The Annals of thoracic surgery
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Randomized Controlled Trial Comparative Study Clinical Trial
Papaverine delivery to the internal mammary artery pedicle effectively treats spasm.
Left internal mammary artery spasm is well recognized during coronary artery bypass operations. Papaverine has been used by many surgeons to maximize mammary artery flow perioperatively, but the best delivery method is not known. We analyzed two techniques used at our institution. ⋯ Papaverine delivery to the left internal mammary artery after dissection treats spasm effectively, improves blood flow at the time of its anastamosis to the left anterior descending artery, and avoids any risk of intimal injury. Injection of papaverine before mammary artery harvest does not shorten dissection time, and flow is not statistically improved.
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Comparative Study
Intraaortic balloon pumping improves hemodynamics and right ventricular efficiency in acute ischemic right ventricular failure.
Left ventricular unloading has a potentially deleterious effect in right ventricular failure as a result of altered septal interplay. However, a positive effect of an intraaortic balloon pump during right ventricular failure has been suggested. We investigated the impact of intraaortic balloon pumping on hemodynamics and both left and right ventricular function in an experimental model of isolated right ventricular failure. ⋯ Intraaortic balloon pump support does not alter right or left ventricular function in acute right ventricular failure. However, arterial pressure, cardiac output, and right ventricular efficiency are improved, possibly because of a balloon pump-induced reduction in pulmonary arterial resistance.
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Chronic allograft dysfunction limits the long-term success of lung transplantation. Increasing evidence suggests nonimmune mediated injury such as due to reflux contributes to the development of bronchiolitis obliterans syndrome. We have previously demonstrated that fundoplication can reverse bronchiolitis obliterans syndrome in some lung transplant recipients with reflux. We hypothesized that treatment of reflux with early fundoplication would prevent bronchiolitis obliterans syndrome and improve survival. ⋯ Reflux is a frequent medical complication after lung transplantation. Although the number of patients undergoing early fundoplication is small, our results suggest early aggressive surgical treatment of reflux results in improved rates of bronchiolitis obliterans syndrome and survival. Further research into the mechanisms and treatment of nonalloimmune mediated lung allograft injury is needed to reduce rates of chronic lung failure.
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We describe tricuspid valve repair using papillary muscle shortening for severe tricuspid regurgitation due to leaflet prolapse in children combined with De Vega annuloplasty. The papillary muscle was shortened until the prolapsed leaflet was at the same height as the other nonprolapsed leaflets. Although echocardiographic tricuspid regurgitation tends to increase over time, it rarely requires long-term intervention.