The heart surgery forum
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The heart surgery forum · Jan 2007
Case ReportsGiant right atrial myxoma mimicking hepatic cirrhosis: a case report.
Cardiac myxomas are rare benign tumors of the heart. The growth rate of these tumors remains unknown. Right atrial myxoma can simulate nonspecific constitutional symptoms, such as remittent or lasting fever, weight loss, and chronic anemia, and may escape timely diagnosis until the development of severe complications such as pulmonary hypertension due to embolism from fragments originating from the tumor mass or blockage of the right atrioventricular ostium or Budd-Chiari syndrome with acute abdominal pain. We present a case of a giant right atrial myxoma mimicking hepatic cirrhosis in a 52-year-old man.
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The heart surgery forum · Jan 2007
Case ReportsA novel approach for off-pump atrial septostomy applications.
Atrial septostomy or septectomy are required to enable atrial mixture in various congenital cardiac lesions. The aim of this article was to introduce a technique where atrial septostomy application could be employed off pump with the aid of a new device. ⋯ We report the results of 7 patients for whom we employed our technique successfully using a new combined device as an alternative to traditional methods. The major advantage of our approach was avoiding detrimental effects of cardiopulmonary bypass applications.
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The heart surgery forum · Jan 2007
Comparative StudyEpidural anesthesia improves outcome and resource use in cardiac surgery: a single-center study of a 1293-patient cohort.
Thoracic epidural anesthesia (TEA) combined with general anesthesia in cardiac surgery has the potential to initiate earlier spontaneous ventilation and extubation, improved hemodynamics, less arrhythmia or myocardial ischemia, and an attenuated neurohormonal response. The aim of the current study was to characterize the correlation between TEA and postoperative resource use or outcome in a consecutive-patient cohort. The study was performed in a tertiary care, 3-surgeon, university-affiliated hospital that performs 350 to 400 cardiac surgeries per year. ⋯ Total ICU costs decreased from US $18,700 to $9900 per patient. Combining TEA and general anesthesia for cardiac surgery allows a significant change in anesthesia strategy. This change improves immediate postoperative outcomes and reduces the use and costs of ICU resources.
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The heart surgery forum · Jan 2007
High-risk patients with multivessel disease--is there a role for incomplete myocardial revascularization via minimally invasive direct coronary artery bypass grafting?
Patients with multivessel disease with high predicted mortality for conventional coronary artery bypass grafting (CABG) and the left anterior descending coronary artery (LAD) as the major target vessel may be suitable for minimally invasive direct coronary artery bypass (MIDCAB) despite incomplete revascularization. ⋯ Incomplete revascularization via MIDCAB is a safe and effective procedure in selected patients with multivessel disease. Compared to conventional CABG in high-risk patients, MIDCAB carries a lower incidence of inhospital death, neurological events, and perioperative myocardial infarction with comparable midterm results.
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The heart surgery forum · Jan 2007
Detection of coronary arteries and evaluation of anastomoses with a commercially available 15-MHz, broadband, linear array transducer.
In coronary artery bypass surgery the detection of the target vessels can be difficult due to their intramural location, coverage by adipose tissue, calcification, or fibrous tissue formation. Their identification is especially critical during off-pump coronary artery bypass (OPCAB) and minimally invasive direct coronary artery bypass (MIDCAB) surgeries. Our objectives were to identify whether (1) the epimyocardial use of the broadband linear array transducer CL15-7 allows a clear and rapid identification of the target artery during on-pump coronary bypass (CPB), OPCAB and MIDCAB surgeries; and (2) if this transducer is helpful in investigating the anastomotic morphology with 2D and color flow Doppler. ⋯ The CL15-7 transducer gives excellent near field visibility of the LAD and RCA. This is extremely valuable for the safe dissection of these vessels, especially during off-pump coronary surgery. The anatomical morphology of the anastomoses can be identified but, due to the shape of the transducer handle, only the coronary arteries on the anterior surface of the heart can be evaluated. A flexible, rather than a rigid, hockey stick-shaped handle would eliminate this problem. Training is essential to obtain reliable results.