The Annals of thoracic surgery
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Comparative Study
Pressure gradient across the pulmonary artery anastomosis during lung transplantation.
Perioperative monitoring of pulmonary artery (PA) pressures in lung transplant recipients is critical. This report characterizes an intraoperative gradient across the PA anastomosis in a series of patients undergoing bilateral sequential lung transplantation. ⋯ The present study demonstrates that during single-lung ventilation and perfusion, the PA pressure measured proximally may not reflect accurately the pressure distal to the vascular anastomosis.
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This report describes the conditions and results of coronary-coronary bypass using the radial artery on the right coronary artery. The angiographic and clinical results are excellent.
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Echocardiography can detect aortic regurgitation (AR) that may interfere with the adequate delivery of cardioplegia solution to the myocardium during cardiac operation. When aware of this lesion, the surgeon can modify the operative technique accordingly. We sought to evaluate the ability of intraoperative transesophageal echocardiography to detect AR and to correlate the severity of the lesion with the need for retrograde cardioplegia administration. ⋯ Transesophageal echocardiography can provide accurate information regarding the presence and severity of AR. The calculated severity of AR on transesophageal echocardiography is associated with the need for retrograde cardioplegia administration.
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Central nervous system damage remains a feared complication after heart operations. Air embolism (AE) is one of several possible causes of central nervous system damage. In previous studies, intraoperative transesophageal echocardiography (ITEE) has been used to detect AE, but identification of the periods of risk and the origin of AE is lacking. ⋯ Careful standard cardiac deairing did not prevent AE caused by the delayed release of air trapped in the lung vessels. Routine use of ITEE is recommended to assess the thoroughness of deairing procedures. This will help eliminate AE or at least lead to an increased awareness of the problem of retained air. Minimizing AE during open heart operations should contribute to a reduction in central nervous system damage and improvement of intellectual function after heart operations.
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Comparative Study
Exercise oximetry versus spirometry in the assessment of risk prior to lung resection.
Spirometry remains a standard method of assessing patient risk prior to lung resection despite its poor sensitivity and specificity. This study compares the relative ability of standardized exercise oximetry and spirometry--forced expiratory volume in the first second--to predict morbidity and mortality after lung resection. ⋯ We conclude that standardized exercise oximetry is a superior screen of the high-risk patient than spirometry (forced expiratory volume in the first second) prior to pulmonary resection when there are no other risk factors noted on initial history and physical examination. A prospective, randomized trial is required to substantiate this conclusion.