The Annals of thoracic surgery
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The surgical management for bridging patients with univentricular heart and systemic obstruction to a Fontan procedure remains controversial. ⋯ Initial management of patients with univentricular heart and systemic obstruction by Norwood-like procedures provides a better outcome. Success of the Fontan operation relies on the ability to provide timely relief of subaortic stenosis.
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Advances in myocardial protection have been instrumental in making cardiac surgery safer. Debate exists over the optimal medium and the optimal temperature for cardioplegia. Currently blood cardioplegia is preferred over crystalloid; the optimal temperature, however, remains controversial. ⋯ Warm blood cardioplegia represents the latest development in myocardial protection. Preliminary studies support its efficacy. Additional studies are needed to determine the ideal route of delivery and to identify any risks associated with the inherent warm cardiopulmonary bypass required.
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Comparative Study
Pressure gradient across the pulmonary artery anastomosis during lung transplantation.
Perioperative monitoring of pulmonary artery (PA) pressures in lung transplant recipients is critical. This report characterizes an intraoperative gradient across the PA anastomosis in a series of patients undergoing bilateral sequential lung transplantation. ⋯ The present study demonstrates that during single-lung ventilation and perfusion, the PA pressure measured proximally may not reflect accurately the pressure distal to the vascular anastomosis.
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Comparative Study
Exercise oximetry versus spirometry in the assessment of risk prior to lung resection.
Spirometry remains a standard method of assessing patient risk prior to lung resection despite its poor sensitivity and specificity. This study compares the relative ability of standardized exercise oximetry and spirometry--forced expiratory volume in the first second--to predict morbidity and mortality after lung resection. ⋯ We conclude that standardized exercise oximetry is a superior screen of the high-risk patient than spirometry (forced expiratory volume in the first second) prior to pulmonary resection when there are no other risk factors noted on initial history and physical examination. A prospective, randomized trial is required to substantiate this conclusion.