The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jan 2011
Pericardial effusions in the cancer population: prognostic factors after pericardial window and the impact of paradoxical hemodynamic instability.
In the cancer population, pericardial effusions are a common and potentially life-threatening occurrence. Although decompression benefits most patients, paradoxical hemodynamic instability (PHI) develops in some, with hypotension and shock in the immediate postoperative period. This study examines paradoxical hemodynamic instability after pericardial window and identifies prognostic factors in patients with cancer who are treated for pericardial effusion. ⋯ Postoperative hemodynamic instability after pericardial window portends a grave prognosis. Evidence of tamponade, larger effusion volumes, and positive cytologic findings may predict a higher risk of paradoxical hemodynamic instability and anticipate a need for invasive monitoring and intensive care postoperatively.
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J. Thorac. Cardiovasc. Surg. · Jan 2011
Comparative StudyPulmonary hepatic flow distribution in total cavopulmonary connections: extracardiac versus intracardiac.
Pulmonary arteriovenous malformations can occur after the Fontan procedure and are believed to be associated with disproportionate pulmonary distribution of hepatic venous effluent. We studied the effect of total cavopulmonary connection geometry and the effect of increased cardiac output on distribution of inferior vena caval return to the lungs. ⋯ Extracardiac and intracardiac total cavopulmonary connections have inherently different streaming characteristics because of contrasting mixing characteristics caused by their geometric differences. Pulmonary artery diameters and inferior vena caval offsets might together determine hepatic flow streaming.
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J. Thorac. Cardiovasc. Surg. · Jan 2011
Does early surgical intervention improve left ventricular mass regression after mitral valve repair for leaflet prolapse?
Left ventricular hypertrophy is associated with adverse cardiovascular outcomes. It is unclear whether hypertrophy caused by severe chronic mitral regurgitation regresses after mitral valve repair and, if so, which factors promote reverse remodeling and influence its prognostic significance. ⋯ Performing mitral valve repair before a decrease in left ventricular ejection fraction and the development of significant secondary tricuspid valve regurgitation is associated with a greater likelihood of significant regression of left ventricular mass, possibly predicting improved recovery of normal left ventricular function after surgical intervention. These data provide additional support for early degenerative mitral valve repair.
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J. Thorac. Cardiovasc. Surg. · Jan 2011
Short- and long-term outcomes of 1000 adult lung transplant recipients at a single center.
Lung transplantation has become accepted therapy for end-stage pulmonary disease. The objective of this study was to review a single-institution experience of adult lung transplants. ⋯ Five-year survival has improved over the study period, but long-term outcomes are limited by bronchiolitis obliterans syndrome. Primary graft dysfunction is associated with higher rates of bronchiolitis obliterans syndrome and impaired short- and long-term survival. A better understanding of primary graft dysfunction and bronchiolitis obliterans syndrome is critical to improve outcomes.