Circulation
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Comparative Study
Global left ventricular performance and regional systolic function after suture annuloplasty for chronic mitral regurgitation.
In surgery for chronic mitral regurgitation, the mitral subvalvular apparatus, including annulus, may play an important role in preserving left ventricular (LV) performance. The suture annuloplasty for mitral regurgitation allows annular contraction of the mitral valve. The potential effects of suture annuloplasty on the postoperative LV performance have not been fully defined. ⋯ These data suggest that suture annuloplasty can provide more desirable postoperative LV systolic performance than conventional MVR by preserving both the contraction of the mitral annulus and the mitral valvular-ventricular interaction.
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Comparative Study
High-frequency jet ventilation for respiratory failure after congenital heart surgery.
Extracorporeal membrane oxygenation (ECMO) is considered when respiratory failure (RF) persists despite increasing conventional mechanical ventilation (CMV). High-frequency jet ventilation (HFJV) can improve ventilation with comparable mean airway pressure (PAW) to that found on CMV. This study was undertaken to determine whether HFJV is an effective treatment and alternative to ECMO for RF after congenital heart surgery. ⋯ This study suggests that HFJV improves ventilation and is an alternative to ECMO in patients with RF after surgery for congenital heart disease.
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BACKGROUND. The fenestrated Fontan operation has been applied to high-risk patients with univentricular hearts, resulting in improved survival. The purpose of this study was to determine the hemodynamic factors responsible for these improved results. ⋯ CONCLUSIONS. The fenestrated Fontan operation improves survival in high-risk patients by increasing cardiac index and maintaining oxygen delivery, despite mild arterial O2 desaturation. Subsequent transcatheter fenestration closure can be performed after hemodynamic assessment.
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Acute bacterial endocarditis continues to be a condition with high morbidity. Although the majority of patients are treated by high-dose antibiotics, a high-risk patient group requires surgical intervention, which is the subject of this article. ⋯ The morbidity and mortality after surgical treatment of acute endocarditis depend on the site, the severity, and the subject infected. Early aggressive surgical intervention is indicated to optimize surgical results, especially in patients with nonstreptococcal infection or PVE.
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Thrombosis is a serious complication of heart valve replacement, and management is often difficult. In recent years, thrombolytic therapy has been used as the primary technique by some investigators. ⋯ Fibrinolytic treatment appears to be an attractive nonsurgical alternative for prosthetic heart valve thrombosis, but because of the risk of cerebral embolism, its use should be reserved for tricuspid valve thrombosis or critically ill patients with mitral or aortic valve thrombosis. The use of a fibrinolytic agent in cases of small, nonobstructive paravalvular thrombosis demonstrated with transesophageal echocardiography needs further studies.