The Annals of thoracic surgery
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Multicenter Study Clinical Trial
Serum brain natriuretic peptide and risk of acute kidney injury after cardiac operations in children.
Acute kidney injury (AKI) after pediatric cardiac operations is associated with poor outcomes and is difficult to predict. We conducted a prospective study to evaluate whether preoperative brain natriuretic peptide (BNP) levels predict postoperative AKI among children undergoing cardiac operations. ⋯ Preoperative BNP levels did not predict postoperative AKI in this cohort of children undergoing cardiac operations. Both preoperative and postoperative BNP levels are associated with postoperative outcomes. Clinical Trial Registration at Clinicaltrials.gov as NCT00774137.
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Multicenter Study
Association between preoperative statin use and acute kidney injury biomarkers in cardiac surgical procedures.
Acute kidney injury (AKI) is a serious complication of cardiac operations for which there remains no specific therapy. Animal data and several observational studies suggest that statins prevent AKI, but the results are not conclusive, and many studies are retrospective in nature. ⋯ Statins may prevent kidney injury after cardiac operations, as evidenced by lower levels of kidney injury biomarkers.
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Comparative Study
A propensity-matched comparison of pleurodesis or tunneled pleural catheter for heart failure patients with recurrent pleural effusion.
Patients with severe heart failure often have recurrent pleural effusions that produce dyspnea and shortness of breath. It is unclear whether chemical pleurodesis or the placement of a tunneled pleural catheter that can be used for intermittent pleural drainage produces superior palliation, a shorter hospital stay, and less morbidity. This investigation compares these two treatments. ⋯ This investigation found that a tunneled pleural catheter provided palliation of patients' pleural effusions and freedom from reintervention equal to that of talc pleurodesis using thoracoscopy while resulting in a shorter mean length of hospital stay. Lower rates of operative morbidity and readmission related to the pleural effusion were also seen in the tunneled catheter treatment group. This method of palliation of recurrent pleural effusion should be considered for symptomatic patients with advanced heart failure.
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Case Reports
Rewarming a patient with accidental hypothermia and cardiac arrest using thoracic lavage.
The optimal treatment for severe accidental hypothermia is cardiopulmonary bypass because this offers the most rapid rate of rewarming. However, cardiopulmonary bypass therapy is not available in every hospital. In these circumstances, rewarming has to be achieved with other methods. We present a patient who was successfully rewarmed with thoracic lavage after he had been found with a core temperature of 21°C and asystole.
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Left atrial intramural hematoma is a rare complication of percutaneous intervention. We report the case of a 69-year-old man with recurrent angina after CABG 19 years ago who was admitted for percutaneous intervention. ⋯ Transesophageal echocardiography showed a large expanding hematoma within the left atrial wall causing obstruction of the mitral valve and compressing the right atrium from across the septum. An emergency thoracotomy was performed and with transesophageal echocardiography guidance and left atrial intramural hematoma was drained successfully.