The Annals of thoracic surgery
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Comparative Study
Comparison of techniques for implantation of aortic valve allografts.
Various implantation techniques for allograft aortic valve replacement have evolved over the years. Our objective was to examine the effects of different implantation methods on subsequent valve performance and durability. ⋯ The insertion of an aortic valve allograft as a cylinder, retaining the sinotubular junction, appears to result in less aortic regurgitation at 7 years postoperatively, and with additional follow-up may result in less reoperation for AR.
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Centrifugal pumps are being used increasingly for short-term extracorporeal circulation purposes such as during heart operations. Whether the centrifugal pump improves the cardiopulmonary bypass biocompatibility has not been fully documented. ⋯ A heparin-coated cardiopulmonary bypass surface reduces the blood activation potential during cardiopulmonary bypass, and the centrifugal pump causes less hemolysis than the roller pump.
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Intraaortic balloon pumping is known to be ineffective in severe cardiogenic shock. The efficacy of balloon volumes larger than those commonly used is examined. ⋯ Experimental and clinical data indicate that the effectiveness of intraaortic balloon pumping in severe cardiogenic shock may be improved by increasing the volume of the balloon (i.e., until it fully occupies the aorta).
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Traumatic thoracic aortic rupture is a rare injury in the pediatric patient. Experiences with thoracic aortic rupture in patients less than 17 years of age are needed to help identify factors that can influence injury occurrence, diagnosis, management, and outcome. ⋯ The multiply injured child with severe blunt trauma and an abnormal chest roentgenogram requires a search for aortic injury. We believe the most effective algorithm to follow for the diagnosis of traumatic thoracic aortic rupture in the child involves selective performance of chest computed tomography and transesophageal echocardiography. Our experience suggests that the mechanism of injury, the duration to diagnosis of an aortic injury, and failure to use seat belts may contribute to morbidity. A high index of suspicion and a systematic approach to the diagnosis and to the management strategy for injuries to the thoracic aorta can contribute to a good outcome in those few children who survive the injury.