Heart, lung & circulation
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Heart, lung & circulation · Apr 2006
Case ReportsIntraaortic balloon pump insertion through the subclavian artery. Subclavian artery insertion of IABP.
The intraaortic balloon pump (IABP) is frequently used in the management of cardiac failure in the setting of myocardial infarction or as a bridge for coronary revascularisation surgery. The IABP is usually inserted through the femoral artery. Occasionally severe aorto-iliac occlusive disease prevents the retrograde passage of the balloon, in which case an anterograde route, usually through the ascending aorta is used. We describe four patients in whom an IABP was placed through the subclavian artery by the joint efforts of cardiologists and vascular surgeons.
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Heart, lung & circulation · Apr 2006
Routine histological analysis of resected lung tissue in primary spontaneous pneumothorax -- is it justified?
Surgical management of spontaneous primary pneumothorax consists of pleurectomy together with resection of blebs or bullae. We analysed the utility of routine histological examination of these resected specimens. A consecutive series of 64 resected specimens were reviewed, of which 43 (67%) showed the presence of bullae or blebs. ⋯ Examination of the lung parenchyma revealed inflammation in 34 (53%) cases. In all 64 cases, the histological results did not result in a change in medical therapy. Although resected lung specimens from patients with primary spontaneous pneumothorax show diversity in their histological characteristics, we would question the utility of routine pathological analysis of resected lung specimens in primary spontaneous pneumothorax.
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Heart, lung & circulation · Feb 2006
Case ReportsPre-operative use of levosimendan in two patients with severe aortic stenosis and left ventricular dysfunction.
We describe two patients with severe aortic stenosis, coronary artery disease, severe left ventricular dysfunction and heart failure in which the calcium-sensitising agent, levosimendan was administered prior to aortic valve replacement and coronary artery bypass graft surgery. In both cases, drug infusion was well tolerated at the doses used, heart failure improved significantly prior to surgery and peri-operative management was relatively uncomplicated in cases that would traditionally be considered high risk. Further investigation of the use of levosimendan both for treating heart failure in the presence of severe aortic stenosis and as pre-operative therapy is warranted.
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Heart, lung & circulation · Dec 2005
Case ReportsMinimally invasive surgery for cardiac myxomas using an upper hemi-sternotomy and biatrial septal approach.
Minimally invasive surgery is pervading all fields of surgery with the principal benefits being: reduced pain, smaller incision, faster recovery, shorter hospital stay and reduced cost. Cardiac surgery is no different. Cardiac myxoma morbidity and mortality depends on early diagnosis, adequate exposure, complete resection, minimal manipulation and unifocal presence. We reviewed our cases of cardiac myxoma excised via an upper hemi-sternotomy with a biatrial septal cardiac approach, to demonstrate this technique as a valid alternative to a full-length median sternotomy. ⋯ Most proposed benefits of minimally invasive surgery were demonstrated in cardiac myxoma application without significant compromise to patient care and recovery using upper hemi-sternotomy and biatrial septal approach. Cardiac myxoma excision via upper hemi-sternotomy and biatrial septal approach can be achieved without compromise to patient care.
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Heart, lung & circulation · Mar 2005
Ethyl pyruvate enhances ATP levels, reduces oxidative stress and preserves cardiac function in a rat model of off-pump coronary bypass.
Off-pump coronary artery bypass grafting is associated with transient periods of myocardial ischemia during revascularization resulting in myocardial contractile dysfunction and oxidative injury. The purpose of this study was to investigate the efficacy of ethyl pyruvate as a myocardial protective agent in a rat model of off-pump coronary artery bypass grafting associated with transient myocardial dysfunction without infarction. ⋯ Ethyl pyruvate enhances myocardial ATP levels, reduces oxidative stress, and preserves myocardial function in a model of transient ischemia/reperfusion injury not subject to myocardial infarction.