Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Aug 2008
Randomized Controlled TrialShort-term transcutaneous electrical nerve stimulation after cardiac surgery: effect on pain, pulmonary function and electrical muscle activity.
This study aimed to evaluate the effectiveness of transcutaneous electrical nerve stimulation (TENS) for treatment of postoperative pain in patients who underwent cardiac surgery. In addition, we sought to determine whether TENS would be related to improved pulmonary function and muscle electrical activity in this patient population. Forty-five patients, 32 males and 13 females, aged 41-74 years were randomly allocated to receive TENS (n=23) or sham treatment (n=22) during 4 h on the third postoperative day. ⋯ There was also improvement in chest wall-pulmonary mechanics after TENS with proportional increases in tidal volume and vital capacity (P<0.05). In addition, electrical activity of both muscle groups was enhanced after TENS, but not post sham (P<0.05). TENS is a valuable strategy to alleviate postoperative pain following cardiac surgery with positive effects on pulmonary ventilatory function and electrical activity of thoracic and girdle muscles.
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Interact Cardiovasc Thorac Surg · Aug 2008
Case ReportsRescue peri-operative management of the patient with giant electrical storm and severe left ventricular dysfunction: support by levosimendan and intraaortic balloon counterpulsation.
We present a case of a 62-year-old male patient (coronary heart disease, and stenosis of aortic valve) with severe left ventricular dysfunction (left ventricular ejection fraction 20%, left ventricular end-diastolic diameter 80 mm, end-diastolic volume 329 ml) who developed giant electrical storm (on the whole 115 episodes of pulseless ventricular tachycardia treated by antiarrhythmics and electrical discharges) with low-elevation of cardiac biomarkers. The patient was referred to emergent cardiac surgery (double coronary bypass grafting, aortic valve replacement, and implantation of left ventricular epicardial electrode). Levosimendan and intraaortic balloon counterpulsation were used for successful weaning from the cardiopulmonary bypass; no other arrhythmia appeared in the post-bypass period. Postoperatively no arrhythmic events were detected, and repeated echocardiographic examinations of the patient in good general condition showed gradual improvement of left ventricular ejection fraction (30-35%), likewise in other parameters (left ventricular end-diastolic diameter 72 mm, end-diastolic volume 285 ml).
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Interact Cardiovasc Thorac Surg · Aug 2008
Case ReportsAsymptomatic pseudo-aneurysm of the aortic arch in a patient with aberrant right subclavian artery. A complication of Kommerell's diverticulum?
Kommerell's diverticulum is an aortic arch deformity associated with an aberrant subclavian artery. Symptoms related to compression of adjacent structures, dilatation of the aortic diverticulum or accelerated atherosclerosis leading to increased risks of dissection and rupture represent the indications for surgical treatment. ⋯ The patient also presented an aberrant right subclavian artery originating from the posterior wall of the ecstatic take-off of the left subclavian artery. Our surgical strategy was limited to the resection of the aneurysm without any manipulation of the aortic diverticulum and aberrant right subclavian artery, as the wall of both aorta adjacent to the saccular aneurysm and left subclavian artery was normal, the Kommerell's diverticulum was small and the patient was asymptomatic.
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Interact Cardiovasc Thorac Surg · Aug 2008
Case ReportsSerotonin syndrome following cardiac surgery.
Selective serotonin reuptake inhibitors (SSRIs) are widely used to treat depression. We report a case of serotonin syndrome following cardiac surgery. ⋯ In patients with polypharmacy, it is important to take cognisance of serotonergic antidepressants and anticipate their potential interactions with drugs used peri-operatively. Early recognition and treatment is important as this condition is potentially fatal.
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Interact Cardiovasc Thorac Surg · Aug 2008
Thrombocytopenia after aortic valve replacement with the Freedom Solo stentless bioprosthesis.
Stentless bioprostheses have been considered to achieve superior hemodynamics over stented bioprostheses for aortic valve replacement with improved long-term performance. We observed severe thrombocytopenia in patients who received the Sorin Freedom Solo aortic stentless pericardial bioprosthesis within the first days after implantation. Absolute and relative platelet counts within 2 weeks after implantation of either a stentless (Sorin Freedom Solo) or a stented (Sorin Mitroflow) bovine pericardial bioprosthesis were compared in a matched-pairs analysis in 40 patients. ⋯ No bleeding complications or other morbidity occurred. Attention should focus on the platelet count after implantation of the Freedom Solo bioprosthesis, especially in patients who are supposed to receive platelet inhibitors. However, the described phenomenon remains unexplained.