The Annals of thoracic surgery
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In patients with moyamoya syndrome requiring heart surgery, the brain blood flow during the low perfusion state under cardiopulmonary bypass is a concern. We report on a successful mitral valve repair and tricuspid repair in a patient with moyamoya syndrome, performed using an integrated cerebral protection strategy with cerebral oxygen saturation monitoring, intraaortic balloon pumping, and cardiopulmonary bypass perfusion at a relatively high pressure. An integrated approach with a thorough discussion among cardiac surgeons, anesthesiologists, and perfusionists was invaluable to protect brain perfusion in a patient with moyamoya syndrome.
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Case Reports
CorMatrix Extracellular Matrix Used for Valve Repair in the Adult: Is There De Novo Valvular Tissue Seen?
Decellularized extracellular matrix from porcine intestinal submucosa is available as an approved material for the repair of tissues including cardiac structures. Although pathologic findings of explanted CorMatrix (CorMatrix Cardiovascular, Inc, Roswell, GA) used for valvular repair have been reported in the pediatric population, there is a paucity of data in the adult population. Herein, we report the histologic changes in explanted CorMatrix from 2 adults at 10 and 18 months post-implant.
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Extracorporeal life support (ECLS) has proven success after conventional cardiac surgery. Its use after pediatric heart transplantation is less well documented. We reviewed ECLS after pediatric heart transplantation, to understand better predisposing factors, morbidity, and mortality. ⋯ The requirement for ECLS was higher than expected for conventional cardiac surgery. Although just over one half of patients requiring ECLS survived to discharge, they had excellent medium-term survival, with all still alive. Although ECLS is an expensive, invasive therapy, with significant morbidity and mortality, without it, those patients would have perished. Its judicious use, therefore, can be recommended.
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The use of mechanical assist devices has been established as an effective therapy for patients with end-stage heart failure. Implantable left ventricular assist devices are becoming more common in the clinical practice of cardiac surgery. This report illustrates the use of a HeartMate II (Thoratec Pleasanton, CA) left ventricular assist device in a patient with a single lung and dilated cardiomyopathy. To our knowledge, this is the first report of a left ventricular assist device placement in a patient with a prior pneumonectomy.