The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Dec 2010
Reproducibility of left atrial ablation with high-intensity focused ultrasound energy in a calf model.
Achieving transmural tissue ablation might be necessary for successful treatment of atrial fibrillation. The purpose of this study was to evaluate the reproducibility of transmural left atrial ablation using a high-intensity focused ultrasound energy system in a calf model. ⋯ Calf left atrial thickness in this study was greater than human left atrial thickness. Human left atrial thickness is generally less than 6 mm, and in this range high-intensity focused ultrasound ablation achieved 100% transmurality. These histological results might correlate with a high success rate of atrial fibrillation ablation by using the high-intensity focused ultrasound system.
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J. Thorac. Cardiovasc. Surg. · Dec 2010
Endothelin-1 is a useful biomarker for early detection of bronchiolitis obliterans in lung transplant recipients.
Bronchiolitis obliterans (BO) is a severe complication limiting long-term survival after lung transplantation. To date, no cure exists for BO, and the mechanisms leading to BO are not well understood. Endothelin-1 (ET-1) is a potent mitogenic and profibrotic peptide produced by pulmonary vascular endothelial cells that play a role in the pathophysiology of lung allograft dysfunction. Whether ET-1 could predict BO syndrome (BOS) development is unknown. ⋯ Elevated serum ET-1 concentrations were predictive of BOS, and the assessment of circulating ET-1 might be beneficial in diagnosing and monitoring BO.
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The term acute aortic syndrome refers to a heterogeneous group of conditions that cause a common set of signs and symptoms, the foremost of which is aortic pain. Various pathologic entities may give rise to this syndrome, but the topic has come to focus on penetrating aortic ulcer and intramural hematoma and their relation to aortic dissection. ⋯ It may represent a subcategory of aortic dissection that manifests different behavior by virtue of limited flow in the false lumen. This article reviews the current literature regarding acute aortic syndrome, focusing on management options.
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J. Thorac. Cardiovasc. Surg. · Dec 2010
Comparative StudyThe Bentall procedure: is it the gold standard? A series of 597 consecutive cases.
We compared aortic root reconstructions using conduits with biological valves and mechanical valves. ⋯ The choice of valve for aortic root reconstruction seems to have no influence on long-term outcome. Emergency operation and the presence of clot/atheroma have a significant impact on short-term outcome. Reoperation for either ascending aorta and/or aortic valve is low.
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J. Thorac. Cardiovasc. Surg. · Dec 2010
Measuring the collateral network pressure to minimize paraplegia risk in thoracoabdominal aneurysm resection.
To minimize paraplegia during thoracoabdominal aortic aneurysm repair, the concept of the collateral network was developed. That is, spinal cord perfusion is provided by an interconnecting complex of vessels in the intraspinal, paraspinous, and epidural space and in the paravertebral muscles, including intercostal and lumbar segmental as well as subclavian and hypogastric arteries. ⋯ After subtraction of a measure of spinal cord outflow pressure (cerebrospinal fluid pressure or central venous pressure), collateral network pressure provides a clinically useful estimate of spinal cord perfusion pressure.