European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Apr 2009
ReviewManagement strategies for interrupted aortic arch with associated anomalies.
Interrupted aortic arch (IAA) is characterised by a lack of luminal continuity between the ascending and descending thoracic aorta. It represents a critical ductus dependent congenital heart disease, which without surgery is associated with high mortality in the neonatal period. ⋯ Long-term morbidity and need for repeated interventions are areas of concern. It is difficult to make generalised recommendations based on this literature review as complex associated anomalies often require individualised management strategy.
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Eur J Cardiothorac Surg · Apr 2009
Analysis of collateral blood flow to the lower body during selective cerebral perfusion: is three-vessel perfusion better than two-vessel perfusion?
During selective cerebral perfusion (SCP), only the upper body is perfused. However, blood actually returns into the descending aorta through collaterals during SCP. This collateral blood flow (CBF) is thought to be important to protect the visceral organs and spinal cord from ischemia. The left subclavian artery is postulated to be important as a collateral source to the lower body. Therefore, we measured CBF and examined whether a perfusion technique (three- or two-vessel perfusion) affects CBF to the lower body during SCP. ⋯ Visceral organs were perfused to some extent through collaterals and protected from ischemia during SCP. Left subclavian arterial perfusion enabled significant CBF to the lower body. Considering this CBF, three-vessel perfusion appears to be better than two-vessel perfusion during SCP; however, the choice of perfusion technique may not be so important under conditions of hypothermia because the difference in CBF between the two methods was small.
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Eur J Cardiothorac Surg · Apr 2009
Assessment of hepatosplanchnic pathophysiology during thoracoabdominal aortic aneurysm repair using visceral perfusion and shunt.
Despite the recognition of importance to avoid visceral ischemia during thoracoabdominal aortic aneurysm (TAAA) repair, the methodology of visceral perfusion seems still controversial and its pathophysiology has not been clearly understood. We investigated hepatosplanchnic metabolism during visceral perfusion/shunt in TAAA repair. ⋯ Visceral perfusion/shunt in TAAA repair may avoid critical irreversible hepatosplanchnic ischemia but provide unphysiological blood flow to the liver and thus should be shortened.
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Eur J Cardiothorac Surg · Apr 2009
Results of percutaneous and transapical transcatheter aortic valve implantation performed by a surgical team.
Transcatheter aortic valve implantation has been performed by several groups, most of them either specializing on the transapical (surgeons) or the percutaneous femoral transarterial approach (cardiologists). We achieved both transapical and percutaneous transcatheter valve implantation by a surgical team in a hybrid suite. ⋯ Transcatheter aortic valve implantation has become an alternative technique for the treatment of aortic stenosis with reasonable short- and mid-term results at our institution. With the opportunity to treat aortic stenosis by conventional surgical valve replacement and transapical and percutaneous transcatheter procedures, the technique of lowest risk for the individual patient can be chosen and performed by one team.
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Eur J Cardiothorac Surg · Apr 2009
The effect of hypothermia on neuronal viability following cardiopulmonary bypass and circulatory arrest in newborn piglets.
To determine the effect of recovery with mild hypothermia after cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) on the activity of selected key proteins involved in initiation (Bax, Caspase-3) or inhibition of apoptotic injury (Bcl-2, increased ratio Bcl-2/Bax) in the brain of newborn piglets. ⋯ In neonatal piglet model of cardiopulmonary bypass with circulatory arrest, mild hypothermia during post bypass recovery provides significant protection from cellular apoptosis, as indicated by lower expression of Bax and Caspase-3 and an increased Bcl-2/Bax ratio. The biggest protection was observed in striatum probably by decreasing of neurotoxicity of striatal dopamine.