European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Aug 2001
Usefulness of vacuum-assisted cardiopulmonary bypass circuit for pediatric open-heart surgery in reducing homologous blood transfusion.
Open-heart surgery without homologous blood transfusion is still difficult in children because priming volume in cardiopulmonary bypass circuit results in extreme hemodilution. Vacuum-assisted cardiopulmonary bypass circuit has the benefit of improving venous return and results in lowering priming volume. We introduced vacuum-assisted cardiopulmonary bypass circuit in order to reduce priming volume for pediatric patients in March 1995. A retrospective study was made on the efficacy of vacuum-assisted circuit for pediatric open-heart surgery in reducing homologous blood transfusion. ⋯ The findings of this study indicate that vacuum-assisted circuit is useful for pediatric open-heart surgery in reducing homologous blood transfusion.
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Eur J Cardiothorac Surg · Aug 2001
Is there still a place for open surgical valvotomy in the management of aortic stenosis in children? The view from Southampton.
The most appropriate management of aortic stenosis (AS) in children remains controversial. The purpose of this study was to determine the outcome following open valvotomy for AS in children. ⋯ Open valvotomy remains the gold standard in the management of AS in neonates, infants and older children. It is associated with low operative mortality and provides lengthy freedom from recurrent AS and regurgitation. Re-operations are common but if AVR is required, implantation of an adult-sized prosthesis is usually possible. There is a late death-hazard for those with severe associated lesions, but the survival prospects for the patients with isolated AS are excellent.
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Eur J Cardiothorac Surg · Jul 2001
Review Case ReportsPapillary muscle rupture and pericardial injuries after blunt chest trauma.
Non-penetrating cardiac trauma resulting in mitral valve rupture is uncommon, requiring a high degree of suspicion for diagnosis. Sudden and severe mitral regurgitation, unless surgically corrected rapidly lead to congestive heart failure and death. We report a patient with traumatic rupture of the antero-lateral papillary muscle of the mitral valve and pericardial injury, after a lateral blunt chest trauma, who successfully underwent emergency mitral valve replacement.
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Patients with an acute major airway injury are coming at our attention with increasing frequency. Despite of its nature, post-traumatic or iatrogenic, these lesions may be life-threatening. An early diagnosis and a prompt treatment reduce morbidity and mortality. ⋯ Early diagnosis and surgical repair are the goals to persecute to achieve the best outcomes in this potentially lethal lesions. The surgical approach should be the thoracotomy if the trauma involves the 1/3 inferior trachea and/or a mainstem, the cervicotomy in the case it was injured the 2/3 superior trachea and the larynx. Posterior tracheal wall tears may be repaired via the new transcervical/transtracheal technique. The conservative treatment should be reserved to those patients with minimal signs and symptoms, and with an adequate patency of the airways.
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Eur J Cardiothorac Surg · Jul 2001
Case ReportsEsophageal perforation: life threatening complication of endotracheal intubation.
To raise awareness of this complication of tracheal intubation, to emphasize the gravity due to delayed diagnosis, and to advocate a surgical treatment. ⋯ Post intubation esophageal perforation is one of the most life threatening esophageal perforation. Delayed diagnosis is the first cause of gravity. Prevention of this complication begins with recognition of a potentially difficult intubation. Good outcome follows from rapid diagnosis and early surgical treatment.