Scandinavian journal of thoracic and cardiovascular surgery
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Scand J Thorac Cardiovasc Surg · Jan 1996
Case ReportsUnilateral Fontan operation for tricuspid atresia.
A 12-year-old child with tricuspid atresia and acquired hypoplasia of the left pulmonary artery was successfully treated with unilateral Fontan operation. Angiography at age 2 months had shown a normal left pulmonary artery, and a modified Potts shunt was performed. An emergency central shunt was required a year later. Reinvestigation 5 years after the initial operation revealed severe hypoplasia of the left pulmonary artery.
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In minitracheotomy, a relatively simple percutaneous technique for tracheal cannulation, a small-bore tube is inserted via the cricothyroid membrane to provide access to suction removal of excess secretion or aspirated material from the tracheobronchial tree. It allows efficient tracheobronchial toilet while preserving glottic function and avoiding the disadvantages of conventional tracheostomy and endotracheal intubation. The indications for minitracheotomy in 20 cases were excessive postoperative or postpneumonic secretion (14), difficulty with endotracheal suction (5) and acute airway obstruction (1). ⋯ The cannula was retained for 3-8 days and removal was followed by closure within 48 hours. There were no adverse laryngeal effects. Minitracheotomy was well tolerated by the patients and is a useful adjunct for removal of airway secretion and hospitalized patients.
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Scand J Thorac Cardiovasc Surg · Jan 1996
Endothelin in bronchoalveolar lavage fluid is increased in lung-transplanted patients.
Animal studies have shown increased endothelin in bronchoalveolar lavage (BAL) fluid during unmodified rejection. We performed radioimmunoassay of endothelin in 59 BAL fluid samples from ten patients at different times after lung transplantation. All patients received immunosuppressive therapy (cyclosporin, azathioprine and methylprednisolone). ⋯ The endothelin content of BAL (pg/ml) was significantly greater in the rejection group than in the infection group (61.1 +/- 3.8 vs 40.6 +/- 2.0) or in the 35 samples taken in uncomplicated course after lung transplantation (40.9 +/- 5.4), p < 0.01. The endothelin level in BAL fluid from the controls was only 3.0 +/- 1.4 pg/ml, significantly less (p < 0.005) than in all the lung-transplanted groups. Endothelin in BAL fluid thus was increased after lung transplantation, and still further during rejection.
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Scand J Thorac Cardiovasc Surg · Jan 1995
Randomized Controlled Trial Clinical TrialThrombin generation during cardiopulmonary bypass using heparin-coated or standard circuits.
For quantitative comparison of thrombin generation during cardiopulmonary bypass (CPB) with heparin-coated vs conventional CPB circuits, thrombin-antithrombin III complex (TAT) and prothrombin fragment 1 + 2 (F1 + 2) were analyzed in 20 patients undergoing combined heart valve surgery and coronary artery bypass grafting (CABG), in ten cases with heparin-coated circuits (COMB-HC) and in ten with standard circuits (COMB-C). Extensive thrombin generation was found in both groups, with maximal TAT and F1 + 2 levels at the end of CPB. Of 15 operations with only CABG, seven were performed with heparin-coated circuits and heparin dose 40% of normal (CABG-HC), and eight with standard circuits and normal heparin doses (CABG-C). ⋯ The abundant thrombin generation during CPB thus was much more pronounced during complex operations. Use of heparin-coated circuits did not reduce thrombin generation, which was increased by 60% reduction of the systemic heparin dose. The clinical implications are still unknown, as no complications were observed.
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Scand J Thorac Cardiovasc Surg · Jan 1995
Randomized Controlled Trial Clinical TrialCirculating cytokines and granulocyte-derived enzymes during complex heart surgery. A clinical study with special reference to heparin-coating of cardiopulmonary bypass circuits.
Blood contact with artificial surfaces during cardiopulmonary bypass (CPB) triggers a systemic inflammatory response in which complement, granulocytes and cytokines play a major role. Heparin-coated CPB circuits were recently shown to reduce complement and granulocyte activation in such circumstances. The present study comprised 20 complex heart operations, 10 with heparin-coated circuits (group HC) and 10 controls (group C), with evaluation of changes in terminal complement complex, the granulocyte enzymes myeloperoxidase and lactoferrin, and the cytokines interleukin-6 (IL-6) and interleukin-8 (IL-8). ⋯ IL-6 and IL-8 also increased significantly, but tended to be lower in the HC group, starting at CPB end and continuing until 20 hours postoperatively: for IL-6 the difference was significant at CPB end (83 +/- 18 vs 197 +/- 39 micrograms/l, p = 0.21). Significantly increased inflammatory response was thus found during complex heart operations even with use of heparin-coated CPB sets. The heparin-coating of circuits seems to diminish cytokine production.