Heart, lung & circulation
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Heart, lung & circulation · Jul 2011
Five-year analysis of operative mortality and neonatal outcomes in congenital heart disease.
We sought to compare overall mortality with neonatal outcomes over a five year period to define risk factors for mortality and service development priorities. ⋯ This study provides an accurate and contemporary audit of mortality risk associated with congenital heart surgery. Outcomes compare favourably to international benchmarks but highlight the risks of morbidity and mortality associated with neonatal cardiac surgery.
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Heart, lung & circulation · May 2011
Case ReportsReconstruction of trileaflet pulmonary valve using autologous pericardium.
Tetralogy of Fallot with atretic or absent pulmonary valve may require pulmonary valve replacement or reconstruction. We propose a technique of reconstruction of a trileaflet valve at the level of the pulmonary annulus using untreated autologous pericardium. Six cases operated upon, using this technique, had trivial pulmonary regurgitation with a median gradient of 24 mmHg (18-38) across the newly created valve. This approach can be considered in cases with limited availability of more suitable alternatives.
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Heart, lung & circulation · Apr 2011
Case ReportsAcute repair of traumatic tricuspid valve regurgitation aided by three-dimensional echocardiography.
A 54 year-old man without prior cardiac history was involved in a motor vehicle accident. His heart rate was 100/min and blood pressure 128/78 mmHg. He complained of anterior chest pain, and on examination had a loud pan-systolic murmur with no clinical signs of heart failure. ⋯ The majority of cases of tricuspid regurgitation caused by blunt trauma are diagnosed and treated late after the traumatic event. Acute diagnosis is less common but possible with a high level of vigilance, and is greatly aided by clinical indicators of cardiac injury. We describe a case of acute repair of traumatic tricuspid insufficiency, in which diagnosis and surgical planning were greatly aided by 3D-TOE.
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Heart, lung & circulation · Apr 2011
Case ReportsAdjuvant therapy with methylene blue in the treatment of right ventricular failure after pulmonary embolectomy.
Severe pulmonary embolism often leads to right ventricular failure after surgical embolectomy secondary to ischaemia reperfusion injury and acute lung injury (ALI). Acute right ventricular dysfunction is traditionally treated with inotropes and vasopressors to maintain cardiac output and coronary perfusion as well as selective pulmonary vasodilators to provide right ventricular afterload reduction. We report the first case of utilisation of methylene (MB) in a patient with acute right ventricular failure and vasoplegic shock after surgical pulmonary embolectomy.
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Heart, lung & circulation · Mar 2011
Historical ArticleAn Australian experience with aortic arch replacement: a novel approach without circulatory arrest or deep hypothermia.
The potential risks of deep hypothermic circulatory arrest in aortic arch surgery have been well documented. Antegrade cerebral perfusion may ameliorate brain injury but still involves variable periods of cerebral and visceral ischaemia. We describe a novel "branch-first continuous perfusion" technique which avoids both deep hypothermia and circulatory arrest. This brings us closer to the goal of arch surgery without cerebral or visceral ischaemia and the morbidity of deep hypothermia.