Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jan 2007
ReviewCause and prevention of central nervous system injury in neonates undergoing cardiac surgery.
Neurologic morbidity has been identified as increasingly problematic in neonates with congenital heart disease as surgical mortality rates have improved. The presence of "congenital brain disease" in patients with congenital heart disease represents a challenge in improving long-term neurologic outcomes. Mechanisms of central nervous system injury in infants undergoing cardiac surgery include hypoxia-ischemia, emboli, reactive oxygen species, and inflammatory microvasculopathy. ⋯ Postoperatively, secondary neurologic injury may be related to post-cardiopulmonary bypass alterations in cerebral autoregulation and additional hypoxic-ischemic insult, seizures, or other issues associated with prolonged intensive care unit stay. In addition to prenatal and modifiable perioperative factors, genetic and environmental factors are known to be important. Unfortunately, modifiable perioperative factors may explain less of the variability in long-term outcomes than do patient-specific factors.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2007
ReviewMinimally invasive surgery with a partial sternotomy "J" approach.
The minimally invasive partial sternotomy "J" incision can be used for most isolated mitral valves, tricuspid valves, aortic valves, atrial septal defects, maze procedures, aortic repairs, and aortic valve reoperations. This article reviews the technical approaches and outcomes for various procedures. ⋯ Similar results have been obtained for aortic valve procedures. Thus, all patients undergoing isolated aortic or mitral valve repairs are offered a minimally invasive operation.