The Annals of thoracic surgery
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For many years, valvulitis in systemic lupus erythematosus has been known to occur. Our patient was a 17-year-old girl who presented with severe mitral incompetence and renal insufficiency due to lupus valvulitis. ⋯ A reconstructive mitral valve operation would seem to be preferable. However, a conservative operation does not alter the natural history of the disease and the progression of valve thickening and calcification.
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Comparative Study
High and low heparin dose with heparin-coated cardiopulmonary bypass: activation of complement and granulocytes.
Cardiopulmonary bypass with heparin-coated circuits allows reduced amounts of systemic heparin. Heparin inhibits activation of the complement cascade experimentally, but the effects of different levels of systemic heparin on activation of complement and granulocytes in patients have remained unknown. ⋯ Complement activation was significantly reduced in both heparin-coated groups and was independent of the level of systemic heparinization, whereas granulocyte activation was reduced only in patients who received low doses of systemically administered heparin. The results indicate that a moderate reduction of the systemic heparin dose may be an advantage with regard to improved biocompatibility when using heparin-coated cardiopulmonary bypass circuits.
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A 51-year-old woman underwent resection of a renal tumor with intracaval and intracardiac extension. Histologic examination demonstrated an adult Wilm's tumor. Cardiopulmonary bypass and deep hypothermic circulatory arrest were used in a combined abdominal and thoracic procedure to remove the tumor and extension in its entirety without complication.
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Correction of partial anomalous pulmonary venous connection to the superior vena cava (SVC) is often complicated by sinus node dysfunction and occasional pacemaker insertion. ⋯ The very low incidence of late arrhythmias with cavoatrial reconstruction is most encouraging.
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This article provides an overview of the application of intraoperative echocardiography during repair of congenital heart defects based on our experience with 1,000 patients. ⋯ In an era where complete repair of congenital heart defects is emphasized, intraoperative echocardiography provides information that can guide successful operative revision so that babies leave the operating room with optimal results.