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 1996
Upper and lower extremity somatosensory evoked potential recording during surgery for aneurysms of the descending thoracic aorta.
Since tibial nerve somatosensory evoked potentials (SEPs) recording is influenced by hemodynamic changes and anesthetics, alterations cannot always be attributed to spinal cord ischemia, so causing false positive results. Additional recording of median nerve SEPs facilitates interpretation. From January 1988 to July 1993, 60 consecutive patients (44 men, 16 women, mean age 66 years, ranging from 26 to 83 years) underwent surgery for an aneurysm of the descending thoracic aorta using a non-heparinized left heart bypass (Biomedicus pump). ⋯ In two patients (5%) isolated loss of the tibial nerve SEP was due to ischemia in the spinal pathway of the tibial nerve. The tibial nerve SEP signal returned to normal: in one patient after reperfusion of intercostal arteries localized within the aneurysm, in the other patient after drainage of cerebrospinal fluid (CSF). Continuous recording of both tibial and median nerve SEPs gives consistent information on spinal cord ischemia, reducing the false positive rate of the lower extremity SEP to 7.5%.
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Eur J Cardiothorac Surg · Jan 1996
Surgery for aortic dissection with intimal tear in the transverse aortic arch.
This study reports surgical experience of 72 cases of aortic dissection with intimal tear in the transverse aortic arch. ⋯ Early and late surgical result for arch dissection was satisfactory with a surgical principle of resecting the aortic segment that contains the initial intimal tear and graft replacement.
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Eur J Cardiothorac Surg · Jan 1996
Pharyngo-oesophageal dysphagia: surgery based on clinical and manometric data.
High or pharyngo-oesophageal dysphagia (PD) is defined as difficulty in initiating the act of swallowing within 1s. It involves the mechanisms controlling the tongue, pharynx and upper oesophageal sphincter (UOS) and is associated with a wide variety of local, neurologic and muscular disorders, and can also occur after surgery in the area and in response to gastro-oesophageal reflux (GOR). Our study aims at defining the criteria for surgery in PD and to evaluate the clinical results of such treatment. ⋯ In conclusion, pharyngo-oesophageal motility measurement is mandatory in PD, especially when a diverticulum is absent. Cricopharyngeal myotomy with or without diverticulectomy as indicated produces excellent results. Associated oesophageal problems have to be dealt with appropriately.
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Eur J Cardiothorac Surg · Jan 1996
Early and long-term results for correction of total anomalous pulmonary venous drainage (TAPVD) in neonates and infants.
To present our 17-year experience of surgical repair of total anomalous pulmonary venous drainage (TAPVD) in 71 consecutive neonates and infants, with particular emphasis on the role of preoperative pulmonary venous obstruction (PVO), the management of postoperative pulmonary hypertensive crises and the long-term results. ⋯ Early repair of TAPVD with aggressive management of pulmonary hypertensive crises carries low operative mortality nowadays. Preoperative PVO as a risk factor has been neutralized since 1987. Long-term results are gratifying: no late death after 6 months, no reoperation and functional good results. Progressive pulmonary vein fibrosis remains an unpredictable rare cause of death within the 1st year after surgery.
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Eur J Cardiothorac Surg · Jan 1996
Randomized Controlled Trial Comparative Study Clinical TrialIntraoperative internal mammary artery transit-time flow measurements: comparative evaluation of two surgical pedicle preparation techniques.
Myocardial revascularization is performed preferentially with internal mammary artery grafts. Pedicle preparation and pharmacologic vasodilatory treatment vary greatly. Objective measurements are difficult since peripheral and later coronary vascular resistance and possible competitive flow of the native bypassed coronary artery will influence the results significantly. Our objectives were: (1) measurement of internal mammary artery graft flow with the transit-time flow technique; (2) comparison of two surgical take-down techniques (skeletonizing vs standard pedicle preparation); (3) quantitation of transit-time flow compared to the free pedicle flow and (4) the vasodilatory effect of papaverine on internal mammary artery flow. ⋯ Intraoperative transit-time flow measurement is a reliable method for assessing internal mammary artery and coronary artery bypass flow; considering the simple technical application, the procedure may be regarded as a valuable instrument of quality control.