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.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2006
ReviewARDS and diffuse alveolar damage: a pathologist's perspective.
Diffuse alveolar damage (DAD) is the histologic correlate of most patients with adult respiratory distress syndrome (ARDS). It is a relatively straight forward diagnosis and the main differential diagnosis clinically is acute pneumonia and histologically is bronchiolitis obliterans and organizing pneumonia (BOOP). The histologic progression of DAD includes 3 phases (exudative, proliferative, and fibrotic) that correlate with the time rather than its specific cause. The factors that govern which patients will do well and which will develop a fulminant course is not known.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2006
ReviewThe dispersed neuroendocrine system, its bronchopulmonary elements, and neuroendocrine tumors presumed to be derived from them: myths, mistaken notions, and misunderstandings.
The increasing recognition of the dispersed neuroendocrine system and its importance in human physiology has impacted our understanding of physiology, pathophysiology, and histopathology. It has been the subject of a great deal of controversy and debate, giving rise to certain misunderstandings. This article attempts to put some of these issues in perspective, especially as they relate to the bronchopulmonary tree.
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Semin. Thorac. Cardiovasc. Surg. · Jan 2006
ReviewTechnical advances of pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension.
Pulmonary endarterectomy is the definitive treatment for chronic pulmonary hypertension as the result of thromboembolic disease. Although significant progress has been made over the last decade in recognition, diagnostic modalities, and treatment of this disease, chronic thromboembolic pulmonary hypertension (CTEPH) continues to be severely underdiagnosed and as a consequence pulmonary endarterectomy remains an uncommon procedure. ⋯ Medical management in these patients is only palliative, and surgery by means of transplantation for this type of pulmonary hypertension is an inappropriate use of resources with less than satisfactory results. In this article we describe the technical advances of pulmonary endarterectomy and the current procedure as it is performed at University of California-San Diego Medical Center.