Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Aug 2012
Case ReportsHaemostasis of a right ventricle-gunshot wound using a novel haemostatic vacuum device.
Heart wounds are frequently fatal. The haemorrhage from a right ventricle-gunshot wound in a male patient was successfully controlled using a novel haemostatic vacuum device. This case report shows how this simple, quick and efficient method can be used to control critical bleedings.
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Interact Cardiovasc Thorac Surg · Aug 2012
Case ReportsLeft tilt position for easy extracorporeal membrane oxygenation cannula insertion in late pregnancy patients.
The aim was to describe how to avoid technical difficulties during venous femoral cannula insertion for extracorporeal membrane oxygenation (ECMO) in a woman in late pregnancy. A 28-year old pregnant woman presented at 32 weeks of gestation after developing an acute respiratory distress syndrome (ARDS) of an unknown origin that required venovenous ECMO insertion via the femoral vein. ⋯ We proposed a systematic 15°-30° left lateral tilt position during the ECMO femoral cannula insertion in late pregnancy cases needing ECMO. This precaution should avoid an injury to the vessels due to multiple insertion attempts.
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Interact Cardiovasc Thorac Surg · Aug 2012
Morphological analysis of systolic anterior motion after mitral valve repair.
The systolic anterior motion (SAM) of mitral valves occurs at a certain rate despite the introduction of several preventive procedures. The purpose of this study was to investigate its mechanism by analysing the change in mitral valve morphology associated with operative procedures. ⋯ The results of this study show that operative procedures might modify the morphology of mitral valves susceptible to developing SAM. Postoperative smaller annular diameter and anterior shift of coaptation point were considered to contribute to the development of SAM.
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Interact Cardiovasc Thorac Surg · Jul 2012
ReviewWhat do you do with the antiplatelet agents in patients with drug eluting stents who then receive a mechanical valve?
Dual antiplatelet therapy (DAT) with aspirin and clopidogrel is a cornerstone of treatment during and after percutaneous coronary interventions with drug-eluting stent (DES) implantation. Oral anticoagulation (OAC) is the recommended treatment for patients with mechanical heart valves. When patients with DES need a mechanical heart valve or vice versa, we face the difficult choice of their antithrombotic therapy. ⋯ As per the long-term management, antithrombotic management with DAT alone in mechanical aortic valve replacement might be possible, but there is not enough evidence to support it. The available evidence suggests that triple anticoagulation (OAC + DAT) is associated with the best clinical outcome compared with all the other possible strategies. The duration of TT should be 3 months after sirolimus DES implantation, and 6 months after paclitaxel DES implantation, followed by long-term therapy with OAC plus clopidogrel or aspirin with either PPIs, or H2-receptor antagonists (Class IIa Level of Evidence C).
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Interact Cardiovasc Thorac Surg · Jul 2012
ReviewIs heparin needed for patients with an intra-aortic balloon pump?
We addressed the question of whether or not the currently available evidence base supports heparinization in the context of a patient requiring cardiovascular support with an intra-aortic balloon pump (IABP). A best evidence topic was written according to a previously defined structured protocol. A literature search returned 443 papers, 3 of which were deemed relevant. ⋯ Just one study specifically looked at surgical patients. However, the existing data suggest that it is safe to omit heparinization when using IABP counterpulsation. The decision to heparinize should be weighed in the context of other indications or contraindications rather than being an automatic response to the use of IABP.