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 1994
Comparative StudyInfluence of systemic hypothermia on systolic and diastolic functional recovery after continuous warm antegrade blood cardioplegia.
Experimental observations in our laboratory indicate that myocardial recovery is similar following warm or cold antegrade blood cardioplegia when the core temperature is maintained at 37 degrees C. To determine the effects of hypothermia on myocardial recovery, 15 adult mongrel dogs were randomized to normothermic or hypothermic bypass (28 degrees C) during 60 min of continuous warm antegrade blood cardioplegia. The hypothermic group was rewarmed after releasing the aortic cross-clamp and bypass was discontinued at 30 min in both groups. ⋯ Myocardial ultrastructure was preserved after normothermic bypass. In contrast, cellular oedema and mild ultrastructural changes were evident after systemic hypothermia. We therefore conclude that the use of systemic hypothermia during bypass is associated with lower core temperatures during early recovery which results in impaired functional recovery.
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Eur J Cardiothorac Surg · Jan 1994
Case ReportsSuccessful surgical management for multiple cerebral mycotic aneurysms involving both carotid and vertebrobasilar systems in active infective endocarditis.
Mycotic aneurysm is usually found in the middle cerebral artery associated with infective endocarditis. Previous reports we have identified include only 4 cases of vertebrobasilar aneurysm. We report on a 29-year-old female who had multiple mycotic aneurysms involving both the carotid and vertebrobasilar systems complicated by intracranial hemorrhage with infective endocarditis, in whom staged operations, mitral valve replacement and craniotomies, were successfully performed.
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Eur J Cardiothorac Surg · Jan 1994
Randomized Controlled Trial Clinical TrialPre-operative aspirin decreases platelet aggregation and increases post-operative blood loss--a prospective, randomised, placebo controlled, double-blind clinical trial in 100 patients with chronic stable angina.
Aspirin has an established benefit in reducing the incidence of coronary events and vein graft occlusion. We have now assessed the risk of pre-operative aspirin in a prospective, randomised, double-blind clinical trial in 100 patients scheduled for elective coronary artery surgery. Any prescribed aspirin and non-steroidal anti-inflammatory drugs were discontinued 2 weeks pre-operatively and these were replaced by a randomly assigned tablet of either aspirin 300 mg daily or placebo taken until the day of surgery. ⋯ All patients survived to be discharged home (see Table). Aspirin decreases platelet aggregation to arachidonic acid and to collagen both pre- and post-operatively. The benefit of pre-operative aspirin has to be balanced against the risk of increasing post-operative blood loss, re-exploration for excessive bleeding and transfusion requirements.
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Eur J Cardiothorac Surg · Jan 1994
Case ReportsOmentoplasty for postpneumonectomy bronchopleural fistulas.
Postpneumonectomy fistula is one of the most serious complications in general thoracic surgery and remains difficult to manage. From 1984 to 1991, we successfully used pedicled omentum for the treatment of postpneumonectomy bronchopleural fistulas (omentoplasty) in five patients, four of whom had thoracic empyema. For bronchopleural fistulas without early postoperative infection, single-stage closure was performed which was then covered with pedicled omentum. ⋯ Even after open thoracotomy, closure of the wound was achieved. All five patients could be discharged. Omentoplasty was useful in the therapy of postpneumonectomy bronchopleural fistula even in the presence of thoracic empyema.
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Clinical observation led us to believe that aprotinin fails to preserve haemostatic function in patients undergoing deep hypothermic perfusion with or without circulatory arrest. A retrospective study was made of blood loss in 80 consecutive acute Type A dissection patients before and during the aprotinin era (1987-1992). After 1988 all patients were cooled below 20 degrees C pending circulatory arrest. ⋯ We suggest that aprotinin inhibits the protease enzymes which maintain the fluid state of blood during hypothermic low flow and arrest states. Disseminated intravascular coagulation may consume platelets thereby predisposing to abnormal bleeding and potentially fatal thrombotic events. The use of aprotinin in profoundly hypothermic perfusion should be adopted cautiously.