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. · Nov 1998
Selective anticoagulation with active site-blocked factor IXA suggests separate roles for intrinsic and extrinsic coagulation pathways in cardiopulmonary bypass.
Multiple stimuli converge in cardiopulmonary bypass to create a tremendous prothrombotic stimulus. The ideal anticoagulant for cardiopulmonary bypass should selectively target only the intravascular stimuli, thereby eliminating pathologic clotting in the bypass circuit while preserving hemostasis in the thoracic cavity. We propose the inhibition of factor IX as such a targeted anticoagulant strategy. ⋯ Anticoagulation with activated factor IX allows for intravascular anticoagulation with maintenance of extravascular hemostasis. These findings suggest activated factor IX as an agent that not only exemplifies a targeted approach to selective anticoagulation in cardiac surgery but also further characterizes the procoagulant milieu during cardiopulmonary bypass.
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J. Thorac. Cardiovasc. Surg. · Nov 1998
Postischemic hyperthermia exacerbates neurologic injury after deep hypothermic circulatory arrest.
Aggressive surface warming is a common practice in the pediatric intensive care unit. However, recent rodent data emphasize the protective effect of mild (2 degrees - 3 degrees C) hypothermia after cerebral ischemia. This study evaluates different temperature regulation strategies after deep hypothermic circulatory arrest with a survival piglet model. ⋯ Mild postischemic hyperthermia significantly exacerbates functional and structural neurologic injury after deep hypothermic circulatory arrest and should therefore be avoided.