Asian cardiovascular & thoracic annals
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Acute pulmonary embolism is a serious condition and despite diagnostic and therapeutic advances, mortality is still high. Anticoagulation, thrombolytic therapy, catheter embolectomy, and open pulmonary embolectomy are therapeutic options. Surgical embolectomy was considered the management of last resort, but recent studies show the effectiveness of this therapeutic modality. ⋯ Open pulmonary embolectomy is the most effective treatment for acute massive pulmonary embolism. Cardiac arrest is the worst prognostic factor. Less aggressive clot evacuation in patients who are diagnosed late appears to be effective in minimizing postoperative hemoptysis.
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Asian Cardiovasc Thorac Ann · Jan 2007
Randomized Controlled Trial Comparative StudyEffects of tranexamic acid and autotransfusion in coronary artery bypass.
The aim of this study was to compare the effects of intraoperative autotransfusion and tranexamic acid on postoperative bleeding and the need for allogeneic transfusion. In a prospective randomized study, 200 patients undergoing coronary artery bypass were divided into two groups: 100 patients received 1-2 units of autologous blood after termination of cardiopulmonary bypass; and 100 patients were given tranexamic acid 15 mg x kg(-1) before injection of heparin and again before injection of protamine. Postoperative bleeding was significantly lower in the tranexamic acid group (600 mL) than the autotransfusion group (1,100 mL). ⋯ Intensive care and hospital stays were shorter in the tranexamic acid group. There was no hospital mortality and no difference in thrombotic complications between groups. Tranexamic acid was more effective than autotransfusion in reducing postoperative blood loss and allogeneic transfusions after coronary bypass.
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Asian Cardiovasc Thorac Ann · Jan 2007
Risk evaluation and midterm outcome of cardiac surgery in patients on dialysis.
The medical charts of 54 patients on maintenance dialysis who underwent cardiovascular surgery (37 elective and 17 urgent/emergency) from 1994 to 2004 were retrospectively analyzed. Thirty patients had coronary artery bypass grafting (17 elective and 13 urgent/emergency), 18 had valve replacement (16 elective and 2 urgent/emergency), and 6 underwent aortic surgery (4 elective and 2 urgent/emergency). The overall early mortality rate was 11.1%, comprising 2 patients (5.4%) who had elective operations and 4 (23.5%) who had urgent or emergency operations ( p = 0.049). ⋯ The midterm clinical results after elective cardiovascular surgery were acceptable, whereas the results after urgent/emergency surgery were poor. For elective surgery, sufficient and detailed preoperative examinations might have contributed to the better operative outcome. Early diagnosis and consultation to avoid urgent/emergency operations in dialysis patients is recommended.
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Asian Cardiovasc Thorac Ann · Jan 2007
Antithrombin and protein C in systemic inflammatory response syndrome.
Coronary artery bypass grafting with cardiopulmonary bypass can induce systemic inflammatory response syndrome. To assess the prevalence of preoperative antithrombin and protein C deficiencies in relation to the incidence of this syndrome, antithrombin and protein C levels were measured in 130 patients undergoing coronary artery bypass grafting with cardiopulmonary bypass. ⋯ Antithrombin levels were < 80% in 33.8% of patients, and 11.6% had protein C levels < 80%. Postoperative antithrombin and protein C deficiencies are not uncommon in adults undergoing cardiac surgery with cardiopulmonary bypass, but detection of these deficits did not identify patients at increased risk of systemic inflammatory response syndrome.
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Asian Cardiovasc Thorac Ann · Jan 2007
Case ReportsTreatment for intercostal arterial aneurysm in neurofibromatosis type 1.
We report a valuable case in which a spontaneous intercostal arterial aneurysmal rupture associated with neurofibromatosis type 1, and a re-rupture after embolization of the aneurysm were successfully treated by endovascular embolization without surgery. Our case calls for attention as it indicates that recurrent aneurysmal rupture can occur even after an embolization or surgery. It is important to carefully observe the course of the patient by follow-up computed tomography (CT) or angiography in such cases.