The Annals of thoracic surgery
-
Isolated mitral valve injury after blunt chest trauma is a very rare event. This disruption, causing sudden and severe mitral regurgitation, will rapidly lead to congestive heart failure and death unless operatively corrected. A high index of suspicion coupled with appropriate diagnostic tests will provide the diagnosis and allow operative correction. We report a patient who survived this injury and review all previous reports of blunt traumatic disruption of the mitral valve.
-
Randomized Controlled Trial Clinical Trial
Intraoperative autotransfusion reduces blood loss after cardiopulmonary bypass.
A combination of several techniques is necessary to minimize the transfusion requirements for open heart operations. The benefit of plasmapheresis remains in doubt because of smaller and less effective platelets obtained with this technique. Therefore, we evaluated the effects of whole blood intraoperative autotransfusion as part of a blood conservation protocol. ⋯ Autotransfusion during cardiopulmonary bypass provides benefit in addition to other techniques in reducing blood loss and the need for blood products in the postoperative period.
-
Case Reports
Cardiopulmonary bypass in patients with heparin-induced thrombocytopenia using Org 10172.
In patients with heparin-induced thrombocytopenia undergoing cardiac operations, anticoagulation with heparin should be avoided. The low-molecular-weight glycosaminoglycan Orgaran has been used as an alternative, but the overall experience is limited. ⋯ Orgaran might be a useful alternative for anticoagulation during extracorporeal circulation. Adequate dosages and measurement of plasma levels are recommended for its use in cardiopulmonary bypass.
-
We previously demonstrated that standard preservation using Euro-Collins solution impairs lung function in the setting of high-flow reperfusion because of potassium-induced vasoconstriction. Preservation strategies for single-lung transplantation are an important factor in patients with pulmonary hypertension. This study investigates the hypothesis that low-potassium preservation solution will improve function of lungs subjected to high-flow reperfusion. ⋯ These data demonstrate that a low-potassium preservation solution yields improved lung function after high-flow reperfusion in an ex vivo rabbit lung model. Lung preservation should be aimed at the clinical setting.
-
Comparative Study
Cerebral oxygenation measured by near-infrared spectroscopy: comparison with jugular bulb oximetry.
Near-infrared spectroscopy is a potential tool for measuring adequacy of cerebral oxygenation during cardiac operations. The cerebral microcirculation is predominantly venous (by volume) and therefore regional cerebral oxygenation measured by near-infrared spectroscopy should reflect jugular bulb venous saturations. ⋯ These findings suggest that near-infrared spectroscopy may be a useful tool for assessing intravascular cerebral oxygenation during pediatric cardiac operations. Prospective studies of neurologic outcome will be required to establish the value of this technique for assessing the adequacy of cerebral protection.