J Cardiovasc Surg
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Randomized Controlled Trial Clinical Trial
The use of exogenous creatine phosphate for myocardial protection in patients undergoing coronary artery bypass surgery.
A key component in the development of ischemic functional and structural myocardial injury during cardiosurgical procedures is an inadequate cellular energy supply which occurs as a consequence of the cessation of oxidative metabolism. In such conditions high energy phosphates are rapidly depleted. As they play a critical role in the maintenance of cell viability and postischemic recovery of contractile function, their conservation is therefore a primary objective in any procedure designed to reduce ischemic injury. ⋯ Concluding, the authors wish to state that: Exogenous phosphocreatine (Neoton) perioperative administration in coronary artery bypass patients reduced the need for inotropic drugs, which is clinically manifested in lower frequency of low cardiac output syndrome. Perioperative administration of exogenous CP improves electrophysiological stability of the myocardium. Advantageous clinical and electrophysiological effect of exogenous CP may result from its properties to protect sarcolemma of the cardiomyocytes.
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Case Reports
Membranous obstruction of the inferior vena cava and Budd-Chiari syndrome. Report of a case.
Membranous obstruction of the inferior vena cava (MOIVC) is a rare, congenital or acquired, cause of Budd-Chiari syndrome leading to hepatocellular carcinoma in 20 to 40% of the patients. It has a very poor prognosis when treated medically and balloon angioplasty (PTA) represents, nowadays, the treatment of choice, having no mortality or significant morbidity with follow-up as long as 5 years; transatrial membranotomy, direct reconstruction of IVC and bypass surgery are alternative techniques when PTA is not feasible. ⋯ A successful inferior vena cava-right atrium PTFE bypass, with a 3.5-year follow-up, was performed. This surgical approach is a valuable alternative to transatrial membranotomy and direct reconstruction of the IVC.
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Late cardiac tamponade after open heart surgery is a relatively uncommon, but potentially serious complication. We retrospectively analyzed 14 patients who had posterior cardiac tamponade 13 to 210 days after open heart surgery. ⋯ 2-D echocardiography guid pericardiocentesis through left anterior axillary line was found to be a useful, safe, and simple technique. It can be used as an alternative treatment to surgical pericardiotomy for posterior cardiac tamponade after open heart surgery.
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Case Reports
Pseudoaneurysm of the left ventricle following repair for ventricular septal perforation.
The patient was a 64-year-old man who was treated surgically for an infarct-related ventricular septal perforation. Pseudoaneurysm of the left ventricle was recognized on the 38th postoperative day. ⋯ It seemed that insufficient resection of the infarcted myocardium was performed during the initial surgery to avoid narrowing the ventricular dimension by direct closure of the left ventricle, but this resulted in pseudoaneurysm of the left ventricle. Left ventricular free wall plasty with a patch should be performed during the initial surgery.
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We describe a simple technique to prevent the lower limb ischemia during femoral veno-arterial cardiopulmonary support (CPS). ⋯ Active perfusion through a 14-gauge Teflon catheter downstream to the ipsilateral SFA is effective in preventing lower limb ischemia during prolonged femoral veno-arterial CPS after cardiac surgery.