The Annals of thoracic surgery
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Perioperative myocardial injury is a major determinant of postoperative cardiac dysfunction for congenital heart disease, but its assessment during this period is difficult. The objective of this study was to determine the suitability of using postoperative serum concentrations of cardiac troponin I (cTnI) for this purpose. ⋯ This study suggests that cTnI values immediately after operation reflect the extent of myocardial damage from both incisional injury and intraoperative factors. Cardiac tropinin I levels in the first hours after operation for congenital heart disease are a potentially useful prognostic indicator for difficulty of recovery.
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Randomized Controlled Trial Clinical Trial
Cardiopulmonary bypass circuit treated with surface-modifying additives: a clinical evaluation of blood compatibility.
The cardiopulmonary bypass (CPB) circuit induces blood activation and a systemic inflammatory response in cardiac surgical patients. The CPB circuit treated with surface-modifying additive (SMA) has been found to reduce blood activation by in vitro and ex vivo experiments. This study evaluates the surface thrombogenicity and complement activation of SMA circuits during clinical CPB. ⋯ These preliminary clinical results suggest that SMA inhibits platelet interaction with the biomaterial surface of the CPB circuit. Complement activation assessed by the terminal complement complex is not influenced by SMA. The clinical benefit of this surface-modifying technique has yet to be assessed in a larger population of patients undergoing cardiac operations.
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Comparative Study
Intravenous diltiazem and acute renal failure after cardiac operations.
Perioperative administration of intravenous diltiazem to patients undergoing cardiac procedures has been shown to decrease the incidence of ischemia and arrhythmias. However, after adopting this practice in our cardiac surgery program, we perceived an increased incidence of postoperative renal dysfunction. ⋯ Our retrospective analysis suggests that prophylactic use of intravenous diltiazem in patients undergoing cardiac operations was associated with increased renal dysfunction. Further studies of the risk and benefits of intravenous diltiazem in this setting should be undertaken.
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Controversy exists about the choice of treatment for patients with hypertrophic obstructive cardiomyopathy. The purpose of this study was to evaluate clinical and echocardiographic long-term results in patients with hypertrophic obstructive cardiomyopathy after septal myectomy and to determine predictors of event-free survival in these patients. ⋯ Septal myectomy is associated with a low perioperative mortality and a high late survival rate (72% at 15 years' follow-up). Septal myectomy is still an excellent modality in the treatment strategy for symptomatic patients with hypertrophic obstructive cardiomyopathy.
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Case Reports
Acute normovolemic red cell exchange for cardiopulmonary bypass in sickle cell disease.
A patient with sickle cell disease (hematocrit, 28.5%; hemoglobin S fraction, 79%), required mitral valve repair. Partial red cell removal and blood component sequestration with an autotransfusion device before cardiopulmonary bypass initially decreased the sickle red cell mass. ⋯ Both techniques yielded fresh autologous plasma for use; sequestration yielded a platelet-pheresis product. Adequate postbypass hemostasis was demonstrated.