The Annals of thoracic surgery
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Comparative Study
High and low heparin dose with heparin-coated cardiopulmonary bypass: activation of complement and granulocytes.
Cardiopulmonary bypass with heparin-coated circuits allows reduced amounts of systemic heparin. Heparin inhibits activation of the complement cascade experimentally, but the effects of different levels of systemic heparin on activation of complement and granulocytes in patients have remained unknown. ⋯ Complement activation was significantly reduced in both heparin-coated groups and was independent of the level of systemic heparinization, whereas granulocyte activation was reduced only in patients who received low doses of systemically administered heparin. The results indicate that a moderate reduction of the systemic heparin dose may be an advantage with regard to improved biocompatibility when using heparin-coated cardiopulmonary bypass circuits.
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Correction of partial anomalous pulmonary venous connection to the superior vena cava (SVC) is often complicated by sinus node dysfunction and occasional pacemaker insertion. ⋯ The very low incidence of late arrhythmias with cavoatrial reconstruction is most encouraging.
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Arrhythmias occur frequently after Fontan operations, and are related in part to high atrial pressure, wall distention, and scarring caused by extensive suture lines. These arrhythmic factors may be avoided by an extracardiac total cavopulmonary anastomosis. We have embarked on a program of conversion of the hemi-Fontan operation to a fenestrated extracardiac Fontan procedure with a relatively simple operation. ⋯ An extracardiac fenestrated Fontan procedure can safely and successfully be performed after a hemi-Fontan operation, and may have both hemodynamic and arrhythmic benefits.
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For many years, valvulitis in systemic lupus erythematosus has been known to occur. Our patient was a 17-year-old girl who presented with severe mitral incompetence and renal insufficiency due to lupus valvulitis. ⋯ A reconstructive mitral valve operation would seem to be preferable. However, a conservative operation does not alter the natural history of the disease and the progression of valve thickening and calcification.
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Our institution has adopted a protocol of primary repair for all patients with double-outlet right ventricle. ⋯ An institutional protocol of early anatomic biventricular repair of double-outlet right ventricle in infants and neonates achieves excellent survival, making palliative operations unnecessary. Associated lesions should be repaired simultaneously. The complexity of these malformations requires a highly individualized and flexible surgical approach.