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 1995
Case ReportsExtra-pleural haematoma secondary to blunt chest trauma. An unusual presentation.
The case history is described of a young man who presented with an apparent splenic rupture following thoracic compression during a rugby tackle. The actual diagnosis was that of an extra-pleural haematoma following transection of the internal mammary artery. This case is discussed within the context of the rarity of such a presentation--both in the site of the haematoma and the cause of the transection; and the problems posed in making the initial diagnosis.
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Eur J Cardiothorac Surg · Jan 1995
Case ReportsMechanical ventricular assistance for the failing right ventricle after cardiac transplantation.
Right ventricular failure secondary to elevated pulmonary vascular resistance (PVR) following orthotopic cardiac transplant is a complication with a high mortality; and patients with high resistance are often not accepted on transplant waiting lists. We describe six cases of right ventricular failure after cardiac transplant managed by right ventricular assist device (RVAD), four of whom died and two patients who survived following life-threatening complications.
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Eur J Cardiothorac Surg · Jan 1995
Case ReportsEsophageal tracheobronchoplasty for membranous laceration caused by insertion of a dumon stent--maintenance of oxygenation by percutaneous cardiopulmonary support.
A 39-year-old man, whose airway was narrowed due to relapsing polychondritis, sustained a tracheobronchial injury during intubation with an internal stent. In the posterior membranous trachea and left main stem bronchus, a 5-cm longitudinal tear extended across the carina. ⋯ An original esophageal tracheobronchoplasty for repair of the membranous laceration is described. Currently, the patient is asymptomatic 16 months after the surgery.
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Eur J Cardiothorac Surg · Jan 1995
Nitric oxide release during hypothermic versus normothermic cardiopulmonary bypass.
Cardiopulmonary bypass (CPB) produces hemodynamic and inflammatory disorders involving changes in vascular permeability and regional blood flow and alterations of coagulation and complement systems. It has been reported that an abnormal release of vasoactive substances during CPB, like bradykinin or nitric oxide, could play a role. The aim of this study was to investigate the changes in nitric oxide (NO) release occurring in patients undergoing CPB, under both hypothermic and normothermic conditions. ⋯ Although there were no significant variations of NPL shortly after the start of CPB (10 min after), values measured 30 min after CPB commencement and 10 min after the end of CPB showed a significant increase (P < 0.0001) in both groups. Considering the two groups separately, NPL changes seemed to be similar, so independent of temperature; however, in group B higher values of NPL were measured during (30 min) and after (60 min) CPB (P < 0.0001). In conclusion, during CPB there is a progressive increase, independent of temperature in NO release.
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Although cardiomyoplasty has become a recognized treatment for end-stage heart failure, the effects of this procedure on systolic and diastolic function are still unclear. To determine the effects of paced and non-paced latissimus dorsi cardiomyoplasty on systolic and diastolic function, the maximal elastance of the left ventricle (Emax), stroke volume, preload recruitable stroke work and diastolic compliance were measured in an experimental heart failure model. Collateral blood vessels to the latissimus dorsi were ligated 2 weeks before cardiomyoplasty in order to reduce the risk of ischemic injury. Histological examination of muscle biopsies confirmed that the two-stage procedure preserved normal muscle architecture. The non-paced cardiomyoplasty wrap adversely affected both systolic and diastolic function. Paced Latissimus Dorsi during heart failure improved systolic function but had no measurable effect on diastolic function. ⋯ 1. Non-paced, or unstimulated, latissimus dorsi cardiomyoplasty acutely impairs cardiac function. 2. Delayed cardiomyoplasty, 2 weeks after collateral ligation, prevents ischemic injury to the muscle flap.