Journal of cardiac surgery
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Review
Pericardial complications of cardiac surgery: emphasis on the diagnostic role of echocardiography.
Pericardial effusions are common following cardiac surgery; uncommonly they are large in size and may cause tamponade, either in the early or late postoperative period. Such effusions causing tamponade may be circumcardiac, but are frequently loculated, in which case one or more cardiac chambers is selectively compressed. ⋯ Constrictive pericarditis resulting from cardiac surgery is being recognized with increasing frequency and has been associated with various echocardiographic abnormalities. This review also discusses certain other pericardial complications of cardiac surgery including supraventricular arrhythmias, chylopericardium, and posttransplant problems.
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An alternative method to create an intraatrial, cavocaval channel without using any prosthetic material in total cavopulmonary connection is described. This new technique avoids possible thrombotic complication, limitation of heart growth by intraatrial prosthetic material, and reduction in secretion of antinaturetic peptide.
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Patients with postinfarction angina undergoing surgery for unstable angina face an increased risk of operative mortality. Between January 1982 and December 1987, clinical, angiographic, and operative data was collected prospectively in 588 unstable patients with a prior myocardial infarction within 30 days of surgery (MI) and 5951 unstable patients without preoperative damage (NONMI). MI patients were characterized as being older (age greater than or equal to 70 years: MI, 19.7%; NONMI, 11.6%; p less than 0.001) and having more left ventricular dysfunction (left ventricular ejection fraction less than 40%: MI, 34.8%; NONMI, 26.4%; p less than 0.001). ⋯ For NONMI patients, the independent variables were urgent operation, left ventricular dysfunction, reoperation, female gender, left main stenosis, and age. The results of this study indicate that recent preoperative MI adversely influences the surgical results in patients with unstable angina. Alternative treatment strategies are warranted for high risk patients, particularly those with transmural MIs and impaired ventricular function.
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A technical modification to the total cavopulmonary connection in the presence of left superior vena cava (LSVC) is described. Systemic venous to pulmonary artery continuity is achieved by direct anastomosis of the right superior vena cava (RSVC) to the right pulmonary artery. ⋯ By using this technique, we maintain the basic principle of excluding the right atrial chamber from the systemic venous circuit, thereby reducing the potential obstructive complications that have been noted with other forms of complex intraatrial baffles. We have used this technique successfully in three patients with various forms of complex congenital cardiac defects.
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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.