association between preoperative hemoglobin A1c and AF after isolated off-pump coronary bypass grafting. ⋯ Preoperative hemoglobin A1c independently predicts the occurrence of AF after isolated off-pump coronary bypass grafting.