The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Aug 1983
Transient hemodynamic dysfunction after myocardial revascularization. Temperature dependence.
We studied hemodynamics and the effects of right atrial pacing (110 beats/min) following complete myocardial revascularization and hypothermic multidose potassium crystalloid cardioplegia in 12 patients with a normal preoperative left ventricular ejection fraction (LVEF). Measurements were made immediately preoperatively, postoperatively at specified temperatures during the rewarming period (90 degrees F, 94 degrees F, and 98 degrees F), and at 24 hours. No patient had a perioperative myocardial infarction. ⋯ During the rewarming period, there was an inverse relationship between cardiac index and SVRI (r = -0.87). In conclusion, after myocardial revascularization: (1) transient hemodynamic dysfunction occurs during the rewarming period (90 degrees F to 98 degrees F); (2) this dysfunction is temperature-dependent; and (3) right atrial pacing at 110 beats/min does not improve hemodynamic function during the rewarming period. Temperature must be considered in the evaluation of left ventricular and hemodynamic function following myocardial revascularization.
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This report describes our experience with the operative stabilization of flail chest with the use of Judet's struts. In a series of 18 patients with flail chest, the method allowed shorter duration of artificial ventilation and decreased functional sequelae. We find this technique to be better than previously published methods, since it provides better stabilization and immobilization of the ribs and thus obviates the need for artificial ventilation.