Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jun 2007
Effects of cardiopulmonary bypass circuit reduction and residual volume salvage on allogeneic transfusion requirements in infants undergoing cardiac surgery.
Cardiopulmonary bypass in children may cause severe hemodilution and can lead to excessive perioperative blood loss and high transfusion requirements. Minimization of cardiopulmonary bypass circuit and salvage of red blood cells from the residual volume after the procedure are widely utilized to reduce allogeneic transfusion. We evaluated the effectiveness of those measures introduced in infant cardiac surgery in our institution. ⋯ Reduction of the circuit volume significantly diminished use of red blood cell concentrates from 1.6 units to 0.8 units (P<0.0001), and fresh frozen plasma from 1.3 units to 0.4 units (P<0.0001). Utilization of the cell salvage product reduced significantly (P=0.023) the postoperative need for homologous blood transfusion. Therefore, both measures proved to be effective in reducing homologous blood transfusion in infant cardiac surgery.
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Interact Cardiovasc Thorac Surg · Jun 2007
Case ReportsSurgical exclusion of a symptomatic circumflex coronary to right atrium fistula.
Coronary artery fistulas are rare and half of them are symptomatic. Diagnosis is confirmed by echocardiography and coronarography and can be precisely located by multislice CT-scan. ⋯ Surgical exclusion of the fistula was achieved by ligation of both extremities and a running suture on the aneurysmal vessel. Follow-up at 6 months was satisfactory with an asymptomatic patient and absence of recurrence of the fistula on echocardiography.
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Interact Cardiovasc Thorac Surg · Jun 2007
Case ReportsCardiopulmonary bypass using nafamostat mesilate for patients with infective endocarditis and recent intracranial hemorrhage.
Infective endocarditis is a life threatening disease with high mortality and morbidity, including brain infarction concomitant with intracranial hemorrhage. Generally, patients with a recent intracranial hemorrhage are believed to be a contraindication to undergo cardiac surgery with cardiopulmonary bypass. However, some patients with infective endocarditis occasionally require an unavoidable emergent surgery because of uncontrollable heart failure or on-going thromboembolism even if complicated by intracranial hemorrhage. In this study, a cardiopulmonary bypass strategy using nafamostat mesilate as an anticoagulant for such patients is discussed based on three cases we experienced.
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Interact Cardiovasc Thorac Surg · Jun 2007
Correlates of thenar near-infrared spectroscopy-derived tissue O2 saturation after cardiac surgery.
We studied the significance of near-infrared spectroscopy (NIRS), for measuring tissue oxygenation (S(t)O(2)) and perfusion adequacy, and thus for haemodynamic monitoring of patients after cardiac surgery. We compared NIRS-derived S(t)O(2) of the thenar muscle to haemodynamic variables, oxygenation indices, temperature, lactate levels and urinary output, in 23 patients in the course of time after cardiac surgery and admission into the intensive care unit. Clinical variables, global haemodynamics and NIRS% total haemoglobin (%HT) and S(t)O(2) in the thenar for up to 18-22 h after admission were measured. ⋯ From all variables, changes in body-finger temperature difference best correlated to changes in S(t)O(2) (r(s)=-0.48, P<0.001). As judged from clinical and haemodynamic correlates, thenar NIRS S(t)O(2) is a non-invasive measure of peripheral rather than global perfusion adequacy, after cardiac surgery. This may help to define the role of thenar NIRS monitoring after cardiac surgery in future studies.