Journal of cardiac surgery
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Intraoperative use of transesophageal echocardiography (TEE) to detect ischemia is more predictive of a postoperative myocardial infarction than is ECG, and two-dimensional (2-D) TEE has been shown to be more sensitive than ECG in detecting regional wall-motion abnormalities, which are highly suggestive of ischemia. More recent studies have demonstrated that postbypass TEE ischemia is predictive of an adverse outcome. Other potential diagnostic uses of TEE include evaluation and identification of intraoperative ventricular aneurysms and assessment of papillary muscle function. ⋯ In cardiac surgery, contrast TEE has been reported to be useful in evaluating the adequacy of the delivery of cardioplegia as well as aiding in the detection of air emboli. The incorporation of Doppler into TEE probes now enhances the clinician's ability to diagnose and treat patients with valvular heart disease. The value of TEE must be weighed against cost-effectiveness and outcome as it becomes more widely used.
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A new ultra-thin but nonkinkable catheter was used for transfemoral venous right atrial drainage for cardiopulmonary bypass in 35 patients undergoing reoperations for coronary artery disease (CAD) (14), valve replacement (16), combined valve and CAD (4), and left ventricular aneurysm resection (1). Adequate flow rates were obtained with these cannula of 25, 27, and 29 French diameter in all patients. This technique provided excellent drainage of the heart allowing for a decompressed heart to dissect with no bleeding or damage to patent obstructed cardiopulmonary bypass grafts. There was no mortality over perioperative myocardial infarction postoperatively.