European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery
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Eur J Cardiothorac Surg · Oct 2011
Is flexible bronchoscopy necessary to confirm the position of double-lumen tubes before thoracic surgery?
Flexible bronchoscopy is recommended to confirm correct placement of double-lumen tubes used for thoracic anesthesia. However, there is still controversy over routine bronchoscopic confirmation of their position. This study aimed to verify the usefulness of flexible bronchoscopy for confirming the position of double-lumen tubes after blind intubation. ⋯ After blind intubation, 37% of double-lumen tubes required repositioning by means of flexible bronchoscopy, despite positive evaluation made by the anesthesiologist. Our data suggests that initial bronchoscopic assessment should be made with the patient still in the supine position, and confirms that flexible bronchoscopy is useful in verifying the correct position of double-lumen tubes or adjusting possible misplacements, before starting thoracic surgery.
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Eur J Cardiothorac Surg · Oct 2011
Minimally invasive trans-mediastinal endoscopic approach to insert phrenic stimulation electrodes in the human diaphragm: a preliminary description in cadavers.
Diaphragm pacing by phrenic nerve (PN) stimulation is currently used for patients with central respiratory paralysis to be weaned from mechanical ventilation. Electrodes are inserted either through bilateral thoracotomy or through four ports laparoscopy. The aim of this experimental work is to demonstrate the feasibility of trans-mediastinal bilateral implantation of PN electrodes using a flexible gastroscope introduced through a cervical incision in human cadavers. ⋯ Trans-mediastinal implantation of PN stimulation electrodes is possible using a flexible endoscope. This application of endoscopic surgery could allow a minimally invasive placement of PN electrodes in patients with central respiratory paralysis, for example, at the time of tracheostomy.
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Eur J Cardiothorac Surg · Oct 2011
The aortic interleaflet triangles annuloplasty: a multidisciplinary appraisal.
Aortic interleaflets triangles annuloplasty (AITA) reduces interleaflet triangles' circumferential extent through properly placed sutures. To achieve aortic root functional unit (ARFU) stabilization, we aimed at quantifying the effect of suture extent (SE) on aortic valve function and at finding general optimization criteria. ⋯ So far, the AITA seems to be a valuable technique to increase leaflet CL in aortic valve repair and in silico models seem to be able to predict the principles of the phenomena but not the individual complexity.