Journal of cardiac surgery
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Adult respiratory distress syndrome (ARDS) may pose specific challenges in pregnant women, including the need for prone decubitus ventilation and extracorporeal membrane oxygenation (ECMO). We present our experience with ECMO during pregnancy and review the literature on this topic. ⋯ ECMO is a viable treatment for severe ARDS during pregnancy, after failure of other therapeutic strategies; the risk of spontaneous gynecological bleeding is limited. Issues remain about the timing of ECMO implantation and the management of gestation. Close fetal assessment and multidisciplinary discussion are pivotal for decision-making.
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Comparative Study
The Use of Lidocaine Containing Cardioplegia in Surgery for Adult Acquired Heart Disease.
Del Nido cardioplegia, a crystalloid-based solution with lidocaine as a key element, is given as a single dose and has been used successfully in congenital cardiac surgery. ⋯ Lidocaine containing cardioplegia appears to be safe in adults undergoing cardiac procedure when administered for the first 60 minutes of aortic cross clamping. Higher CK-MB levels did not translate into adverse clinical outcomes.
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Constrictive pericarditis is a rare entity following lung transplant, with only seven previous cases reported in the literature. We present two additional cases and review the literature on this subject. Constrictive pericarditis should be considered in lung transplant patients who present with dyspnea and evidence of cardiac failure. Pericardiectomy remains the treatment of choice irrespective of the etiology.
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Whether moderate ischemic mitral regurgitation (IMR) should be repaired during coronary artery bypass grafting (CABG) is still uncertain. This meta-analysis of randomized controlled trials (RCTs) evaluated the efficacy of adding mitral valve repair (MVR) to CABG in patients with moderate IMR. ⋯ Compared with CABG alone, adding MVR to CABG in patients with moderate IMR reduces the residual MR grade, but has no significant effect on mortality, intermediate NYHA class, LVEF, and LVESVI. Further RCTs with larger sample size and longer follow-up are needed to more clearly elucidate the efficacy of MVR as an adjunct procedure to CABG in patients with moderate IMR.