Seminars in thoracic and cardiovascular surgery
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Semin. Thorac. Cardiovasc. Surg. · Jul 1995
Valved conduits of bovine pericardium for right ventricle to pulmonary artery connections.
Between February 1991 and October 1994, 29 patients received right heart bovine pericardial valved conduits. Patients' ages ranged from 19 days to 18 years (mean 3.5 years), with 8 patients younger than 1 year of age. Ten patients had truncus arteriosus type II or III, 7 had pulmonary atresia with ventricular septal defect (VSD), 6 had transposition of the great arteries and pulmonary stenosis (PS), 3 had corrected transposition with VSD and PS, 2 had double-outlet right ventricle, and 1 had aortic atresia with normal left ventricle and VSD. ⋯ The postoperative serial echocardiographic studies showed a mean transconduit gradient of 16 mm Hg with a range of 2 to 37 mm Hg. All patients are in functional class I. Although the intermediate results are satisfactory, considering the late complications known from others conduits, long-term follow-up is necessary.
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Fungal prosthetic valve endocarditis is an unusual cause of endocarditis, yet very important because of its historical poor prognosis. This article will review the incidence, presentation, diagnosis, and treatment results of fungal prosthetic valve endocarditis. ⋯ Unfortunately, 36% of patients developed recurrent fungal prosthetic valve endocarditis, at an average of 25.8 months after their first operation for fungal prosthetic valve endocarditis. The use of oral antiazole antifungal agents for suppression may prevent the high incidence of recurrent endocarditis in this patient population.
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Semin. Thorac. Cardiovasc. Surg. · Jul 1994
Resuscitation for cardiogenic shock with extracorporeal membrane oxygenation systems.
Between 1975 and 1993, 73 patients in cardiogenic shock were supported by a variety of venoarterial pumping (VAP) systems. There were 64 adults and 9 children. Shock was caused by myocardial infarction (MI) (26), failed percutaneous transluminal coronary angioplasty (PTCA) (25), post open heart surgery (9), viral cardiomyopathy (5), idiopathic cardiomyopathy (2), pulmonary embolism (2), hypothermia (2), and arrhythmia (2). ⋯ Resuscitated patients were usually bridged to further therapies such as coronary artery bypass graft (CABG), valve repair or replacement or cardiac transplantation. Overall, 35 patients (48%) survived VAP and additional therapies. We conclude that early application of complete cardiopulmonary support to patients in shock allows resuscitation and corrective therapy with an acceptable salvage rate.