Przegla̧d lekarski
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The authors present the diagnostic and therapeutic management in bleeding episodes associated with cardiosurgical operations, which constitutes the policy that is employed at Department of Cardiac Surgery and Transplantology, Silesian Academy of Medicine, Zabrze, Poland. The paper also presents a compendium of information on the pathophysiology of coagulation processes, most significant from the standpoint of cardiosurgical practice. Separate issues associated with providing optimal hemostasis in patients operated on using cardiopulmonary bypass are discussed, along with the effect of cardiac procedures on coagulation processes. ⋯ In both described patients who were characterized by a high risk of surgical bleeding, the employment of the recombinant activated factor VII led to significant improvement in coagulation system indices and the hemostatic outcome was regarded positive. The authors state that the introduction of the recombinant activated factor VII to clinical practice in a selected group of patients presenting with most serious coagulation abnormalities and difficult to control perioperational bleeding allows for improving therapeutic results and decreasing mortality in cardiac surgery patients. In view of the significant economic barrier associated with a high cost of the preparation, the authors propose a consistent approach of employing at all times the classic, well-balanced hemostatic management, based primarily on extended knowledge of the pathophysiology of the clotting system and on very thorough surgical hemostasis, with the recombinant activated factor VII being reserved for exceptional situations only.
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Comparative Study
[Evaluation of surgical treatment results of coarctation of the aorta in neonates and young infants].
The authors present the analysis of surgical results obtained for coarctation of the aorta (CoA) in children less than 1 year of age. The material consisted of 103 infants (62 Males and 41 Females) aged 0.33-10.5 months (x = 3.3 +/- 2.6 months) treated between January 1, 1985 and December 31, 1999. All the patients were subjected to a detailed physical examination, ECG, chest X-ray and comprehensive echocardiography, while 12 children had additional hemodynamic studies and angiocardiography. Two groups were distinguished among the investigated children: Below 3 months of life (Group 1, N = 65) and above 3 months of life (Group 2, N = 38). In 69 infants, (including 55 from Group 1 and 14 from Group 2), the recommendation for surgery was circulatory failure, while in 34 infants (10 from Group 1 and 24 from Group 2), the recommendation for surgery considerable systemic hypertension with absent femoral pulses. In 76 patients, the Waldhausen procedure was performed, while 24 were subjected to aortic isthmus angioplasty using a Gore-Tex patch and 3 were subjected to end-to-end anastomosis. Six patients died, including 5 from Group 1 and 1 from Group 2. The remaining 97 infants (60 from Group 1 and 37 from Group 2) were followed-up for a mean period of 96.2 +/- 48.2 months. Postoperative recoarctation was encountered in 12 patients (12.4%); the condition was more predominant in Group 1 (16.6%) than in Group 2 (5.4%), but, no statistical significance was noted (Chi 2 = 2.677, p = 0.102). Despite the repair of aortic coarctation, systemic hypertension was noted in 17 children (17.5%) and it was equally common in both groups, but, twice as frequent in children with recoarctation. ⋯ 1. CoAo correction in children below 3 months of age is associated with an increased risk of recoarctation. 2. Even when surgical treatment of CoAo is attempted very early in life, the risk of elevated systemic blood pressure is not completely eliminated.
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Comparative Study
[The role of transesophageal echocardiography (TEE) in assessment of left ventricular tract obstruction].
Twelve children with subaortic stenosis were analysed. Nine of them developed left ventricular outflow obstruction after surgery for congenital heart disease (VSD + IAA, VSD + DORV, VSD + TGA, VSD + CoA) and then developed an isolated form of primary stenosis. ⋯ TTE was sufficient to assess isolated subaortic stenosis. In children after cardiosurgery, TEE was more reliable and provided more detailed visualisation of the stenosis and its relationship to surrounding structures.
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The aim of the study was to evaluate cardiopulmonary exercise capacity (WTS) in adult patients with atrial septal defect (ASD). After excluding 10 patients with additional cardiac, pulmonary or muscle diseases, 53 patients with ASD (Gr-ASD; mean age 37.8 +/- 14.9 years; 35 women, 19 men) were enrolled in our study. In addition, we evaluated 22 healthy age and gender matched control subjects (Gr-K; mean age 36.6 +/- 14.9 years; 13 women, 9 men). First, all subjects underwent resting spirometry and forced vital capacity--(FVC; % of predicted value), one-second forced expiratory volume--(FEV1; % of predicted value) and FEV1/FVC (%) were determined. Then each subject performed a symptom-limited, incremental exercise test (modo Bruce). We evaluated the following parameters of resting metabolism: respiratory rate--(RR; L/min), minute ventilation--(VE; L/min), tidal volume--(Vt; L), oxygen uptake--(VO2; ml/kg/min), end-tidal carbon dioxide pressure--(PET CO2; mmHg), end tidal oxygen pressure--(PET O2; mmHg), ventilatory equivalent for carbon dioxide--(VE/VCO2) and ventilatory equivalent for oxygen--(VE/VO2). The following exercise parameters were analysed: peak oxygen uptake--(VO2 peak; ml/kg/min), VO2 peak expressed as % of predicted value--(VO2 %N), anaerobic threshold--(AT; % VO2 max), ventilatory equivalent for carbon dioxide--(VE/VCO2), end-tidal carbon dioxide pressure--(PET CO2; mmHg), O2 pulse, time of exercise--(T; min) and time to AT--(TAT; min). In addition, we performed a subgroup analysis for ASD patients below and > or = 40 years of age. All values were expressed as mean +/- SD. ⋯ WTS allows appropriate evaluation of cardiopulmonary capacity in ASD patients, though the mechanisms underlying ventilatory and hemodynamic abnormalities are still not fully understood. Adult patients with ASD reveal ventilatory abnormalities with an age-related trend towards deterioration. Cardiopulmonary exercise capacity in adults with ASD is markedly reduced in comparison with healthy population and deteriorates with age. WTS complements echocardiographic and hemodynamic evaluation of patients with ASD, and is helpful in indicating patients for ASD closure and their follow up.
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The article presents most important changes in international guidelines for adult cardiopulmonary resuscitation. In this article guideline changes in basic and advanced life support published in Guidelines 2000 for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care--a Consensus on Science are discussed. Major changes in guidelines presented in this article include: pulse check, ventilation technique for rescue breathing, compression technique, abdominal thrust recommendations, precordial thump, universal algorithm changes.