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 · Dec 2007
Enhanced hemolysis in pediatric patients requiring extracorporeal membrane oxygenation and continuous renal replacement therapy.
Hemolysis during extracorporeal membrane oxygenation (ECMO) may be associated with the development of hemoglobinuria (Hb) nephropathy and acute renal failure. For patients requiring ECMO, continuous renal replacement therapy (CRRT) can be simultaneously performed by attaching a hemofilter to the ECMO circuit, thereby shunting part of the ECMO blood flow through the hemofilter. However, the possibility that CRRT may further enhance hemolysis (and the risk of Hb nephropathy) in patients on ECMO has not been previously investigated. ⋯ Our findings suggest that there is enhanced hemolysis during combined ECMO and CRRT compared with ECMO alone. However, the clinical impact of increased hemolysis on renal function in patients receiving ECMO with or without CRRT remains to be determined.
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Ann Thorac Cardiovasc Surg · Oct 2007
Case ReportsLate-period-onset chylothorax after a pulmonary resection for lung cancer: a case report.
A 65-year-old female had been diagnosed with right lung cancer by her family physician, and she was introduced to our Department of Thoracic Surgery at Matsuyama Red Cross Hospital in May 2004. She underwent a right upper lobectomy and wedge resection of S6 with the systematic dissection of her mediastinal lymph nodes. ⋯ Chylothorax occurred in postoperative day 34. The patient initially received conservative therapy, but subsequently underwent surgical treatment and fibrin glue intubation when conservative therapy proved to be unsuccessful.
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Ann Thorac Cardiovasc Surg · Aug 2007
Case ReportsA case of aortoenteric fistula following abdominal aortic reconstruction.
We report the case of a 64-year-old male patient with graft-enteric fistula. This complication might have been induced by sigmoid colonic ischemia resulting from injury to the mesocolon during abdominal aortic reconstruction. ⋯ Two further emergent operations were required to obtain complete remission from this complication, comprising bilateral extra-anatomical axillofemoral bypass grafts and infected graft removal, followed by an operation for left common iliac artery stump disruption. Although the patient remained in good health for 3 years with no complications, he died of aortic stump disruption 43 months after the last operation.
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A rotary blood pump may be implanted as a bridge to cardiac transplantation. Also, mechanical, histological, and biochemical improvements have been described in cardiac function after the implantation of a left ventricular assists device (LVAD). Thus there is considerable enthusiasm that LVAD might be used as a bridge to the recovery of myocardial function. Unlike a pulsatile pump, however, we cannot stop the rotary blood pump to estimate cardiac function. If the rotary blood pump stops, back flow will occur. In this study, a new method was examined that can estimate cardiac function without stopping the pump. ⋯ This method is simple and useful for estimating the cardiac function without pump stoppage.
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Ann Thorac Cardiovasc Surg · Aug 2007
Case ReportsEarly initiation of polymyxin B-immobilized fiber therapy effective for septic shock after aortic replacement.
A 76-year-old female underwent ascending aorta and partial arch replacement. She developed septic shock on postoperative day 6. She was administered dopamine, 10 microg x kg(-1) x min(-1); dobutamine, 5 microg x kg(-1) x min(-1); and norepinephrine, 0.3 microg x kg(-1) x min(-1). ⋯ Direct hemoperfusion using polymyxin B-immobilized fiber (PMX-DHP) was started; 3 h later, the blood pressure increased to 118/54 mmHg. Norepinephrine was stopped, and dopamine and dobutamine doses were decreased to 5 microg x kg(-1) x min(-1) 3 and 12 h after completing PMX-DHP, respectively. In suspected septic shock, early PMX-DHP simultaneously with drug treatment facilitates hemodynamic improvement.