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 1993
Clinical TrialDilation of the internal mammary artery by external papaverine application to the pedicle--an improved method.
Spasm of the internal mammary artery (IMA) during coronary bypass grafting may cause inadequate graft flow and makes accurate placement of sutures difficult. In addition, IMAs with poor intraoperative flow rates are more likely to occlude. In this study three methods for spasm prevention were compared in 51 patients undergoing coronary bypass surgery. ⋯ Free flow from the IMA was higher in group 3 than in groups 1 and 2 (60 ml/min vs. 44 and 30, respectively, P < 0.03). Morphometric measurements disclosed a larger luminal area and less folding of the internal elastic lamina in group 3 compared with groups 1 and 2 (0.73 mm2 vs 0.33 and 0.37, respectively, P < 0.03). Submersion in papaverine solution thus provides better procurement of IMA grafts than storage of the pedicle in a papaverine-soaked sponge.
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Eur J Cardiothorac Surg · Jan 1993
Comparative StudyRelationship between hemodynamics and blood volume changes after cardiopulmonary bypass during coronary artery bypass grafting.
The blood volume and central hemodynamics were assessed in 22 patients undergoing coronary artery bypass grafting before and after cardiopulmonary bypass. Patients were divided into two groups according to their blood volume after cardiopulmonary bypass. In group A (n = 10) the patients were hypovolemic and in group B (n = 12) the patients were hypervolemic after cardiopulmonary bypass. ⋯ There was a correlation between the changes in cardiac index and changes in total blood volume (r = 0.57; P < 0.01). Patients in neither group suffered from hypoxia. We conclude that extreme hemodilution after cardiopulmonary bypass must be normovolemic, and the pulmonary capillary wedge pressure or right atrial pressure as a guide for blood volume evaluation after termination of cardiopulmonary bypass may be misleading.
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Eur J Cardiothorac Surg · Jan 1993
Case ReportsAn adjunct to cerebral protection during circulatory arrest.
For surgery of dissecting ascending aortic aneurysms we have employed deep hypothermic circulatory arrest to permit construction of the distal aortic anastomosis in a bloodless field. The cerebral complications of circulatory arrest in deep hypothermia are well recognised. Many methods of cerebral protection have been suggested besides deep hypothermia including retrograde cerebral perfusion, administration of thiopentone and cerebroplegia. We report a supplementary technique that theoretically may provide improved cerebral protection, and present the results in four cases.
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Eur J Cardiothorac Surg · Jan 1993
Effect of peri-operative storage solution on the vascular reactivity of the human saphenous vein.
The performance of the saphenous vein as a bypass conduit in myocardial revascularisation may, in part, be determined by its vascular reactivity. The present study investigates whether the choice of peri-operative storage solution influences the response of this vessel to a range of vasoconstrictors and vasodilators. Saphenous vein ring segments (210) were obtained from 24 patients undergoing coronary artery bypass surgery, and following a 1 h incubation in either (1) heparinised blood, (2) heparinised saline, (3) 199-TC solution, (4) St. ⋯ None of the solutions had a significant effect on the potency (EC50) of the constrictors. Relaxations of pre-constricted segments were recorded to acetylcholine and sodium nitroprusside, but there was no difference in efficacy or potency in these responses following storage in the different solutions. This study demonstrates that the choice of peri-operative storage solution may influence the vascular reactivity of the human saphenous vein.
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Eur J Cardiothorac Surg · Jan 1992
Induced hypothermia in the management of refractory low cardiac output states following cardiac surgery in infants and children.
Post-operative low cardiac output states remain a major cause of mortality following cardiac surgery in infants and children. Since 1979 we have used moderate induced whole-body hypothermia in the management of low-output states refractory to conventional modes of therapy. This is based not only upon the relationship between body temperature and oxygen consumption, but also on experimental work showing a beneficial effect of cooling upon myocardial contractility, particularly when there is pre-existing impairment of ventricular function. ⋯ A fall in the platelet count (P < 0.001) was not accompanied by any change in the white cell count (P = 0.15). Although it is impossible to say whether cooling influenced the outcome in any of these children, it was usually effective in stabilising their clinical condition. The technique is simple and has a sound theoretical basis.(ABSTRACT TRUNCATED AT 250 WORDS)