Asian cardiovascular & thoracic annals
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Asian Cardiovasc Thorac Ann · Apr 2007
Case ReportsWandering bullet embolizing to the pulmonary artery: a case report.
Whilst a missile embolizing to the right side of the heart is a common occurrence, embolization to the pulmonary arteries is rare. We report a case of a bullet entering through the right internal jugular vein to the right ventricle, and then migrating to the left pulmonary artery, and its management. To our knowledge, this is the first reported such case from the Indian subcontinent.
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Asian Cardiovasc Thorac Ann · Apr 2007
ReviewPharmacological neuroprotection during cardiac surgery.
Despite more than 30 years of aggressive neuroprotective research by many investigators, neuropsychological deficit after cardiac surgery remains an important cause of postoperative morbidity. Although the neurological outcome is a result of a multifactorial etiology, many physicians world-wide have recognized the importance of this problem, and extensive efforts have been made in attempting to minimize the incidence of neurological and neurocognitive dysfunction. Pharmacological intervention is one of the important potential methods of neuroprotection during cardiac surgery. ⋯ Researchers and clinicians must become more cognizant of the pitfalls and paradoxes that have arisen in attempting to translate the results of animal studies into clinical trial, with regard to neuroprotective therapy during cardiac surgery. There is an extensive need for new pharmacological approaches directed at reducing neurologic and neurocognitive injury during cardiac surgery. This article reviews past and present neuroprotective efforts and interventions during cardiac surgery.
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Asian Cardiovasc Thorac Ann · Apr 2007
Randomized Controlled TrialMiddle cerebral arterial blood flow velocity and hemodynamics in heart surgery.
The aim of this study was to evaluate the effects of propofol, isoflurane, and sevoflurane on middle cerebral arterial blood flow velocity during open heart surgery, and the relationship between these effects and hemodynamic parameters. Fifty-two patients undergoing coronary artery bypass on cardiopulmonary bypass were divided randomly into 3 groups: the first group received 100 microg x kg(-1) x min(-1) propofol, the other groups received one minimum alveolar concentration of sevoflurane or isoflurane for anesthesia maintenance. ⋯ After weaning from cardiopulmonary bypass, cerebral blood flow increased and came close to the value after induction in all groups. The pulsatility index and resistivity index increased significantly only after the propofol infusion, but there was no significant difference between the groups.
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Asian Cardiovasc Thorac Ann · Apr 2007
Fast-track cardiac surgery: application in an Australian setting.
In response to the current state of healthcare in Australia, our unit has employed a fast-track policy for low-risk cardiac surgery patients since January 2000. This study was designed to examine the safety and efficacy of this policy. ⋯ The fast-track group had a lower incidence of complications and significantly decreased median length of hospital stay (5 vs 7 days). We concluded that this policy accurately identifies the low-risk cardiac surgery patients suitable for less intensive postoperative recovery.
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Asian Cardiovasc Thorac Ann · Apr 2007
Radial artery graft use and off-pump coronary artery bypass surgery outcome.
Radial artery is commonly used as a conduit for surgical revascularization. There is scarce data on the effect of radial artery use on outcome following off-pump coronary artery bypass. We prospectively evaluated 591 patients undergoing off-pump coronary artery bypass. ⋯ Coronary arteriography was performed in 27 patients, and 23 underwent re-intervention. Radial artery graft was an independent predictor of increased symptom recurrence and adverse cardiac events. Patients with radial artery grafts also had a tendency towards more angina recurrence, coronary re-intervention, and sudden cardiac death.