Circulation
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Comparative Study Clinical Trial Controlled Clinical Trial
Early changes in ventricular geometry and ventricular septal defect size following Rastelli operation or intraventricular baffle repair for conotruncal anomaly. A cause for development of subaortic stenosis.
Obstruction to left ventricular outflow can be seen after surgical repair of congenital heart disease in which a ventricular septal defect (VSD) is closed by means of a baffle to the systemic great artery arising from the right ventricle (Rastelli operation, intraventricular repair, for conotruncal anomaly). We investigated the hypothesis that obligatory volumetric changes that occur after this operation lead to acute alterations in ventricular geometry and VSD size, resulting in subsequent subaortic stenosis in patients who were thought before operation to have a large, nonrestrictive VSD orifice. ⋯ The left ventricle undergoes geometric change after Rastelli operation or intraventricular repair, surgeries in which the VSD is used as the new left ventricular outflow. These changes are manifested as increased wall thickness, decreased cavity dimensions, and a decrease in VSD size. Patients who subsequently develop left ventricular outflow obstruction have the greatest degree of ventricular contraction and VSD diminution early after surgery.
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Surgical valve repair for mitral regurgitation has significant advantages over valve replacement, but the durability of the technique varies according to the cause of mitral valve disease. In this study, we examined the long-term performance of this procedure in a young rheumatic population and also attempted to identify factors predicting a poor outcome. ⋯ Mitral valve repair in this young rheumatic population is associated with a high long-term morbidity. Presence of active rheumatic carditis has a significantly adverse effect on the success of mitral valve repair.
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Mechanical circulatory support for intractable heart failure as a bridge to transplantation has been used infrequently in children. The lack of clinically available ventricular assist devices has resulted in the use of conventional extracorporeal circuits with oxygenator as the main modality for circulatory support. In this study we reviewed our experience with extracorporeal membrane oxygenation (ECMO) support in children with irreversible heart failure who were awaiting heart transplantation. ⋯ Our experience suggests that ECMO is an effective means of circulatory support as a bridge to transplantation in children. Decompression of the left ventricle is often required to prevent pulmonary edema. Sepsis and bleeding remain a limitation to prolonged mechanical support with ECMO in children.
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Comparative Study
Inhibition of platelet adhesion during cardiopulmonary bypass reduces postoperative bleeding.
Thrombocytopenia and impaired platelet function after cardiopulmonary bypass (CPB) contribute to postoperative bleeding and may increase blood transfusion requirements. We tested the hypothesis that reversible inhibition of glycoprotein IIb/IIIa integrin-mediated platelet adhesion would reduce postoperative bleeding after CPB. ⋯ This study demonstrates that inhibition of platelet adhesion during CPB results in (1) less platelet consumption, (2) better preservation of platelet function, and (3) less postoperative bleeding. Reversible platelet inhibition may have clinical utility in minimizing postoperative bleeding and reducing blood transfusions.
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Comparative Study Clinical Trial Controlled Clinical Trial
Life-threatening arrhythmias and RV dysfunction after surgical repair of tetralogy of Fallot. Comparison between transventricular and transatrial approaches.
Late postoperative arrhythmias and right ventricular dysfunction may occur after classic repair of tetralogy of Fallot. ⋯ The right atrial approach significantly reduced the risk of life-threatening ventricular arrhythmias after repair of tetralogy of Fallot (P < .001) without increasing the incidence of supraventricular arrhythmias. Right ventricular dysfunction and severe pulmonary regurgitation were also more prevalent (P < .01) when the right ventricular approach was used.