Journal of cardiac surgery
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Stretching of suture material is an infrequent cause of delayed mediastinal hemorrhage after lateral repair of the aorta. In contrast to end-to-end reconstructions, lateral patch repairs of the aorta present unusual stress on the anastomotic suture line. We describe a simple technique for repair of loosened suture lines, with suggestions for preventing this complication in cases of lateral aortic reconstruction.
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It has been suggested that cardioplegic arrest during cardiopulmonary bypass (CPB) produces global myocardial ischemia with a risk of myocardial stunning. It has also been postulated that anesthetic technique may affect the course of post-CPB myocardial stunning via exaggerated myocardial depression. However, we have previously found that global ventricular and regional myocardial responses to halothane do not differ in post-CPB and pre-CPB dogs. ⋯ Since other data show normal inotropic stimulation of stunned myocardium, decreases in dobutamine responsiveness cannot be explained by beta-receptor desensitization. Overall, these data indicate that CPB does not result in myocardial stunning. The differences between these data and others showing myocardial stunning following CPB may be due to several factors, such as anesthetic regimen, lack of coronary blood flow abnormalities, and a reduction in sarcoplasmic reticular damage due to the hypothermic conditions used.
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Randomized Controlled Trial Clinical Trial
The effect of prophylactic nitroglycerin infusion on the incidence of regional wall-motion abnormalities and ST segment changes in patients undergoing coronary artery bypass surgery.
The effects of nitroglycerin (NTG) on regional wall-motion abnormalities, ST segment changes, and the incidence of myocardial infarction (MI), cardiac failure, and mortality were studied in 30 patients undergoing coronary artery bypass. Patients received continuous infusions of either normal saline or NTG (1 microgram/kg per min [low dose] or 2 micrograms/kg per min [high dose]) beginning at anesthesia and continuing for 4 hours postoperatively. ⋯ There were no significant differences between the control and NTG groups with regard to the incidence of Holter ST segment events or the incidence of MI, cardiac failure, or cardiac death. NTG reduced the incidence of echocardiographic wall-motion abnormalities in a dose dependent manner while having no significant effect on other parameters examined.
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In spite of recent advances in neonatal open repair for complex cyanotic heart disease, some patients require palliation with a systemic-to-pulmonary artery shunt. We report a 5-year experience (1985-1990) with 112 Blalock-Taussig shunts. Forty-six of the 92 patients had some variant of tetralogy of Fallot, with a wide spectrum of diagnoses in the remainder. ⋯ There was a 21% incidence of clinical congestive heart failure, seen somewhat more commonly in group I. The overall need for reshunting/open repair was similar in both groups, but there was a statistically longer interval between the initial Blalock-Taussig shunt and the second procedure in group I (21.6 vs 12.4 months). The Blalock-Taussig shunt remains a safe, reliable, and effective means of increasing pulmonary flow.
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A low weight has been implicated as one of the major reasons for deferring cardiac surgical procedures on cardiopulmonary bypass (CPB), resorting instead to palliative procedures. The purpose of this study is to analyze the risk factors associated with an increased mortality for surgery using CPB in small infants, and to compare this group with infants weighing over 2.5 kg. Between 1979 and 1990, 60 infants weighing less than 2.5 kg underwent surgery on CPB at our institute. ⋯ They were: (1) presence of preoperative metabolic acidosis; (2) univentricular versus biventricular repair; and (3) duration of CPB. Within the less than 2.5 kg group, low weight per se did not affect the outcome adversely. The main cause of late death was the presence of associated medical conditions, notably bronchopulmonary dysplasia and tracheo bronchomalacia.