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
Restoration of the thoracic aorta in Type A dissection with hybrid prosthesis.
Following successful repair of Type A dissection, late morbidity and mortality depend on the progression of residual chronic Type B dissection. To avoid the development of late aneurysms of the descending thoracic aorta, a persistent aortic false lumen around the stent-graft can be prevented by remodeling the thoracic aorta. Ten consecutive patients (mean age: 56 years) with acute Type A dissection underwent a "frozen elephant trunk operation" with the E-vita hybrid prosthesis, under deep hypothermic circulatory arrest, between October 2009 and April 2010. ⋯ Two patients suffered postoperative pulmonary arterial embolism; one underwent embolectomy. Restoration of the thoracic aorta is a safe procedure to close the false lumen during the primary operation for acute Type A dissection. However, the diameter of the stent should reflect the overall aortic size, independent of the diameter of the true lumen.
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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.