The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Feb 1985
Indications for ultrafiltration in the cardiac surgical patient.
Ultrafiltration is an extracorporeal technique that employs the principle of convective solute transport across a semipermeable membrane and by which plasma water is removed from blood. Ultrafiltration has been employed in 74 cardiac surgical patients intraoperatively, preoperatively, and postoperatively. In 55 patients with clinical evidence of excess body water, the ultrafilter was employed at the start of cardiopulmonary bypass. ⋯ One patient underwent slow continuous ultrafiltration for severe, diuretic-resistant congestive heart failure postoperatively. After 9 days of ultrafiltration, there was an 8 kg weight loss, an improvement in congestive heart failure, and a return of the response to diuretics. From this experience my colleagues and I have developed the following indications for ultrafiltration in the cardiac surgical patient: during cardiopulmonary bypass to prevent further fluid accumulation in the patient with clinical evidence of excess body water; during bypass to prevent excess fluid balance in a patient whose bypass time will be greater than 2 hours; during bypass when the pump reservoir volumes are excessive and/or the hematocrit is less than 18%; preoperatively or postoperatively to increase caloric intake in the fluid-overloaded patient; and preoperatively or postoperatively to reverse severe congestive heart failure in the diuretic-resistant patient.
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J. Thorac. Cardiovasc. Surg. · Feb 1985
The surgical treatment of atrial myxomas. Clinical experience and late results in 33 patients.
Thirty-three patients (28 female and five male) from 17 to 70 years of age (mean age 48 years) underwent excision of left atrial myxomas between 1957 and 1981 at The Cleveland Clinic Foundation. Twenty-four patients presented with congestive heart failure, three with tachyarrhythmias, two with syncope, and one each with angina, peripheral embolization, hemoptysis, and recurrent pleural effusions. Symptoms were present from 1 to 72 months before operation (mean 11.2 months). ⋯ Altogether, 24 patients have been studied by two-dimensional echocardiography up to 20 years after operation (mean 4.0 years). In this series, excellent results were obtained by simple excision of the tumor, with or without a margin of normal atrial septum. Long-term clinical and echocardiographic follow-up is recommended since late recurrence, although rare, has been reported.
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J. Thorac. Cardiovasc. Surg. · Feb 1985
Modified Blalock-Taussig shunt in infants and young children. Clinical and catheterization assessment.
The effectiveness of 19 modified Blalock-Taussig shunts performed with expanded polytetrafluoroethylene was evaluated clinically and by cardiac catheterization with angiography 4 to 24 months after operation. Fifteen patients underwent operation in infancy. Conduit diameters included 4 mm (nine cases), 5 mm (eight cases), and 6 mm (two cases) sizes. ⋯ There were no deaths. Thirteen children underwent more complete elective cardiac repair 5 to 24 months later. Although the modified Blalock-Taussig procedure is an effective short-term alternative to the classic Blalock-Taussig shunt, the effectiveness of the 4 mm diameter conduit may be limited without postoperative anticoagulant therapy.
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J. Thorac. Cardiovasc. Surg. · Feb 1985
Venoarterial bypass: a technique for spinal cord protection.
In the present study, we examined the effects of various levels of oxygen tension on spinal cord blood flow while using somatosensory evoked potentials to monitor spinal cord sensory function during hypoxia. In this experiment, six adult, mongrel dogs were heparinized and placed on right atrial-femoral artery bypass with an oxygenator in the bypass circuit. The aorta was cross-clamped proximal to the left subclavian artery, and bypass flow and fluid balance were adjusted so as to maintain a distal aortic perfusion pressure of greater than 80 mm Hg. ⋯ The somatosensory evolved potential signal was invariably present as long as the distal aortic pressure was greater than 80 mm Hg; there were several transient hypotensive episodes (less than 5 minutes), which were accompanied by reversible loss of somatosensory evolved potentials. The spinal cord blood flow increased from 13.6 to 119.7 ml/100 gm/min as the distal oxygen tension fell to a mean value of 30 mm Hg, while latency of somatosensory evolved potentials increased 19.3% and amplitude decreased 43.3%. These results suggest the following conclusions: (1) In response to hypoxia, spinal cord blood flow dramatically increases and somatosensory evolved potentials deteriorate (increase in latency and decrease in amplitude). (2) However, during prolonged hypoxia, spinal cord sensory function can be maintained by sufficiently high flow rates and perfusion pressures. (3) Somatosensory evolved potentials can be used to monitor continuously spinal cord sensory function under these conditions.