The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 2003
Comparative StudyGene expression profile after cardiopulmonary bypass and cardioplegic arrest.
This study examines the cardiac and peripheral gene expression responses to cardiopulmonary bypass and cardioplegic arrest. ⋯ By establishing a profile of the gene-expression responses to cardiopulmonary bypass and cardioplegia, this study allows a better understanding of their effects and provides a framework for the evaluation of new cardiac surgical modalities directly at the genome level.
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J. Thorac. Cardiovasc. Surg. · Nov 2003
Comparative StudyInhaled nitric oxide versus prostacyclin in chronic shunt-induced pulmonary hypertension.
Cardiac surgery for congenital heart defects is commonly complicated by shunt-induced chronic pulmonary hypertension and associated acute hypertensive crises. To investigate the effects of vasodilators in chronic and acute pulmonary hypertension, we used the innominate artery to create a growing aortopulmonary shunt in young piglets. ⋯ A growing aortopulmonary shunt in the young pig is a reliable model of chronic pulmonary hypertension, with medial hypertrophy, increased resistance, and increased elastance. In this model inhaled nitric oxide is a better pulmonary vasodilator than intravenous prostacyclin, with neither drug having a specific inotropic effect, and normal coupling is preserved in chronic and acute pulmonary hypertension.
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J. Thorac. Cardiovasc. Surg. · Nov 2003
Comparative StudyFacilitated endoscopic beating heart coronary artery bypass grafting using a magnetic coupling device.
Suturing of a coronary anastomosis in totally endoscopic coronary artery bypass grafting on the beating heart is technically demanding. The potential benefits of the endoscopic Magnetic Vascular Positioner device (Ventrica, Inc, Fremont, Calif) to facilitate construction of a coronary anastomosis in a closed chest environment were evaluated. ⋯ The combination of robotic technology allowing for dexterous manipulation in a closed chest environment and a simple yet effective and timesaving technique for anastomotic coupling may facilitate beating heart totally endoscopic coronary artery bypass grafting.
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J. Thorac. Cardiovasc. Surg. · Nov 2003
Comparative StudyThe antioxidant N-acetylcysteine preserves myocardial function and diminishes oxidative stress after cardioplegic arrest.
Oxidative stress contributes to myocardial ischemia-reperfusion injury. We hypothesized that administration of the antioxidant N-acetylcysteine would have beneficial effects on myocardial function after cardiopulmonary bypass and cardioplegic arrest. ⋯ Administration of the antioxidant N-acetylcysteine preserves systolic function and enhances myocardial edema resolution after cardiopulmonary bypass/cardioplegic arrest. Furthermore, oxidative stress was significantly reduced in the treated animals. Therefore, our findings support the hypothesis that oxidative stress is the main cause for myocardial dysfunction after ischemia-reperfusion.
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J. Thorac. Cardiovasc. Surg. · Nov 2003
Home surveillance program prevents interstage mortality after the Norwood procedure.
To determine whether early identification of physiologic variances associated with interstage death would reduce mortality, we developed a home surveillance program. ⋯ Daily home surveillance of arterial oxygen saturation according to pulse oximetry and weight selected patients at increased risk of interstage death, permitting timely intervention, primarily with early stage 2 palliation, and was associated with improved interstage survival. Diminished growth identified 4 to 5 months after the Norwood procedure brings into question the value of delaying stage 2 palliation beyond 5 months of age.