European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Jan 1995
Case ReportsExtra-pleural haematoma secondary to blunt chest trauma. An unusual presentation.
The case history is described of a young man who presented with an apparent splenic rupture following thoracic compression during a rugby tackle. The actual diagnosis was that of an extra-pleural haematoma following transection of the internal mammary artery. This case is discussed within the context of the rarity of such a presentation--both in the site of the haematoma and the cause of the transection; and the problems posed in making the initial diagnosis.
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Eur J Cardiothorac Surg · Jan 1995
Comparative StudyInterrupted warm blood cardioplegia for coronary artery bypass grafting.
Continuous warm blood cardioplegia has been used with good clinical outcome in both antegrade and retrograde delivery. However, the continuous delivery of cardioplegia is sometimes interrupted for adequate visualization and flow is not constant with heart manipulation during operation. We studied the effects of interrupted antegrade delivery of warm blood cardioplegia on myocardial metabolism and clinical results after surgery. ⋯ After removal of the aortic cross-clamp, the heart returned to sinus rhythm spontaneously in 90% of the patients with warm cardioplegia and 15.4% of those with a cold heart (P < 0.01). Postoperatively, there was no significant CK-MB or MDA release in either group except for one patient with perioperative myocardial infarction. After operation inotropic support was required for two and one patient in the warm and cold groups, respectively, although there were significantly more patients with poor left ventricular function in the warm, than in the cold, group (P < 0.05).(ABSTRACT TRUNCATED AT 250 WORDS)
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Eur J Cardiothorac Surg · Jan 1995
Case ReportsMechanical ventricular assistance for the failing right ventricle after cardiac transplantation.
Right ventricular failure secondary to elevated pulmonary vascular resistance (PVR) following orthotopic cardiac transplant is a complication with a high mortality; and patients with high resistance are often not accepted on transplant waiting lists. We describe six cases of right ventricular failure after cardiac transplant managed by right ventricular assist device (RVAD), four of whom died and two patients who survived following life-threatening complications.
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Eur J Cardiothorac Surg · Jan 1995
Case ReportsEsophageal tracheobronchoplasty for membranous laceration caused by insertion of a dumon stent--maintenance of oxygenation by percutaneous cardiopulmonary support.
A 39-year-old man, whose airway was narrowed due to relapsing polychondritis, sustained a tracheobronchial injury during intubation with an internal stent. In the posterior membranous trachea and left main stem bronchus, a 5-cm longitudinal tear extended across the carina. ⋯ An original esophageal tracheobronchoplasty for repair of the membranous laceration is described. Currently, the patient is asymptomatic 16 months after the surgery.
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Eur J Cardiothorac Surg · Jan 1995
Hospital morbidity and mortality after myocardial revascularisation surgery: current changes in risk factors.
To identify the operating risks for mortality and morbidity in patients undergoing aortocoronary bypass surgery, the data of 514 myocardial revascularisation procedures performed consecutively between January 1991 and December 1992 were analysed; 73.2% of the patients had associated diseases and 59.3% had suffered one or more previous myocardial infarctions. The mean ejection fraction of the population as a whole was 52.2 +/- 13. In 10.5% of the cases there was severe left ventricular (LV) function impairment with a mean ejection fraction (EF) of 30.2 +/- 4.4 (range 20-35). ⋯ Perioperative acute myocardial infarction occurred in 5.4% of the patients (CL 4.4-6.4), in three cases resulting in death [10.7% (CL 4.8-15.8)]. Fourteen of the acute myocardial infarctions (AMI) occurred in the 42 patients undergoing emergency surgery for acute coronary occlusion (33.3%). A percentage of 18.7% of the 493 surviving patients suffered a postoperative complication.(ABSTRACT TRUNCATED AT 250 WORDS)