The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jul 1984
Systemic-pulmonary shunts in infants and children. Early and late results.
From September, 1978, to January, 1983, 44 cyanotic infants and children underwent a systemic-pulmonary artery shunt for the treatment of reduced pulmonary blood flow. Age ranged from 18 hours to 4 years (mean age = 0.49 years). Weight ranged from 1.7 kg to 13.2 kg (mean weight = 4.9 kg). ⋯ Four shunts required early revision: one thrombosed central shunt, a kinked patent interposition Blalock-Taussig shunt, a small but patent Blalock-Taussig shunt, and one excessive Great Ormond Street type of Blalock-Taussig shunt. Two late deaths were probably shunt-related: one Blalock-Taussig and one central. All four types of shunts provided good palliation, but the Great Ormond Street type of Blalock-Taussig shunt is our preferred shunt because of (1) low operative risk, (2) predictable patency (100% in our series), (3) lack of distortion of pulmonary arterial anatomy, and (4) technical ease of insertion as well as takedown.
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J. Thorac. Cardiovasc. Surg. · Jul 1984
Comparative Study Clinical TrialLimitations of blood conservation.
Blood conservation has been most successful when blood salvage techniques have been combined with postoperative normovolemic hemodilution. The hemodynamic and myocardial metabolic responses to normovolemic hemodilution were assessed in a prospective randomized trial. Twenty-seven patients were randomized to receive either blood and colloid solutions (colloid group, 13 patients) or crystalloid fluids (crystalloid group, 14 patients) following elective coronary revascularization. ⋯ Volume loading and atrial pacing 3 to 5 hours postoperatively maintained myocardial lactate extraction in the colloid group but decreased myocardial lactate extraction to ischemic levels in the crystalloid group. The use of crystalloid rather than colloid fluids in the early postoperative period conserved blood products but resulted in postoperative anemia and was associated with a delay in myocardial metabolic recovery. Normovolemic hemodilution should be employed with caution in patients who are at risk of perioperative ischemic injury.