The heart surgery forum
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The heart surgery forum · Jan 2007
Case ReportsSuperior vena cava rupture during balloon angioplasty and stent placement to relieve superior vena cava syndrome: a case report.
Percutaneous stenting of the superior vena cava (SVC) has been an accepted therapy for SVC syndrome for more than a decade. Complications are uncommon and usually of minor consequence. ⋯ We report a fourth case of SVC rupture during angioplasty and stenting that required immediate pericardiocentesis followed by open surgical repair via sternotomy for direct control and repair. An algorithm for rapid recognition and prompt intervention is described.
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The heart surgery forum · Jan 2007
Good recovery after nontransthoracic cardiopulmonary bypass in rats.
Cardiopulmonary bypass (CPB) has been shown to be associated with systemic inflammatory response leading to postoperative organ dysfunction. Unwanted side effects of CPB are well known but poorly understood due to the absence of a stable recovery animal model that is easy to handle and reduces experiment cost and time. The purpose of this study was to establish a good recoverable rat model of CPB to study the pathophysiology of these potential complications. ⋯ The rat model of CPB can in principle simulate the clinical setting of human CPB. The non-transthoracic model is easy to establish and is associated with excellent recovery. This reproducible model may open the field for various studies on the pathophysiological process of CPB and systemic ischemia-reperfusion injury in vivo.
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The heart surgery forum · Jan 2007
A novel mechanical circulatory approach for patients with cardiogenic shock in the intensive care unit.
The capacity of the heart to maintain cardiac output can be acutely impaired as a result of myocardial infarction, graft failure after transplantation, or other cardiac events. Medical therapy or the use of an intra-aortic balloon pump may be insufficient to help the patient overcome acute cardiogenic shock. The set-up of mechanical assist devices such as extracorporeal membrane oxygenation or patient relocation into the operating room requires valuable time that is often not available. The aim of our study was to test whether a novel left ventricular assist device can be percutaneously implanted without fluoroscopy under echocardiographic navigation in a preclinical model. ⋯ The ability to abstain from fluoroscopy and the feasibility of inserting the afferent cannula across the interatrial septum guided by TEE allows for application of this system in intensive care units, saving precious time as well as financial and human resources.
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The heart surgery forum · Jan 2006
Randomized Controlled TrialThe changes and effects of the plasma levels of tumor necrosis factor after coronary artery bypass surgery with cardiopulmonary bypass.
Systemic inflammatory response after cardiopulmonary bypass (CPB) is thought to result from contact of cellular and humoral blood components with the synthetic material of the extracorporeal circulation system, leukocyte and endothelial activation caused by ischemia and reperfusion or endotoxins, or by surgical trauma. Proinflammatory cytokines, such as tumor necrosis factor (TNF)-alpha, interleukin (IL)-6, and IL-8, play an important role in the inflammatory processes after CPB and may induce cardiac and lung dysfunction. This study examined the association of the increased release of TNF-alpha with increased myocardial and lung injury after CPB and its effect on postoperative morbidity. ⋯ Cardiac surgery and CPB stimulate systemic inflammatory processes characterized clinically by changes in cardiovascular and pulmonary function. Significant morbidity is rare, but most patients undergoing CPB exhibit some degree of organ dysfunction due to activation of the inflammatory response. This study showed that there were no major clinical results of TNF-alpha and white blood cell level, C-reactive protein, and erythrocyte sedimentation rate after the operation, but in patients with a high level of TNF-alpha (more than 20 pg/mL), increased mediastinal bleeding and longer orotracheal intubation time was observed. A number of studies have shown the increase of TNF-alpha after open heart surgery; however, the specific level of TNF-alpha was first described as 20 pg/mL in this study.
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The heart surgery forum · Jan 2006
Randomized Controlled TrialPentoxifylline affects cytokine reaction in cardiopulmonary bypass.
Cardiac surgery is associated with an inflammatory response that may cause myocardial dysfunction after cardiopulmonary bypass. We examined the efficacy of pentoxifylline to attenuate the cardiopulmonary bypass-induced inflammatory response during heart operations. ⋯ Our results indicate that pentoxifylline infusion during cardiac surgery inhibits the proinflammatory cytokine release caused by cardiopulmonary bypass.