ASAIO journal : a peer-reviewed journal of the American Society for Artificial Internal Organs
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Case Reports
Implantation of a Berlin Heart as single ventricle by-pass on Fontan circulation in univentricular heart failure.
The clinical management of ventricular failure after the Fontan operation presents a formidable challenge to surgeons. We report our experience with successful implantation of a Berlin Heart EXCOR ventricular assist device as a bridge to transplantation in a child with Fontan circulation.
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Supravalvular aortic stenosis is a rare congenital cardiac anomaly occurring mainly as a part of Williams-Beuren syndrome. Aortic narrowing above the level of the aortic valve causes obstruction of the left ventricular outflow tract, and a pressure gradient between the left ventricle and the aorta causes left ventricle hypertrophy. We report here a case of a 22-year-old man who underwent extended patch aortoplasty because of supravalvular aortic stenosis accompanying Williams-Beuren syndrome. ⋯ We successfully treated this patient with extended patch aortoplasty and immediate postoperative echocardiography showed reduction of gradient. Good surgical outcome of congenital supravalvular aortic stenosis in adults can be achieved with this treatment. This technique provides symmetric reconstruction of the aorta with good postoperative results and no gradient across aortic valve and aortic valve insufficiency remains, providing excellent long-term relief of localized supravalvular gradients and preservation of aortic valve competence.
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Comparative Study
Comparison of four different pediatric 10F aortic cannulae during pulsatile versus nonpulsatile perfusion in a simulated neonatal model of cardiopulmonary bypass.
We compared four commercially available 10F pediatric aortic cannulae with different geometric designs (DLP-Long tip, DLP-Short tip, RMI-Long tip, and Surgimedics-Short tip) during pulsatile versus nonpulsatile perfusion in terms of pressure drops and surplus hemodynamic energy (SHE) levels in an in vitro neonatal model of cardiopulmonary bypass. The pseudo patient was subjected to seven pump flow rates at 100 ml/min increments in the 400-1,000 ml/min range. A total of 44 experiments (n = 22, nonpulsatile; n = 22, pulsatile) were performed at each of the seven flow rates. ⋯ Surgimedics generated a significant lower SHE level when compared with the other three cannulae at all flow rates at both precannula and postcannula sites. The results suggest that different geometries of aortic cannulae have a significant impact on pressure drops of the cannulae as well as hemodynamic energy generation and delivery. Pulsatile perfusion generates more "extra" hemodynamic energy when compared with the nonpulsatile perfusion mode with all four cannulae used in this study.
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In this review, we summarize the history of tracheal reconstruction and replacement as well as progress in current tracheal substitutes. In Part 1, we covered the historical highlights of grafts, flaps, tube construction, and tissue transplants and addressed the progress made in tracheal stenting as a means of temporary tracheal support. In Part 2 we analyze solid and porous tracheal prostheses in experimental and clinical trials and provide a summary of efforts aimed at generating a bioengineered trachea. In both parts, we provide an algorithm on the spectrum of options available for tracheal replacement.
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Comparative Study
Coagulation management in pediatric mechanical circulatory support.
The anticoagulation treatment of children on pulsatile assist devices was studied. The results of 40 children (group A) on mechanical circulatory support with the formerly used anticoagulation treatment were compared with 32 children (group B) on assist devices treated with a new anticoagulation regime. In groups A and B, respectively, 19 (47.5%) and 12 (38%) had bleeding complications; 14 (35%) and 8 (25%) had chest re-exploration; 2 (5%) and 1 (3%) had cerebral hemorrhage; 9 (23%) and 7 patients (22%) had thromboembolic events; and 6 (15%) and 2 (6%) had strokes. ⋯ The differences in survival were significant (alpha = 0.003). Embolic and bleeding complications were seen in both groups, but the incidence was lower in group B. Since, however, thrombogenicity of the systems continues to be their main problem, further improvement of treatment is required.