Asian cardiovascular & thoracic annals
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Asian Cardiovasc Thorac Ann · Apr 2011
Randomized Controlled Trial Comparative StudyLevosimendan vs. intra-aortic balloon pump in high-risk cardiac surgery.
The purpose of our study was to compare the efficiency of levosimendan and preventive intra-aortic balloon pump in high-risk cardiac patients (left ventricular ejection fraction <35%) operated under cardiopulmonary bypass. In 20 patients, intra-aortic balloon pump was started 16-18 h before surgery; another 20 had a levosimendan infusion starting after induction of anesthesia with an initial bolus of 12 μg·kg(-1) for 10 min, followed by 0.1 μg·kg(-1)·min(-1) for 24 h. Postoperative complications, hemodynamics, and markers of cardiac damage were analyzed. ⋯ Intensive care unit stay was significantly shorter in the levosimendan group. It was concluded that the use of levosimendan in high-risk cardiac patients is as effective as intra-aortic balloon pump, in terms of maintaining stable hemodynamic during and after operations under cardiopulmonary bypass. The lower level of troponin I at 6 h postoperatively suggests cardioprotective properties of levosimendan, but requires further investigation.
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Asian Cardiovasc Thorac Ann · Apr 2011
Randomized Controlled TrialRandomized controlled trial of bilateral intrapleural block in cardiac surgery.
The aim of this study was to determine the efficacy of bilateral intrapleural block with bupivacaine as a preemptive analgesic for postoperative pain in coronary artery bypass graft surgery. In a double-blind prospective clinical trial, 70 patients were randomly divided into a bupivacaine group (20 mL bupivacaine 0.25% and 0.5 mL adrenaline 1/200,000 each side) and a control group (20.5 mL normal saline each side). ⋯ There were no side-effects related to intrapleural block, such as pneumothorax or emphysema. In coronary artery bypass graft candidates, preemptive analgesia with bilateral intrapleural block using bupivacaine provided relatively less painful conditions during the first 24 h after surgery, but it did not improve the clinical outcome.
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Asian Cardiovasc Thorac Ann · Apr 2011
Comparative StudyDiffusion-weighted magnetic resonance for pulmonary nodules: 1.5 vs. 3 Tesla.
The usefulness of diffusion-weighted magnetic resonance for assessing malignant pulmonary nodules was examined in 58 patients with 76 (58 malignant, 18 benign) pulmonary nodules (1.0-5.6 cm) who underwent 1.5-T and 3-Tesla imaging and (18)F-fluorodeoxyglucose positron-emission tomography prior to surgery. The sensitivities and specificities of these techniques for discriminating benign and malignant nodules were compared. ⋯ The apparent diffusion coefficient on 1.5-T imaging showed a significant reverse correlation with positron-emission tomography, and the correlation between 3-T imaging and positron-emission tomography was marginally significant. Both 1.5-T and 3-T diffusion-weighted magnetic resonance imaging modalities are equally useful for assessing malignant pulmonary nodules.
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Asian Cardiovasc Thorac Ann · Apr 2011
Comparative StudySignificance of mitral valve repair for active-phase infective endocarditis.
Mitral valve repair is preferred to replacement in infective endocarditis, but in the active phase, it often requires extensive debridement of infected tissue and complex reconstruction. We investigated 22 consecutive native mitral valve operations during active-phase infective endocarditis. The time from initiation of medical treatment to operation was 16.8 ± 16.4 days. ⋯ Mitral regurgitation requiring reoperation occurred in 3 patients during follow-up. Mitral valve repair is feasible in active-phase infective endocarditis, and results in improved regression of left ventricular dimensions compared to valve replacement. However, complex mitral valve repair with extensive leaflet resection may not have long-term durability.
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Asian Cardiovasc Thorac Ann · Apr 2011
Ketamine-etomidate for children undergoing cardiac catheterization.
The purpose of this study was to determine the effects of combined low-dose ketamine and etomidate on hemodynamics during cardiac catheterization in children with congenital cardiac shunts. Sixty children undergoing routine diagnostic cardiac catheterization were included: 30 had a right-to-left shunt, and 30 had a left-to-right shunt. Both groups were given a single dose of etomidate 0.3 mg·kg(-1) with ketamine 1 mg·kg(-1). ⋯ In cases of left-to-right shunt, there were significant differences in heart rate, right atrial pressure, mean arterial pressure, mean pulmonary artery pressure, pulmonary artery wedge pressure, and systemic vascular resistance index. Decreases in pulmonary blood flow and pulmonary-systemic shunt ratio were also observed. Further studies are required with dose titration of this anesthetic combination in pediatric patients with congenital heart disease involving a left-to-right shunt.