Circulation
-
Patients undergoing open heart surgery who have had recent cardiogenic embolic stroke or have central nervous system dysfunction pose a difficult management problem. There is always the risk that cardiopulmonary bypass and heparinization may exacerbate the neurologic injury. There is no clear data indicating what is a safe interval of time from the onset of neurologic symptoms to the time of surgery. ⋯ One patient died in the postoperative period from multisystem failure; all other patients have been followed since discharge (6 months to 4 years). All surviving patients demonstrated improvement in their neurologic symptoms and eight patients had complete neurologic recovery. The results of this study indicate that open heart surgery can be safely performed in patients with recent neurologic injury.
-
In cardiac surgery significant residual lesions increase postoperative morbidity and mortality. Although intraoperative epicardial real-time two-dimensional Doppler echocardiography (two-dimensional Doppler) is an accurate and efficient technique for assessing the presence and severity of a residual lesion, it requires placement of a transducer in the operating field and consequent obstruction of the operative procedure. Transesophageal two-dimensional Doppler echocardiography (transesophageal two-dimensional Doppler), which can be applied intraoperatively and postoperatively without such problems, was performed in 35 patients during cardiac surgery (12 patients) and/or at an intensive care unit within 6 hr after cardiac surgery (30 patients). ⋯ In two patients with congenital heart disease, a small residual shunt was detected. In a patient in which a composite valve graft with direct coronary artery reattachment (Bentall's operation) was performed, reattachment was confirmed to be satisfactory. In conclusion, intraoperative and early postoperative monitoring of cardiac function by transesophageal two-dimensional Doppler echocardiography can improve the results of cardiovascular surgery by providing accurate information on cardiovascular structure and blood flow dynamics.