The Annals of thoracic surgery
-
Twenty patients undergoing a posterolateral thoracotomy for lung resection or a nonpulmonary procedure were divided into four groups. Group 1 was the control group. Patients in Group 2 had an intercostal nerve block at the time of closure. ⋯ It is concluded that bedside spirometry is a simple and reliable technique to assess postoperative changes in ventilatory mechanics due to pain. The pain that follows posterolateral thoracotomy can be substantially decreased with a continuous intercostal nerve block. Anterolateral thoracotomy is notably less painful than posterolateral thoracotomy and should be considered the approach of choice for patients with decreased pulmonary reserve who undergo uncomplicated pulmonary resection.
-
The diagnosis of rupture of the thoracic aorta or its major branches depends largely on the recognition of mediastinal hemorrhage from the initial chest radiograph and subsequent thoracic aortography. This review discusses the radiographic manifestations of mediastinal hemorrhage, including widening of the mediastinum; a ratio of mediastinal width to chest width greater than 0.25; abnormalities of aortic contour; opacification of the aortopulmonary window; depression of the left main bronchus; deviation of the trachea to the right; deviation of the nasogastric tube to the right; the apical cap sign; widening of the paraspinal lines; widening of the right paratracheal stripe; and left hemothorax. The relationship of these manifestations to major thoracic arterial injury is examined. Pitfalls in the radiographic evaluation of mediastinal abnormalities are considered, and indications for computed tomography of the thorax and thoracic aortography in the severely injured patient are reviewed.
-
Systemic-pulmonary artery shunts remain an important treatment in cyanotic patients. Central shunts continue to pose early and late problems when standard Blalock-Taussig shunts are not possible. Twenty patients underwent subclavian-pulmonary artery shunt procedures with polytetrafluoroethylene (PTFE) prostheses between October, 1980, and August, 1982. ⋯ Recatheterization in 11 patients has demonstrated normal pulmonary pressures and good pulmonary artery growth without vessel distortion. Subclavian-pulmonary shunts using PTFE provide long-term palliation in cyanotic patients. This type of shunt appears to offer important advantages over other shunt procedures, including the classic Blalock-Taussig operation, in newborns.
-
Comparative Study
Hydroxyethyl starch versus albumin for colloid infusion following cardiopulmonary bypass in patients undergoing myocardial revascularization.
Hydroxyethyl starch or hetastarch (HES), a synthetic colloid for intravascular volume expansion, was compared with albumin after coronary artery operations in 30 patients (15 in each study group). Cardiac index, atrial pressures, heart rate, and systolic blood pressure were similar in both groups. There were no differences in cumulative urine output at 24 hours or in weight change during the first 7 postoperative days. ⋯ Coagulation variables were similar, but prothrombin and partial thromboplastin times were higher 12 hours postoperatively and fibrinogen level was lower 7 days postoperatively in the patients receiving HES. There was no clinical evidence of excessive bleeding, although cumulative chest drainage at 12 and 24 hours was slightly higher in the HES group (p = 0.09 and 0.08, respectively). We conclude that hetastarch is a safe and effective colloid to use following coronary operations.
-
Ultrafiltration during crystalloid hemodilution cardiopulmonary bypass (CPB) was evaluated in two groups of mongrel dogs: in one group during 2 hours of CPB with the heart empty and beating and in the other during 90 minutes of cold cardioplegic arrest followed by 30 minutes of recovery. In both groups, the accumulation of extravascular lung water was less in the dogs undergoing ultrafiltration than in control animals. ⋯ The amount of fluid removed ranged from 1,700 to 6,100 ml (mean, 3,240 +/- 1,481 ml [standard deviation]) and resulted in an average intraoperative fluid balance of -901 +/- 2,537 ml, a weight gain of 1.9 +/- 2.5 kg, and a decrease in extravascular lung water from 1,132 +/- 183 ml to 919 +/- 267 ml (p = 0.209). Ultrafiltration is a safe, effective means of removing body water and of preventing further accumulation of such water during hemodilution CPB.