J Cardiovasc Surg
-
Comparative Study
r-Hirudin inhibits platelet-dependent thrombosis during cardiopulmonary bypass in baboons.
Systemic anticoagulation is required during cardiopulmonary bypass (CPB) to inhibit the activation of platelets, the coagulation system and ultimately thrombus formation. Unfractionated heparin is most commonly used, but it is neither entirely safe nor completely effective. The use of protamine sulphate to reverse the anticoagulant effect further complicates the use of heparin. The clinical need for a heparin substitute is therefore obvious. We evaluated the efficacy of r-Hirudin, a potent and specific inhibitor of thrombin, as anticoagulant in a baboon model of cardiopulmonary bypass. ⋯ Our results strongly suggest that r-Hirudin is superior to heparin especially with respect to its inhibitory effect on platelet dependent thrombogenesis caused by the biomembranes of the oxygenator.
-
Comparative Study
Long-term results after correction of anterior chest wall deformities.
Surgical correction of pectus deformities was mainly performed for cosmetic and psychologic reasons but eventual cardiopulmonary symptoms improved. Whether this results from alterations in cardiopulmonary physiology is still controversial ⋯ The subjective physical improvement after operation cannot be explained by changes in static lung volumes or in cardiorespiratory function at exercise, but is due to other unexplained factors. Satisfactory subjective long-term results of most patients justify surgical correction. Both physical as well as psychologic and cosmetic factors may allow operative correction.
-
Tricuspid regurgitation caused by blunt chest trauma is generally quite tolerable for a long time in a clinical setting. This article reports on a 68-year-old patient suffering from progressive dyspnea after a blunt chest trauma having occurred 5 months previously. Flu-like symptoms occurred for several days before severe respiratory distress began upon the day of admission. ⋯ Cyanotic congestive heart failure occurred suddenly. He underwent emergency surgical repair with success. Based on the results presented herein, we recommend that early diagnosis be made for traumatic regurgitation and endocarditis by echocardiography so as to ensure therapeutic intervention.