The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 2011
Hemodynamics and myocardial blood flow patterns after placement of a cardiac passive restraint device in a model of dilated cardiomyopathy.
The present study examined a cardiac passive restraint device which applies epicardial pressure (HeartNet Implant; Paracor Medical, Inc, Sunnyvale, Calif) in a clinically relevant model of dilated cardiomyopathy to determine effects on hemodynamic and myocardial blood flow patterns. ⋯ In a large animal model of dilated cardiomyopathy, the cardiac passive restraint device did not appear to adversely affect basal resting myocardial blood flow. However, after acute HeartNet Implant placement, left ventricular maximal coronary reserve was blunted. These unique results suggest that cardiac passive restraint devices that apply epicardial transmural pressure can alter myocardial blood flow patterns in a model of dilated cardiomyopathy. Whether this blunting of coronary reserve holds clinical relevance with chronic passive restraint device placement remains unestablished.
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J. Thorac. Cardiovasc. Surg. · Nov 2011
Wave energy patterns of counterpulsation: a novel approach with wave intensity analysis.
In counterpulsation, diastolic augmentation increases coronary blood flow and systolic unloading reduces left ventricular afterload. We present a new approach with wave intensity analysis to revisit and explain counterpulsation principles. ⋯ Intra-aortic balloon pumps generate backward-traveling waves that predominantly drive aortic and coronary blood flow during counterpulsation. Wave intensity analysis of arterial circulations may provide a mechanism to explain diastolic augmentation and systolic unloading of intra-aortic balloon pump counterpulsation.
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J. Thorac. Cardiovasc. Surg. · Nov 2011
The impact of body mass index on morbidity and short- and long-term mortality in cardiac valvular surgery.
Limited data exist on patients with cardiac cachexia or morbid obesity presenting for valvular heart surgery. The objective of this study was to investigate the relationship between body mass index and morbidity and mortality after valvular surgery. ⋯ Patients with body mass index 24 or less are at significantly increased risk of in-hospital and long-term mortality after cardiac valvular surgery. This high-risk patient population warrants careful risk stratification and options for less-invasive valve therapies.
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J. Thorac. Cardiovasc. Surg. · Nov 2011
Surgical palliation of primary pulmonary arterial hypertension by a unidirectional valved Potts anastomosis in an animal model.
Patients with idiopathic pulmonary hypertension are at risk for right-sided heart failure and sudden death. Despite improvement in pharmacologic management, some still require lung transplantation. Potts anastomosis has been demonstrated as a good palliation in children to alleviate symptoms and medical therapy despite desaturation in the lower part of the body. Young adult patients with pulmonary hypertension and isosystemic pressure remain at risk, particularly at exercise. The goal of this research was to find a palliation for patients in whom suprasystemic pulmonary hypertension developed at exercise. Creating a Potts anastomosis involved a unidirectional valve between the left pulmonary artery and the descending aorta. ⋯ Palliation of exercise suprasystemic pulmonary hypertension was demonstrated by a unidirectional valved Potts anastomosis. This technique can be of help in young adult patients with pulmonary hypertension and isosystemic pressure but with exercise intolerance.