The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Sep 1991
Diagnosis and management of purulent pericarditis. Experience with pericardiectomy.
Twelve cases of purulent pericarditis seen over 6 years are described. Staphylococcus aureus was the most common causative organism (six patients), and a respiratory infection was the most common preceding illness. The chest radiograph and echocardiogram were useful pointers to the diagnosis, but the electrocardiogram was not reliable. ⋯ The importance of early diagnosis before a significant degree of cardiac tamponade occurs is noted. Although there is general agreement that surgical drainage is mandatory, the approach, methods of drainage, and extent of pericardial resection have been the subject of some discussion, and at least seven techniques are available. We conclude that pericardiectomy has a definite place in the management of purulent pericarditis.
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J. Thorac. Cardiovasc. Surg. · Sep 1991
Continuous arterial and venous blood gas monitoring during cardiopulmonary bypass.
A new monitoring technique, based on optical fluorescence chemistry, allows continuous monitoring of all blood gas variables during cardiopulmonary bypass. To evaluate the clinical performance of this monitor, we drew 220 arterial and 216 venous blood samples from 15 patients, and simultaneous blood gas values displayed by the monitor were compared with standard laboratory measurements. The continuous monitor predicted laboratory values with varying degrees of accuracy. (R2 values by linear regression: arterial oxygen tension 0.86, venous oxygen tension 0.36, arterial carbon dioxide tension 0.58, venous carbon dioxide tension 0.72, arterial pH 0.53, venous pH 0.58; pH 0.53, venous pH 0.58; p less than 0.0001). ⋯ In conclusion, arterial and venous carbon dioxide tension and pH monitoring provide acceptably accurate alternatives to laboratory measurement of these variables during cardiopulmonary bypass. Arterial oxygen tension monitoring accurately indicates changes in oxygen tension in the arterial oxygen tension range typically produced during extracorporeal circulation. Oxygen tension monitoring in the venous oxygen tension range is too imprecise for clinical decision-making purposes.
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J. Thorac. Cardiovasc. Surg. · Sep 1991
Sternal wound infections and use of internal mammary artery grafts.
Previous studies have provided conflicting evidence as to whether an increased risk of mediastinitis is associated with use of the internal mammary artery as a coronary bypass graft. In this study the effects of internal mammary artery grafts on wound complications were analyzed in a prospective, nonrandomized fashion. At New York University Medical Center from January 1985 through May 1988, 2356 patients underwent isolated coronary revascularization. ⋯ The use of bilateral internal mammary artery grafting doubled the odds ratio of the risk compared with use of a single mammary graft, and the combination of diabetes and double internal mammary artery grafts increased the odds ratio 13.9-fold. Patients with an internal mammary artery graft who had sternal infection had a longer period of hospitalization than patients without a mammary artery graft who had sternal infection. We conclude that the risk of sternal infection is increased by the use of an internal mammary artery graft, especially use of double mammary grafts in the presence of diabetes.
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J. Thorac. Cardiovasc. Surg. · Sep 1991
Case ReportsResection of residual mediastinal germ cell masses with the Cavitron ultrasonic surgical aspirator.
Residual mediastinal masses after chemotherapy for germ cell tumors should be resected. Complete excision of bulky residual masses may sometimes be difficult because of problems with exposure in the region of the great vessels and important nerves. ⋯ Complete excisions were accomplished and no viable tumor was found, so that the patients were spared the immediate need for further therapy. Both had uneventful recoveries.
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J. Thorac. Cardiovasc. Surg. · Sep 1991
The evolution of single lung transplantation for emphysema. The Washington University Lung Transplant Group.
Classic transplantation dogma mandated bilateral lung replacement for lung transplant candidates with end-stage emphysema to avoid air trapping in the native lung and subsequent crowding of the newly transplanted lung. During a recent 12-month period 11 patients with emphysema received a single lung transplant. ⋯ Substantial improvement in pulmonary function was seen as early as 2 weeks after transplantation, with significant functional improvement seen by 6 weeks, despite some residual ventilation-perfusion mismatch. We have demonstrated the utility and safety of single lung transplantation for patients with end-stage emphysema, and it is our operation of choice in recipients more than 50 years of age.