The Annals of thoracic surgery
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Randomized Controlled Trial Clinical Trial
Effect of nitric oxide gas on platelets during open heart operations.
The increased bleeding tendency observed after cardiopulmonary bypass is caused in part by thrombocytopenia and impaired platelet function induced by the procedure. Previous in vitro studies have shown that nitric oxide (NO) added to the oxygenator sweep gas reduces platelet activation during experimental perfusion. We evaluated the effect of 40 ppm of NO, added to the oxygenator sweep gas, on platelet consumption and activation in patients undergoing cardiopulmonary bypass. ⋯ Nitric oxide might reduce the platelet consumption encountered during cardiopulmonary bypass without having any adverse effect on platelet function, as reflected by the preserved aggregation response seen in our patients. However, the best route of NO administration and the optimum dose remain to be established.
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The technique of using 3.5-mm acetabular reconstruction plates for multiple rib fractures with cerclage wires has been successful. We modified it by securing the reconstruction plates to the fractured ribs with cortical screws using the standard AO-ASIF (Arbeitsgemeindschaft fur Osteosynthesefragen [Association for the Study of Internal Fixation]) group technique. Our method for the internal fixation of the unstable chest wall is described. It is relatively simple and provides uniform results.
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We used a Freestyle (Medtronic, Minneapolis, MN) porcine root to replace a regurgitant aortic valve and repair acute type A dissection. A Hemashield (Meadox Medicals, Oakland, NJ) graft was used to replace the ascending aorta with the "open anastomosis" technique. This method is a valuable alternative to conventional root replacement in acute type A dissection.
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Case Reports
Successful thrombolysis of an occluded modified Blalock shunt three days after operation.
A 10-day-old boy with pulmonary atresia received a right-sided aortopulmonary polytetrafluoroethylene shunt. Three days after the operation he became cyanotic and was reintubated. Shunt occlusion was confirmed with angiography. ⋯ The thrombus was completely resolved after 2 days. When administration of recombinant tissue plasminogen activator was stopped, heparin infusion was started for 5 days. Shunt patency was demonstrated by angiography at 3 months postoperatively.
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A time-dependent decline in cerebral blood flow (CBF) has been reported in cardiac surgical patients despite stable pump flows and arterial carbon dioxide tension. Other studies have failed to support these hypothermic cardiopulmonary bypass (CPB) results, showing preservation of CBF during CPB. The purpose of the study was to define the influence of mildly hypothermic CPB duration on CBF. ⋯ Our experimental results include the following: (1) during mildly hypothermic bypass, CBF does not decrease in relation to time and (2) cerebral flow-metabolism coupling is intact at 35 degrees C.