The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Feb 1987
Influence of operations with cardiopulmonary bypass on polymorphonuclear leukocyte function in infants.
To determine the effect of operations with cardiopulmonary bypass on the immunologic function of polymorphonuclear leukocytes in infants, we studied polymorphonuclear leukocyte function and immunologic profile in 16 infants undergoing repair of congenital heart lesions. An oxygen/air/high-dose fentanyl anesthetic was used for all patients. Absolute neutrophil count increased significantly (p less than 0.05) after bypass and remained increased 48 hours afterward. ⋯ Serum opsonizing capacity to bacterial and fungal antigens was variably altered, and complement factors 3 and 4 decreased significantly after cardiopulmonary bypass. Total hemolytic complement decreased significantly immediately after cardiopulmonary bypass and returned to normal by 48 hours. These data suggest that operations with cardiopulmonary bypass in infants significantly affect the immunologic function of polymorphonuclear leukocytes and result in consumption of complement.
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J. Thorac. Cardiovasc. Surg. · Jan 1987
Extracorporeal membrane oxygenation for postoperative cardiac support in children.
Prolonged circulatory support for cardiac failure has been increasingly successful in adults but has had very limited use in children. From January 1982 to December 1985, 13 children with postoperative cardiac failure refractory to conventional therapy were treated with extracorporeal membrane oxygenation. Ages ranged from 9 days to 17.6 years (mean = 3.8 years); weights ranged from 2.8 to 50 kg (mean = 13.8 kg). ⋯ There has been one late death 6 months after oxygenator support was withdrawn. At most recent examination, five children were well, with normal cardiac function 7 months to 4.3 years postoperatively (mean = 32 months). This series suggests that profound cardiac insufficiency in children after cardiac operations can be successfully managed with extracorporeal membrane oxygenation with excellent functional recovery, although major complications are common in this critically ill group of patients.
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J. Thorac. Cardiovasc. Surg. · Jan 1987
Prosthetic heart valve replacement in children. Results and follow-up of 273 patients.
We report the results and long-term follow up in 273 children (aged 2 to 16 years) who underwent prosthetic valve replacement. Mechanical valves (mostly Starr-Edwards) were used in almost all, and in 62 children more than one valve was replaced. Operative mortality was 4.7%. ⋯ Thus valve replacement can be performed with low mortality in children, and with satisfactory long-term survival. Thromboembolism remains a significant problem, although it appears to be less common than in adults. In this study, treatment with antiplatelet drugs only did not carry a higher rate of thromboembolic events than did treatment with warfarin.
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The records of 165 patients with diaphragmatic injuries seen at Detroit Receiving Hospital from July 1980 through June 1985 were reviewed. Causes included gunshot wounds in 89 patients, stab wounds in 65, and blunt trauma in 11. Mortality rates were 18%, 5%, and 27%, respectively, deaths being caused primarily by bleeding from associated injuries. ⋯ However, even in these high-risk patients, if resuscitation raised the initial operating room blood pressure to more than 70 mm Hg, reduced the shock time to less than 30 minutes, and kept blood loss below 10 units, the mortality was only 8% (1/12). In contrast, if none of these conditions could be met, the mortality in this high-risk group was 100% (16/16). Thus more aggressive resuscitative efforts and earlier control of bleeding seem to provide the best chance for improved survival.
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Between 1953 and 1984, 53 patients (40 male and 13 female) underwent thoracotomy for treatment of pulmonary aspergilloma. The median age was 58 years (range 4 to 86 years). Either underlying lung disease or immunologic risk factors were present in 49 patients (92%). ⋯ Although operative mortality in patients with complex aspergilloma was high, 67% of the survivors had a good long-term result in terms of absence of symptoms, but they frequently died of underlying disease. In contrast, operation in patients with simple aspergilloma was done with low risk, and approximately 90% of survivors had a good late result. Late appearance of contralateral disease did occur and argues for rigorous postoperative surveillance.