Seminars in thoracic and cardiovascular surgery
-
Semin. Thorac. Cardiovasc. Surg. · Oct 1999
Potential preoperative markers for the risk of developing atrial fibrillation after cardiac surgery.
Postoperative atrial arrhythmias after cardiac surgical procedures are common, with a reported overall incidence of approximately 50%. The pathophysiological mechanisms responsible for atrial fibrillation after a cardiac procedure remain unclear, although several clinical studies published during the past decade have identified certain preoperative risk factors associated with postoperative atrial fibrillation. In this study, we attempted to identify the histopathological changes in atrial cardiomyocytes that might predict the development of atrial fibrillation during the postoperative period. ⋯ The only clinical independent risk factor for the development of postoperative atrial fibrillation was chronic obstructive pulmonary disease (COPD) (P = .037). Histologically, there were 3 findings in the atrial myocardium that were more common in patients who developed postoperative atrial fibrillation: (1) vacuolation size (P = .017), (2) vacuolation frequency (P = .0136), and (3) lipofuscin content (P = .013). The identification of these histological markers for the development of postoperative atrial fibrillation may contribute not only to our understanding of the underlying pathophysiology that leads to postoperative atrial fibrillation but also to a method of preventing this troublesome complication of cardiac surgery.
-
Semin. Thorac. Cardiovasc. Surg. · Apr 1999
ReviewEvaluation of patients with suspected chronic thromboembolic pulmonary hypertension.
Chronic thromboembolic pulmonary hypertension (CTEPH) can be a difficult diagnosis to establish, typically requiring a high index of suspicion on the part of the clinician when challenged by a patient reporting exertional dyspnea. The importance of this diagnosis is heightened by the appreciation that it is a potentially curable form of pulmonary hypertension, by a surgical procedure called pulmonary thromboendarterectomy. This article highlights the clinical presentation, evaluation, and criteria for surgical candidacy of those patients suspected of having CTEPH.
-
Semin. Thorac. Cardiovasc. Surg. · Apr 1999
ReviewNeurological complications of cardiac surgery: the need for new paradigms in prevention and treatment.
Neurological injury is a devastating complication of cardiac surgery that results in a longer duration of hospitalization, increased costs, and increased likelihood of death. Such injury can affect any level of the central nervous system, and its manifestations are broad, ranging from neurocognitive dysfunction to frank stroke. Many variables have been found to be indicative or risk for perioperative neurological injury, but the predictive models are more useful for stroke risk than for neurocognitive dysfunction. ⋯ Results of laboratory investigations have provided insight into the mechanisms of ischemic neuronal injury and a basis for the development of neuroprotective drugs. Neuroprotection may best be accomplished during cardiac surgery because, in contrast to nonsurgical situations, potential agents can be administered before the neurological insult occurs. Reducing the incidence of perioperative stroke will require a multidisciplinary approach that includes novel diagnostic and therapeutic strategies.
-
Semin. Thorac. Cardiovasc. Surg. · Apr 1999
ReviewPrevalence of left ventricular diastolic filling abnormalities in adult cardiac surgical patients: an intraoperative echocardiographic study.
The incidence of left ventricular (LV) diastolic abnormalities in adult cardiac surgical patients has not previously been adequately investigated. The present study was performed to characterize LV diastolic filling patterns by performing transesophageal Doppler echocardiographic (TEE) studies in patients undergoing cardiac surgical procedures and thus indirectly assess diastolic function in these patients. Doppler TEE studies were performed and transmitral flow (TMF) and pulmonary venous flow (PVF) velocities were recorded in 104 patients intraoperatively. ⋯ Patients with impaired relaxation had a greater incidence of recent myocardial infarction and congestive heart failure (CHF) than those with normal or pseudonormal filling patterns. Within group II, patients with CHF had higher TMF E deceleration rates and lower PVF S/D ratios compared with those without CHF (P < .05). Doppler echocardiographic examination of TMF and PVF velocities suggests that abnormalities in diastolic function are prevalent in adult cardiac surgical patients.
-
Semin. Thorac. Cardiovasc. Surg. · Apr 1999
ReviewOptimal management of bleeding and transfusion in patients undergoing cardiac surgery.
Patients undergoing cardiac surgery with cardiopulmonary bypass (CPB) are at increased risk for excessive perioperative blood loss requiring transfusion of blood products. Point-of-care evaluation of platelets, coagulation factors, and fibrinogen can enable physicians to rapidly assess bleeding abnormalities, facilitate the optimal administration of pharmacological and transfusion-based therapy, and also identify patients with surgical bleeding. The ability to reduce the unnecessary use of blood products in this setting has important implications for emerging issues in blood inventory and blood costs. The ability to decrease surgical time, along with exploration rates, has important consequences for health care costs in an increasingly managed health care environment.