Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia
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Ann Thorac Cardiovasc Surg · Feb 2000
Review Case ReportsRight-sided pleural effusion in spontaneous esophageal perforation.
Spontaneous esophageal perforation (Boerhaave's syndrome) is a rare clinical entity in which overindulgence in a large meal precedes vomiting and chest pain. Early diagnosis and aggressive management are keys to minimizing the morbidity and mortality. We report an unusual presentation of this already uncommon occurrence in a 33-year-old female. ⋯ She underwent emergency operation. After three months of hospital care, she was discharged in relatively good condition. This case of right-sided pleural effusion extends the reported description of Boerhaave's syndrome.
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Ann Thorac Cardiovasc Surg · Feb 2000
The benefits and new predictors of early extubation following coronary artery bypass grafting.
This study researched cardiorespiratory effects and cost-effectiveness of early extubation in patients following coronary artery bypass grafting. ⋯ Early extubation within 8 hours into the ICU stay was accomplished in 55% of the patients in this study. We speculate that the benefits of early extubation contain improvement of cardiac function, reduction in respiratory infection and complications, and cost saving as the result of diminished ICU admission. Also, we have shown that decreased FEV1.0%, decreased CI and the usage of a postoperative temporary pacemaker were independent predictors of prolonged intubation in our study.
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Ann Thorac Cardiovasc Surg · Feb 2000
Case ReportsIntraoperative acute occlusion of aortic bifurcation during extracorporeal circulation.
A 36-year-old male patient showed a significant decrease of arterial pressure in the lower extremities during coronary artery bypass grafting (CABG) with extracorporeal circulation (ECC). Arterial pressure measured in the femoral artery fell to 10-20 mmHg at the end of ECC, whereas in the upper extremities arterial pressure levels were normal. At the end of the surgery a complete ischemia of both lower extremities was observed. ⋯ The shape and superficial structure of the extracted embolus, which was partly covered with endocardium, confirmed our suspicion. No complications occurred throughout the postoperative period. On the 10th postoperative day, the patient left our department for postoperative rehabilitation with a normal perfusion of the lower extremities.
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Ann Thorac Cardiovasc Surg · Feb 2000
The effect of modified ultrafiltration in pediatric open heart surgery.
Since 1997 we have performed modified ultrafiltration (MUF) in pediatric open heart operations. To elucidate the clinical effects of MUF, patients under 20 kg in weight who underwent corrective open heart operation since 1997 are divided into 2 cohorts according to the enforcement of MUF (control group versus MUF group) retrospectively. Procedures, age, bodyweight, cardiopulmonary bypass (CPB) time, operation time, amount of donor blood use, postoperative inotrope dose, postoperative intubation time, and postoperative gas exchange capacity of lung expressed with respiratory index (RI) were compared between groups. ⋯ Multivariate analysis revealed that the enforcement of MUF was an independent correlate of postoperative RI. Analyses on the scattergrams revealed that the above mentioned favorable effects of MUF were prominent in the patients younger than 3 years or weighing less than 10 kg. We concluded that MUF had significant effects on pulmonary function preservation in pediatric open heart operations, especially for smaller children.
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Ann Thorac Cardiovasc Surg · Feb 2000
Effects of supplemental L-arginine during warm blood cardioplegia.
Effects of supplemental L-arginine, nitric oxide precursor, during warm blood cardioplegia were assessed in the blood perfused isolated rat heart. ⋯ The results suggest that augmented nitric oxide by adding L-arginine to warm blood cardioplegia can preserve left ventricular function and ameliorate endothelial inflammation. The technique can be a novel cardioprotective strategy in patients undergoing cardiac surgery.