European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jul 2006
The influence of positive end-expiratory pressure on stroke volume variation and central blood volume during open and closed chest conditions.
Intermittent positive pressure ventilation and positive end-expiratory pressure (PEEP) affect cardiac preload. Their effect is dependent on chest wall compliance. This study compares the effects of intermittent positive pressure ventilation and PEEP on stroke volume variation and central blood volume during open and closed chest conditions. ⋯ We conclude that PEEP increases right and left ventricular stroke volume variation both during open and closed chest conditions. The concomitant reduction of right ventricular end-diastolic volume further indicates that PEEP has a preload reductive effect during open chest conditions, too.
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Eur J Cardiothorac Surg · Jul 2006
Psychotic symptoms in patients undergoing coronary artery bypass grafting and heart valve operation.
Delirium on internal medicine and surgical wards of the general hospital is associated with several predisposing and precipitating factors as well as adverse outcomes. Whether psychosis, the symptom of delirium that may be recognized most promptly, is similarly associated with these factors and outcomes is largely unknown. ⋯ Psychotic symptoms are independently associated with several chronic and peroperative problems (including mild hypothermia during surgery), closely resembling those for delirium (with and without psychotic symptoms). Psychotic symptoms are also independently associated with adverse outcomes. Prompt diagnostic and therapeutic intervention aimed at the underlying problem may improve outcomes.
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Eur J Cardiothorac Surg · Jul 2006
Effects of basic fibroblast growth factor microspheres on angiogenesis in ischemic myocardium and cardiac function: analysis with dobutamine cardiovascular magnetic resonance tagging.
Therapeutic angiogenesis with angiogenic growth factors has described as one of the promising methods for collateral formation in the treatment of ischemic heart diseases. The purpose of this study is to assess the value of intramyocardial injection of slow-released basic fibroblast growth factor microspheres on angiogenesis and cardiac function in the early period of acute infarcted myocardium with dobutamine cardiovascular magnetic resonance tagging. ⋯ Intramyocardial administration of basic fibroblast growth factor microspheres can promote the growth of microvessels and improve left ventricular function and myocardial viability in the early period of acute myocardial infarction.
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Eur J Cardiothorac Surg · Jun 2006
Multicenter StudyEffect of risk-adjusted, non-dialysis-dependent renal dysfunction on mortality and morbidity following coronary artery bypass surgery: a multi-centre study.
As little is known about the impact of non-dialysis-dependent renal dysfunction on short- and mid-term outcomes following coronary surgery we have conducted a large multi-centre study comparing patients with no history of renal dysfunction to those with preoperative renal dysfunction. ⋯ Patients undergoing coronary surgery with non-dialysis-dependent renal dysfunction have significantly increased perioperative morbidity and mortality. Mid-term survival is also significantly reduced at 5-years.
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Eur J Cardiothorac Surg · Jun 2006
Randomized Controlled Trial Comparative StudyComparative hemodynamic effects of vasopressin and norepinephrine after milrinone-induced hypotension in off-pump coronary artery bypass surgical patients.
Phosphodiesterase inhibitor is essential to the pharmacologic management of decompensated heart failure because it increases contractility and decreases afterload of right ventricle. It also improves hemodynamics and increases blood flow of the grafted internal mammary arteries and middle cerebral arteries during coronary artery bypass surgery. However, it induces vasodilation and necessitates the use of vasoconstrictors, such as norepinephrine. We hypothesized that vasopressin could recover hypotension induced by milrinone with less effect on pulmonary vascular resistance (PVR) compared to norepinephrine. ⋯ In the patients undergoing CABG surgery, both norepinephrine and low dose vasopressin were effective in restoring milrinone-induced decrease of SVR. However, only low-dose vasopressin decreased the PVR/SVR ratio that was increased by milrinone. Considering the importance of maintaining systemic perfusion pressure as well as reducing right heart afterload, milrinone-vasopressin may provide better hemodynamics than milrinone-norephinephrine during the management of right heart failure.