The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Dec 1998
Comparative StudyAortic function in patients during intra-aortic balloon pumping determined by the pressure-diameter relation.
The physiologic basis for the hemodynamic and clinical improvement achieved by the use of intra-aortic balloon pumping in patients with cardiogenic shock has not been clarified in all its aspects. This study evaluated the possible contribution of pump-induced alterations of aortic mechanics to the overall benefit gained by the implementation of this therapeutic modality in patients with acute heart failure of ischemic origin. ⋯ During intra-aortic balloon pumping, aortic distensibility was improved, and wave reflection from the arterial periphery was reduced. The relationship between cardiac index and myocardial oxygen demand and aortic stiffness suggests that improvement of the elastic properties of the aorta was an important mechanism by which intra-aortic balloon pumping improved circulatory function.
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J. Thorac. Cardiovasc. Surg. · Dec 1998
Comparative StudyTotal repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collaterals: an integrated approach.
Predicting postrepair right ventricular/left ventricular pressure ratio has prognostic relevance for patients undergoing total repair of pulmonary atresia, ventricular septal defect, and major aortopulmonary collateral arteries. To this purpose, we currently rely on 2 novel parameters: (1) preoperative total neopulmonary arterial index and (2) mean pulmonary artery pressure changes during an intraoperative flow study. ⋯ The integrated approach to total repair of pulmonary atresia, ventricular septal defect, and major aortopulmonary collaterals by preoperative calculation of total neopulmonary arterial index, right ventricular outflow tract reconstruction (when required), and intraoperative flow study may lead to optimal intermediate results.
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J. Thorac. Cardiovasc. Surg. · Dec 1998
Comparative StudyEnoxaparin suppresses thrombin formation and activity during cardiopulmonary bypass in baboons.
This study tests the hypotheses that enoxaparin, a low molecular weight heparin and potent inhibitor of factor Xa, alone or in combination with standard heparin, inhibits thrombin formation and activity and modulates complement activation and neutrophil elastase release during cardiopulmonary bypass in baboons. ⋯ Enoxaparin significantly reduces thrombin formation and activity during cardiopulmonary bypass but does not suppress complement activation and neutrophil elastase release and is not adequately reversed by protamine after bypass.
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J. Thorac. Cardiovasc. Surg. · Dec 1998
Comparative StudyAnti-C5a monoclonal antibody reduces cardiopulmonary bypass and cardioplegia-induced coronary endothelial dysfunction.
Because C5a induces tissue injury by activating polymorphonuclear leukocytes, the hypothesis was that inhibition of C5a activity would reduce cardioplegia-related injury. ⋯ Inhibition of C5a limits neutrophil-mediated impairment of endothelium-dependent relaxation after cardiopulmonary bypass and cardioplegic reperfusion, but it has no effect on short-term myocardial functional preservation.