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
Case ReportsCardiac tamponade secondary to intrapericardial rupture of a hepatic amoebic abscess.
We report the case of a patient who underwent an emergency subxiphoid pericardiectomy with evacuation of 1700 cc of anchovy sauce-like fluid. On pericardial inspection a fistulous communication was seen with a cavity in the left hepatic lobe. ⋯ The hepatic cavity and pericardium were drained: bacteriological investigation of the fluid yielded entamoeba histolytica and chloroquine was administered. Apart from the rarity of the observation in western countries, we discuss surgical approaches in cases of unknown purulent pericardial effusions, stressing the possibility of achieving a good surgical result even with a minor surgical procedure such as subxiphoid pericardiectomy and drainage.
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Eur J Cardiothorac Surg · Jan 1994
Comparative StudyGlucose-insulin-potassium (GIK) prevents derangement of myocardial metabolism in brain-dead pigs.
Brain death is associated with neuroendocrine changes resulting in reduced myocardial glycogen content. The purpose of this study was to investigate the effects of glucose-insulin-potassium (GIK), on myocardial metabolism in brain-dead pigs. Sixteen brain-dead pigs were given GIK infusion (n = 8), or Ringer solution (n = 8). ⋯ Plasma levels of FFA were significantly lower in the GIK group, and the myocardial uptake of FFA was 5 times higher in the control group compared to the GIK group. There were no significant differences in hemodynamic variables among the groups. In conclusion, intravenous supply of GIK to brain-dead pigs results in increased myocardial glycogen content and seems to prevent abnormal myocardial metabolism, which may have clinical implications for the myocardial protection of donor hearts.
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Eur J Cardiothorac Surg · Jan 1994
Case ReportsStent-angioplasty of an anastomotic stenosis of the pulmonary artery after lung transplantation.
Anastomotic stenosis of the pulmonary artery after lung transplantation is a rare complication, which commonly necessitates surgical correction. Transesophageal Doppler sonography and pulmonary arteriogram are standard diagnostic means for visualization of venous and arterial anastomoses. Balloon dilatation combined with implantation of a vascular endoprosthesis was successfully used for treatment of severe anastomotic stenosis of the pulmonary artery after lung transplantation.
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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
Decision making in the surgical treatment of massive pulmonary embolism.
Pulmonary embolectomy in the treatment of acute massive pulmonary embolism (PE) is the subject of considerable controversy with regard to indication, technique of embolectomy and perioperative management. Since 1968 50 patients have undergone surgery for massive PE in our unit. ⋯ Univariate analysis disclosed age (< 60 vs > 60), preoperative hemodynamics (cardiogenic shock vs cardiac arrest), location of emboli (peripheral vs central), duration of symptoms (hours vs days vs weeks) and number of episodes (first episode vs recurrent pulmonary emboli) as predictive factors of the post-operative outcome. The results of the retrospective analysis show that pulmonary embolectomy remains an acceptable procedure in patients with acute massive pulmonary emboli who are in refractory cardiogenic shock or who need intermittent resuscitation.