Journal of cardiac surgery
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Case Reports
Right ventricular failure following heart transplantation--recovery after extended mechanical support.
Early graft failure, particularly right ventricular dysfunction, remains a significant determinant of early morbidity and mortality in heart transplant recipients. If conservative medical management fails to help recover cardiac allograft function, mechanical circulatory support either bridging to recovery or retransplantation remains the last option. We report on a 16-year-old patient with hypertropic nonobstructive cardiomyopathy who was weaned successfully from a right ventricular assist device (RVAD) after extended right ventricular mechanical support for three months following heart transplantation.
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Acute fulminant myocarditis can cause left ventricular dysfunction that predisposes the patients to critical condition. Left ventricular assist device (LVAD) is a useful option for the patient whose condition is resistant to medical therapy. However, when right ventricular dysfunction with hypoxia is complicated with left ventricular dysfunction, it can be difficult to make a prompt decision in order to achieve better outcome. We present our case in which the support on LVAD and extracorporeal membrane oxygenation (ECMO) was effective to treat critically ill patients.
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Real-time readings of the regional oxygen saturation (rSO(2)) using near-infrared spectroscopy (NIRS) during the aortic arch surgery can provide an early detection of perfusion or oxygenation abnormalities. ⋯ Continuous monitorization of the cerebral O(2) saturation during aortic arch surgery in adults and infants is a feasible technique to control an adequate cannula positioning and to optimize clinical outcomes avoiding neurological complications related to cerebral malperfusion.
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Case Reports
The use of intraoperative Doppler assessment to guide the surgical treatment of anomalous right coronary arteries.
Despite its rarity, anomalous origin of the right coronary artery (RCA) from the left coronary sinus can pose risk of sudden death. Because of this risk, many patients elect surgical correction of this anomaly. Surgical strategies for correction of this include ostioplasty, coronary artery reimplantation, and, more commonly, coronary artery bypass grafting. ⋯ In each case, the RCA was bypassed using a saphenous vein graft (SVG) that was used to bypass origin of the RCA. Flow through the graft was compared with and without ligation of the proximal RCA, before creation of the proximal anastomosis. In each case, flow through the SVG was not significantly reduced with the proximal RCA patent and ligation was not performed.