Journal of cardiac surgery
-
Case Reports
Right ventricular failure following heart transplantation--recovery after extended mechanical support.
Early graft failure, particularly right ventricular dysfunction, remains a significant determinant of early morbidity and mortality in heart transplant recipients. If conservative medical management fails to help recover cardiac allograft function, mechanical circulatory support either bridging to recovery or retransplantation remains the last option. We report on a 16-year-old patient with hypertropic nonobstructive cardiomyopathy who was weaned successfully from a right ventricular assist device (RVAD) after extended right ventricular mechanical support for three months following heart transplantation.
-
Case Reports
The use of intraoperative Doppler assessment to guide the surgical treatment of anomalous right coronary arteries.
Despite its rarity, anomalous origin of the right coronary artery (RCA) from the left coronary sinus can pose risk of sudden death. Because of this risk, many patients elect surgical correction of this anomaly. Surgical strategies for correction of this include ostioplasty, coronary artery reimplantation, and, more commonly, coronary artery bypass grafting. ⋯ In each case, the RCA was bypassed using a saphenous vein graft (SVG) that was used to bypass origin of the RCA. Flow through the graft was compared with and without ligation of the proximal RCA, before creation of the proximal anastomosis. In each case, flow through the SVG was not significantly reduced with the proximal RCA patent and ligation was not performed.
-
Comparative Study
Kinetic of procalcitonin in the early postoperative course following heart transplantation.
It was the aim of the study to determine the kinetics of procalcitonin (PCT) levels following heart transplantation (HTx) and to investigate the prognostic suitability of postoperative changes in PCT levels for patients' outcome. ⋯ PCT levels have been consistently low (<10 ng/mL) in patients with an uneventful course, but more frequently increased in patients with postoperative complications and even associated with an increased mortality early postoperatively when values exceed 80 ng/mL. As a clinical consequence, PCT levels in the first few days following cardiac transplantation can help to identify patients at risk, when concentrations exceed the "normal" posttransplant range.
-
Real-time readings of the regional oxygen saturation (rSO(2)) using near-infrared spectroscopy (NIRS) during the aortic arch surgery can provide an early detection of perfusion or oxygenation abnormalities. ⋯ Continuous monitorization of the cerebral O(2) saturation during aortic arch surgery in adults and infants is a feasible technique to control an adequate cannula positioning and to optimize clinical outcomes avoiding neurological complications related to cerebral malperfusion.