Asian cardiovascular & thoracic annals
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Asian Cardiovasc Thorac Ann · Sep 2003
Accordion-like prosthesis for modified Blalock-Taussig shunt.
From March 1996 to July 2002, 26 consecutive patients, with a mean age of 17.9 months and a mean body weight of 6.6 kg, underwent the modified Blalock-Taussig shunt with a tubular accordion-like prosthesis. In a mean follow-up period (defined as the interval between the shunt procedure and repair or last evaluation) of 10.9 months (range, 1 to 32 months), there were 1 death due to excessive pulmonary blood flow in a neonate with hypoplastic left heart syndrome and 3 reoperations to correct shunt-related problems, 2 of them early and 1 late (to regulate pulmonary blood flow after left ventricular retraining for transposition of the great arteries). There was no occurrence of shunt obstruction or kinking. ⋯ Shunt patency was confirmed by Doppler echocardiography in all patients and also by angiography in 73% of the patients. This prospective study confirmed our preliminary results with this prosthesis. The use of this prosthesis is justified for reducing early and late complications potentially associated with the modified Blalock-Taussig shunt, particularly distortion of the pulmonary arteries.
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Asian Cardiovasc Thorac Ann · Jun 2003
Transesophageal echocardiography in hypotensive post-coronary bypass patients.
The utility of transesophageal echocardiography in the evaluation of hypotension in the postoperative period after coronary artery bypass was assessed in 126 patients in the intensive care unit. There were 86 men and 40 women, with a mean age of 58.3 years. The indication for transesophageal echocardiography was hypotension refractory to conventional treatment. ⋯ The mean time required to obtain a diagnosis was 9.6 +/- 2.8 min. No significant complications were noted. Our experience suggests that transesophageal echocardiography is highly specific in diagnosing the cause of postoperative hypotension, thus preventing unnecessary surgical intervention and facilitating decision making in cardiac surgical emergencies.
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Asian Cardiovasc Thorac Ann · Jun 2003
Age and left ventricular impairment predict reopening for bleeding.
Statistical analysis of data collected prospectively from all patients undergoing surgery under cardiopulmonary bypass from September 1994 to November 1998 (group 1) was performed to identify preoperative risk factors for reopening for bleeding. Multiple logistic regression analysis of 19 preoperative variables was carried out with reoperation for bleeding as the endpoint. The protocol for intraoperative use of aprotinin was then changed to include high-risk patients. ⋯ There were no independent predictors of reopening in group 2. Older age and chronic renal failure were the predictors of reexploration for bleeding in patients undergoing primary isolated coronary artery grafting. Prophylactic measures to prevent excessive bleeding should be used in elderly patients and those with severe left ventricular impairment, redo surgery, and chronic renal failure.
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Asian Cardiovasc Thorac Ann · Mar 2003
Case ReportsSuccessful treatment of accidental air embolism in warm heart surgery.
Normothermic cardiopulmonary bypass has recently been proposed as a superior technique for maintaining body metabolism. However, its use remains controversial since the degree of cerebral protection provided might be inferior to that conferred by conventional hypothermic techniques. We report a case of accidental massive air embolism during coronary artery bypass surgery under normothermia, which was successfully managed with induced hypothermia at 20 degrees C and retrograde cerebral perfusion.
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Asian Cardiovasc Thorac Ann · Dec 2002
Comparative StudyComparison of off-pump versus conventional coronary revascularization.
Between May 1999 and August 2001, 231 patients underwent off-pump coronary bypass, of whom 171 required revascularization of the anterior vessels of the heart. They were compared with a group matched for age, sex, and risk factors undergoing revascularization of the same group of vessels under cardiopulmonary bypass. Mortality was comparable in both groups but the incidence of cerebrovascular accident, respiratory insufficiency, and renal failure was less in the off-pump group. ⋯ Intensive care and hospital stay were shorter in the off-pump patients. A considerable number of patients are potential candidates for off-pump coronary bypass, the only contraindication being technical limitations. Follow-up at 6 to 24 months indicates that off-pump coronary bypass can be performed safely with a decrease in morbidity and more rapid return to normal lifestyle.