The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Feb 1999
Comparative StudyRole of the endothelium in placental dysfunction after fetal cardiac bypass.
Fetal cardiac bypass causes placental dysfunction, characterized by increased placental vascular resistance, decreased placental blood flow, hypoxia, and acidosis. Vasoactive factors produced by the vascular endothelium, such as nitric oxide and endothelin 1, are important regulators of placental vascular tone and may contribute to this placental dysfunction. ⋯ The basal endothelial regulatory mechanisms of placental vascular tone were deranged after fetal cardiac bypass. Endothelin receptor blockade, which substantially reduced postbypass placental dysfunction, and other interventions aimed at preserving endothelial function may be effective means of optimizing fetal outcome after cardiac bypass.
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J. Thorac. Cardiovasc. Surg. · Feb 1999
Comparative StudyAtrial fibrillation after minimally invasive coronary artery bypass grafting: A retrospective, matched study.
Atrial fibrillation after cardiac operations is a source of morbidity and resource consumption. Various factors common to cardiac operations have been cited as causal. Comparison of the incidences of atrial fibrillation after conventional cardiac operations and minimally invasive cardiac operations may provide some insight into the mechanisms of this complication. ⋯ According to these data, mechanisms traditionally implicated in atrial fibrillation after coronary artery bypass grafting, such as the use of cardiopulmonary bypass, mechanical manipulation of the atrium, and atrial ischemia, are not causal but may be related to the duration of the arrhythmic complication. Strategies directed toward management and reduction of the incidence of postoperative atrial fibrillation should be focused accordingly.
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J. Thorac. Cardiovasc. Surg. · Feb 1999
Comparative StudyVesnarinone and amrinone reduce the systemic inflammatory response syndrome.
The systemic inflammatory response is an important cause of organ dysfunction. The present study tested the hypothesis that 2 clinically used agents, amrinone and vesnarinone, would decrease inflammation and cardiac dysfunction in a relevant model of systemic inflammatory response activation. ⋯ Vesnarinone and amrinone, which are used clinically for their inotropic and vasodilating properties, may be useful to limit inflammatory activation and consequent organ dysfunction. Structure-activity and/or pharmacokinetic between the compounds may be important, particularly in preventing inflammatory signaling within certain tissues.
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J. Thorac. Cardiovasc. Surg. · Feb 1999
Results of 102 cases of complete repair of congenital heart defects in patients weighing 700 to 2500 grams.
Published data suggest that low birth weight is a risk factor for poor outcome in corrective surgery for many cardiac defects. Congenital heart defects in low birth weight infants are typically managed with supportive therapy or palliative operations, with definitive repair delayed. The morbidity associated with such approaches is high. ⋯ In general, delaying repair of congenital heart defects in low birth weight infants does not confer a benefit and is associated with higher preoperative morbidity. Complete repair of both simple and complex lesions can be achieved in such cases with good results. Growth after repair approximates the normal curve for low birth weight infants without heart disease. It is recommended that such infants, especially when they have symptoms, undergo early surgical repair rather than prolonged medical management or other forms of palliation.