The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jul 2015
Quantifying "normalized" regional left ventricular contractile function in ischemic coronary artery disease.
When significant coronary lesions are identified by angiography, regional left ventricular (LV) contractile function often plays a role in determining candidacy for revascularization. To improve on current subjective and nonquantitative metrics of regional LV function, we tested a z-score "normalization" of regional strain information quantified from clinically acquired high-resolution LV geometric datasets. ⋯ Nonsubjective normalization of regional LV contractile function by z-score calculation from a normal human strain database can localize and quantitatively display regional wall motion abnormalities in patients with CAD. This high-resolution localization of regional wall motion abnormalities may help improve the accuracy of therapeutic intervention in patients who have CAD.
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J. Thorac. Cardiovasc. Surg. · Jul 2015
Subclinical seizures identified by postoperative electroencephalographic monitoring are common after neonatal cardiac surgery.
The American Clinical Neurophysiology Society recommends continuous electroencephalographic monitoring after neonatal cardiac surgery because seizures are common, often subclinical, and associated with worse neurocognitive outcomes. We performed a quality improvement project to monitor for postoperative seizures in neonates with congenital heart disease after surgery with cardiopulmonary bypass. ⋯ Continuous electroencephalographic monitoring identified seizures in 8% of neonates after cardiac surgery with cardiopulmonary bypass. The majority of seizures had no clinical correlate and would not have been otherwise identified. Seizure occurrence is a marker of greater illness severity and increased mortality. Further study is needed to determine whether seizure identification and management lead to improved outcomes.
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J. Thorac. Cardiovasc. Surg. · Jul 2015
Risk factors for acute kidney injury after surgery of the thoracic aorta using antegrade selective cerebral perfusion and moderate hypothermia.
The development of acute kidney injury (AKI) in cardiac surgery is associated with increased morbidity and mortality. The aim of the study was to assess the incidence and risk factors for AKI after thoracic aorta surgery, using antegrade selective cerebral perfusion (ASCP) and moderate hypothermia. ⋯ The incidence of AKI after thoracic aorta surgery is fairly common, and its occurrence strongly affects outcomes. Preoperative renal status and preoperative conditions are the main influences on AKI development. Predictive models can be improved by adding intraoperative and postoperative variables.
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J. Thorac. Cardiovasc. Surg. · Jul 2015
Is bronchoscopy necessary in the preoperative workup of a solitary pulmonary nodule?
This study evaluated the role of conventional bronchoscopy in the preoperative workup of patients with solitary pulmonary nodules (SPNs). ⋯ In the preoperative evaluation of SPN, bronchoscopy is most likely to reveal malignancy in larger SPNs and in male patients. Bronchoscopy is not indicated in SPNs that present with ground-glass opacity on computed tomography scan.