American heart journal
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American heart journal · Jun 1993
ReviewDeep hypothermic circulatory arrest during cardiac surgery: effects on cerebral blood flow and cerebral oxygenation in children.
Deep hypothermic circulatory arrest has become an essential technique to allow repair of complex congenital cardiac lesions in children. The arrested state has concerned the surgeon, cardiologist, and anesthesiologist alike, and yet deep hypothermic circulatory arrest has been highly successful with a low incidence of neurologic sequelae. ⋯ That the hypothermic arrested brain likely becomes anoxic and recovery of the anoxic brain depends in large part on recirculatory hemodynamics suggests that the lack of hyperemia and hyperoxia may play more major roles than was previously believed. The mechanism of protection may be related to suppression of oxygen free radicals.
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American heart journal · Jun 1993
Comparative StudyThe role of transesophageal echocardiography in cardiac donor screening.
Transthoracic echocardiography has played a useful role in the screening of cardiac transplant donors. However, transthoracic echocardiograms may be suboptimal in many patients on ventilators. The role of transesophageal echocardiography in cardiac donor screening is unknown. ⋯ In 16 of 17 patients with technically adequate transthoracic echocardiograms, transesophageal and transthoracic echocardiographic findings agreed and demonstrated normal hearts in 13 patients, left (n = 2) and right (n = 1) ventricular wall motion abnormalities in two patients, and isolated concentric left ventricular hypertrophy in one patient. In 1 of the 17 patients with a technically adequate transthoracic echocardiographic study, a bicuspid aortic valve was demonstrated by transesophageal echocardiography but not diagnosed by transthoracic echocardiography. Overall seven patients were eliminated as cardiac donors on the basis of transesophageal echocardiograms (n = 7), transthoracic echocardiograms (n = 2), or both.(ABSTRACT TRUNCATED AT 250 WORDS)