The Annals of thoracic surgery
-
When right ventricular failure occurs during aortic valvular operation, inadequate myocardial protection may be the culprit. However, other causes of right ventricular failure should be considered, such as air or particulate matter embolization. Right ventricular failure unexpectedly occurred during an aortic valvular operation, and the cause was found to be a mechanical problem with the right coronary ostium. ⋯ We conclude that when right ventricular failure unexpectedly occurs during an aortic valvular operation and does not improve with reperfusion, a mechanical problem in the RCA should be considered. In this situation we recommend that the RCA be bypassed with a segment of saphenous vein graft.
-
Comparative Study
Use of verapamil and nitroglycerin solution in preparation of radial artery for coronary grafting.
The radial artery (RA) has been used as an alternative arterial graft for coronary artery bypass grafting. This artery has been reported to be spastic; therefore, use of spasmolytic drugs (vasodilators) during the preparation of the RA is recommended. The combination of calcium antagonists and nitroglycerin (verapamil plus nitroglycerin, VG solution) has been suggested to be effective in other bypass grafts. This study was designed to investigate (1) the effect of the VG solution during preparation of the RA for coronary artery bypass grafting and (2) whether the effect would last for a prolonged period after topical use. ⋯ The present study suggests that the combination of verapamil and nitroglycerin may provide a rapid onset, a complete relaxation, and a long-lasting vasorelaxant effect when used to prepare the RA for grafting. This study adds a new method to prevent RA spasm during coronary artery bypass grafting.
-
Comparative Study Clinical Trial
Steroid administration in heart and heart-lung transplantation: is the timing adequate?
The release of cytokines after cardiopulmonary bypass may play an important role in postoperative morbidity. The release of proinflammatory cytokines, such as tumor necrosis factor alpha, interleukin (IL)-6 and IL-8, is even greater in patients undergoing heart transplantation (HTx) than coronary artery grafting. We tested the hypothesis that in HTx patients the earlier administration of steroids, before rather than after cardiopulmonary bypass as usual, can reduce the inflammatory response. ⋯ Earlier steroid administration in the immunosuppressive protocol for HTx or HLTx may be preferable to reduce the inflammatory response to cardiopulmonary bypass, as reflected by a lower production of tumor necrosis factor alpha and IL-8, and a greater release of IL-10.
-
Compartment syndrome of the lower leg is an occasional complication of prolonged ischemia and reperfusion. Compartment syndrome of the thigh is a less well-recognized complication. We present 2 patients with compartment syndrome of the ipsilateral thigh after femoral arterial and venous cannulation for cardiopulmonary bypass. Early diagnosis and urgent decompressive fasciotomy may limit the extent of local tissue damage and subsequent myonephropathic syndrome.
-
A case of tracheogastric fistula after laryngopharyngoesophagectomy for cervical esophageal cancer is described. The surgical management of the tracheogastric fistula is detailed and accompanied by a pertinent review of the literature. The one-stage repair in this report can provide an effective palliation or definitive treatment for this debilitating and unusual complication.