The Thoracic and cardiovascular surgeon
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Thorac Cardiovasc Surg · Aug 1998
Clinical TrialNeuropsychological changes after cardiopulmonary bypass for coronary artery bypass grafting.
An alarming incidence (1% to 83%) of neuropsychological dysfunction has been reported after operations using cardiopulmonary bypass (CPB). The present clinical study re-evaluates these complications with current CPB technology in a strictly selected low-risk group of coronary artery bypass (CABG) patients. ⋯ Biochemical markers demonstrate significant postoperative cerebral injury during and immediately after CPB. However, CPB for CABG does not lead to marked impairment of neuropsychological scores, and clinically relevant neurological findings were observed in one patient only.
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Thorac Cardiovasc Surg · Aug 1998
Continuous, less invasive, hemodynamic monitoring in intensive care after cardiac surgery.
A pulse-contour-based method for continuous measurement of cardiac output (CO) and systemic vascular resistance (SVR) was tested and arterial thermodilution, used for calibration, was compared to pulmonary artery thermodilution. In 30 patients CO and SVR were measured by pulse contour analysis (COpc, SVRpc) 270 times in 24 h and compared to arterial (COart, SVRart) and pulmonary arterial (COpa, SVRpa) thermodilution measurements. The mean difference between COpa and COart was 0.26 L/min (3.6%) with a standard deviation (SD) of 0.7 L/min, the correlation coefficient was 0.96, and the coefficient of variation was 5.0% and 5.9% respectively. ⋯ Mean COpc and SVRpc did not differ significantly from COpa or COart and SVRpa or SVRart during the 24 h study period. It is concluded that COart correlates well with COpa and can be used to calibrate COpc. COpc and SVRpc agree with thermodilution-based CO and SVR without recalibration for 24 hours.
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Thorac Cardiovasc Surg · Jun 1998
Clinical Trial Controlled Clinical TrialArterial hypertension in adults after surgical treatment of aortic coarctation.
Despite primarily successful surgical repair of aortic coarctation (CoA), postoperative persistent, recurring, or newly developing hypertension is regarded as a risk factor of earlier mortality compared with a normal population. The present study shows that even after surgical correction of CoA many patients have hypertension at rest or during exercise. Out of 44 patients, 72% had a pathological profile at rest, 20% during exercise, and 53% during ambulatory blood pressure measurement. ⋯ Since these processes yield very different answers they should be combined and evaluated critically for a proper assessment of the blood pressure situation and effective treatment. Ambulatory blood pressure measurement allows the recognition of round-the-clock behavior of blood pressure and of patients with 'occult' or 'white-coat' hypertension, and furthermore it helps to control the effectiveness of the treatment. It thus makes an essential contribution to the postoperative care of patients after surgical treatment of CoA.
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In contrast to its use in other surgical disciplines, intraoperative sonography has so far been of minor importance in thoracic surgery. The technique of intrathoracic, intraoperative, ultrasonic examination was applied in 85 patients with different indications: in 61 patients during thoracoscopy, in 24 patients during open thoracic surgery. 6 patients eventually underwent a combination of both procedures. In order to improve the intrathoracic maneuverability of the sonographic probe we developed an electrically controllable handle for the probe. ⋯ The sound frequency available so far for intraoperative application allows a safe distinction of non-infiltrating tumors from vascular structures; the reliable identification of an infiltration mostly requires a higher resolution. If our experiences are confirmed by further application of the method, explorative thoracotomies will surely be partly replaced by explorative thoracoscopic interventions. Ultrasonography has also proved to be useful in visualisation of mediastinal lymph-nodes and tumors, with the possibility of assessing their size.
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Thorac Cardiovasc Surg · Jun 1998
Case ReportsCoarctation of the aorta presenting in a 79-year-old male.
We present a case of coarctation of the aorta with a post-stenotic aneurysm in a 79-year-old male patient. Diagnostic studies included computed tomographic angiogram, magnetic resonance angiogram and digital subtraction angiogram. Our patient underwent operative therapy that resulted in improvement of his hypertension and cardiac function.