J Cardiovasc Surg
-
Penetrating wounds of the anterior chest wall are often associated with cardiac tamponade. Eighty to ninety percent of stab wounds to the heart result in acute tamponade, whereas delayed cardiac tamponade or hemothorax are rare, but hurtful for the patient. Of the cases reviewed, fifty percent of the patients who underwent sternotomy required repair of cardiac injuries. The presented case report adds further justification for early sternotomy in case of precordial penetrating chest injury in the danger zone.
-
Operations on the open heart under perfusionless deep hypothermia were performed in 3,141 patients with congenital cardiac defects. The patients ages ranged from 3 months to 44 years. The body was cooled to 26-24 degrees C by covering with crushed ice. ⋯ The frequencies of neuropsychological complications were not related to the time of circulatory arrest. Unstable hemodynamics after operation was the most contributory factor to the development of neurological complications. Perfusionless deep hypothermia is an efficient method providing conditions for performance of open heart operations, and it can be used in surgical repair of congenital cardiac defects.
-
We evaluated cerebral metabolism during retrograde cerebral perfusion (RCP) and circulatory arrest under profound hypothermia, and also investigated the effect of pulsatile flow on RCP. Eighteen adult mongrel dogs were placed on cardiopulmonary bypass and were cooled to a nasopharyngeal temperature of 20 degrees C. At this temperature, hypothermic circulatory arrest (HCA; n = 6), non-pulsatile RCP (NP-RCP; n = 6), and pulsatile RCP (P-RCP; n = 6) were performed for 60 minutes. ⋯ The cerebral tissue water content was significantly lower in the P-RCP group than in the NP-RCP group. These findings suggest that hypothermia of the central nervous system, the supply of oxygen, the excretion of metabolites, aerobic metabolism, and the cerebral ATP level were maintained by RCP. In conclusion, RCP may possibly provide adequate metabolic support for the brain during total circulatory arrest, and pulsatile flow appears to reduce cerebral edema when compared with non-pulsatile flow in dogs.
-
Randomized Controlled Trial Comparative Study Clinical Trial
Femoral vein valve repair with limited anterior plication (LAP).
Limited anterior plication (LAP) of the incompetent femoral vein was used in 2 groups of subjects with venous hypertension due to deep and superficial venous incompetence. Group 1 subjects were treated only with superficial veins surgery while groups 2 was treated with external valvuloplasty (LAP) at the level of the incompetent femoral vein. The plication was performed at the anterior side of the vein after limited dissection and manipulation. ⋯ A lower AVP and RT was found in subjects treated with LAP in comparison with those in Group 1. Also the number of recurrent varicose veins (incompetent venous sites) and the average diameter of the femoral vein were higher in Group 2 (superficial surgery only). As no complications were observed LAP can be considered an alternative to the standard external valvuloplasty in cases of moderate incompetence when valve cusps are present and functional and incompetence is mainly due to relative enlargement of the vein diameter.
-
Review Case Reports
Aortoesophageal fistula secondary to thoracic aortic aneurysm repair.
The development of a fistula between the aorta and the oesophagus after graft replacement of the thoracic aorta is extremely rare. We report a case which occurred 3 years and 7 months after repair of an aneurysm of the descending thoracic aorta and review the previous reports of this uniformly fatal condition.