The Thoracic and cardiovascular surgeon
-
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.
-
Thorac Cardiovasc Surg · Jun 1998
ReviewNear-infrared spectrophotometry of the brain in cardiovascular surgery.
Neuropsychological and neurological deficits are still major causes of mortality and morbidity after cardiac operations and are thought to be caused by embolism and cerebral hypoxia. Near-infrared spectrophotometry (NIRS) is a promising method for non-invasive monitoring of cerebral oxygenation and hemodynamics. Different devices provide information on changes of oxygenated (HbO2) and deoxygenated hemoglobin (Hb), oxidized cytochrome aa3 (CytOx) or regional oxygen saturation (rSO2). ⋯ Therefore, the CytOx signal is of great interest for future studies. NIRS must prove its ability to diagnose cerebral hypoxia consistently during cardiac surgery in a large patient study before this method is brought into routine clinical practice. Absolute quantification and definitions of critical oxygenation margins will be helpful for this goal.
-
Thorac Cardiovasc Surg · Jun 1998
Case ReportsChronic herniation of the lung in a patient with chronic obstructive pulmonary disease. Case report and review of the literature.
Lung herniation is a rare condition and can be classified by both anatomical site and etiology. A 70-year-old man was referred with dyspnea, productive cough, and right-sided chest pain. ⋯ Two years after surgical repair the patient is free of complaints. Treatment can be conservative or surgical, but as experience is limited no long-term results have been reported.
-
Thorac Cardiovasc Surg · Apr 1998
Percutaneous dilatational tracheostomy done early after cardiac surgery--outcome and incidence of mediastinitis.
During November 95 to April 97, 45 percutaneous dilatational tracheostomies were performed in a nonselected patient series of 2788 open cardiac surgery cases. Tracheostomy was performed as early as the 2nd postoperative day (median: 6th day), when extubation was not foreseen within the next few days. Duration of intubation was 13 days (mean). ⋯ Clinically evident tracheal stenosis and inadequate granulation of the stoma were not observed after extubation. In our opinion, percutaneous dilatational tracheostomy is justifiable, shows good results, and entails minimal risk if done early after cardiac surgery, and it is also superior to standard surgical tracheostomy. Increased incidence of mediastinitis was not seen.
-
Thorac Cardiovasc Surg · Feb 1998
Randomized Controlled Trial Clinical TrialPreconditioning enhances myocardial protection in patients undergoing open heart surgery.
To date, ischemic preconditioning is regarded as the most powerful form of endogenous myocardial protection. For the purpose of surgical myocardial protection, a few clinical studies have investigated the effects of ischemic preconditioning in conjunction with hypothermia or blood cardioplegia during open heart surgery, but the results were controversial. We now tested the hypothesis that preconditioning improves myocardial protection in patients undergoing cold crystalloid cardioplegic arrest. 36 patients needing mitral prosthetic valve replacement for rheumatic heart disease were studied. ⋯ The results indicated that there was a significant reduction of ST-segment shifting (ST-segment elevation, 0.07 +/- 0.02 vs 0.22 +/- 0.07 mV, p < 0.05, at 4 hours post reperfusion) and smaller release of creatine kinase-MB (87 +/- 11.5 vs 143 +/- 17.2 IU/L, p < 0.05, at 12 hours post reperfusion) in the preconditioning group. Preconditioning also enhanced myocardial contractility (dp/dtmax = 1490 +/- 75 vs 1280 +/- 88 mmHg/sec, at 30 minutes post reperfusion, p < 0.05) and promoted early postoperative recovery. The present study suggests that ischemic preconditioning reduces ischemia-reperfusion injury in human hearts even when combined with cold crystalloid cardioplegia.