The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Aug 2000
Clinical Trial Controlled Clinical TrialOptimizing cerebral oxygenation during cardiac surgery: a review of experimental and clinical investigations with near infrared spectrophotometry.
Near-infrared spectrophotometry (NIRS) is a promising method for non-invasive monitoring of cerebral oxygenation and hemodynamics. This paper reviews studies in which we aimed to validate NIRS in an experimental model of cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) (validation study), use the method in experimental settings to optimize cerebral oxygenation during CPB (oxygenation study), and test its utility during routine cardiac surgery (clinical study). ⋯ NIRS measurements, especially the CytOx signal, correlate well with high energy phosphates and have a high sensitivity to predict histologic brain damage. NIRS is an important and useful tool in studies investigating cerebral oxygenation during CPB. The CytOx signal predicted impaired neuropsychological outcome in patients. Therefore, the CytOx signal holds much interest for future studies.
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Thorac Cardiovasc Surg · Aug 2000
Comparative StudyClinical use of a computer-enhanced surgical robotic system for endoscopic coronary artery bypass grafting on the beating heart.
The aim of the study was to perform endoscopic coronary artery bypass grafting on the beating heart using a surgical robotic system. In the study, the surgical system ZEUS was used in combination with 3D visualization for endoscopic coronary artery bypass grafting in 25 patients. ⋯ All patients had an uneventful angiographic control result. An endoscopic coronary artery anastomosis is possible on the arrested as well as on the beating heart.
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Thorac Cardiovasc Surg · Aug 2000
Case ReportsBilobectomy and amphotericin B in a case of endobronchial mucormycosis.
Lung mucormycosis is a rare fungal infection that has been described mainly in oncologic and diabetic patients. We here report the case of an endobronchial lesion caused by this fungus in an immunocompetent person. Prompt diagnosis, and therapy with Amphotericin B and surgery, permitted the complete resolution.
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Ebstein's malformation can be defined as an anomaly of the tricuspid valve existing in the setting of a right ventricular dysfunction. The technique introduced by Carpentier in 1980 is based on the concept of mobilization of the restrictive anterosuperior leaflet associated with a longitudinal plication of the inlet component of the right ventricle. From January 1980 to December 1999, 142 patients underwent surgery. ⋯ We conclude that tricuspid valvoplasty associated with longitudinal right ventricular plication is superior to valve replacement. The arrangement producing a tricuspid sack is not suitable for conservative surgery. An associated cavo-pulmonary anastomosis decreases the operative mortality in patients at high risk, and seems to preserve right ventricular function.