Scandinavian cardiovascular journal : SCJ
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Scand. Cardiovasc. J. · Jan 1997
Comparative StudyEffect of nitroglycerin in patients with increased pulmonary vascular resistance undergoing cardiac transplantation.
Acute right ventricular failure due to persistent pulmonary hypertension is a risk factor for premature death after cardiac transplantation. The purpose of this study was to follow changes in pulmonary haemodynamics in patients with pulmonary hypertension undergoing heart transplantation, and to examine whether postoperative changes can be predicted from a preoperative nitroglycerin (NTG) challenge. Seventeen consecutive patients with NYHA class IV heart failure and pulmonary hypertension (pulmonal vascular resistance (PVR) > 2.5 Wood units) underwent an NTG infusion before cardiac transplantation and were followed up using measurements of pulmonary haemodynamics before, early (24 h) and late (6 months) after cardiac transplantation. ⋯ Postoperative PVR and mPAP were accurately estimated by preoperative NTG infusion (NTG vs 24 h posttranspl: PVR 2.2 +/- 0.2 vs 1.9 +/- 0.2 Wood units, p > 0.05; mPAP 30 +/- 2 vs 26 +/- 1 mmHg, p > 0.05). Heart transplantation candidates with pulmonary hypertension responsive to NTG can be expected to obtain a postoperative immediate fall in pulmonary pressures and PVR. The magnitude of this circulatory improvement can be predicted from a preoperative NTG infusion and is not different from values measured 6 months after transplantation.
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Scand. Cardiovasc. J. · Jan 1997
Expression of adhesion and activation molecules on lymphocytes during open-heart surgery with cardiopulmonary bypass.
Open-heart surgery with cardiopulmonary bypass (CPB) and abdominal surgery are associated with lymphocytopenia. We measured a panel of adhesion and activation molecules on lymphocytes to clarify possible association of CPB with increased expression of these molecules. Eight patients undergoing open-heart surgery and eight with abdominal surgery were studied. ⋯ The proportion of CD11a/CD18-positive lymphocytes rose from 67.6 +/- 8% to 86.4 +/- 3% after aortic declamping (p < 0.05). The expression of activation molecules CD25, CD69 and CD71 was unchanged during and after open-heart as well as abdominal operations. Thus CPB was associated with increased expression of the adhesion molecule CD11a/CD18 on lymphocytes, while the expression of activation molecules on lymphocytes was unchanged.
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Scand. Cardiovasc. J. · Jan 1997
Randomized Controlled Trial Clinical TrialEffect of methylprednisolone on the oxidative burst activity, adhesion molecules and clinical outcome following open heart surgery.
Following cardiac surgery with cardiopulmonary bypass (CPB), activated granulocytes may be involved with ischaemia/ reperfusion injury. The purpose of this study was to investigate whether steroids could reduce the oxidative burst activity of granulocytes, the expression of adhesion molecules on granulocytes and improve clinical outcome. Sixteen patients undergoing open heart surgery participated in the study. ⋯ Steroids prevented hyperthermia in the postoperative period but did not improve the weaning from the ventilator or reduce the stay in the intensive-care unit. In conclusion, treatment with steroids prevented hyperthermia following open heart surgery with CPB and reduced capillary leak during ECC. Methylprednisolone, however, did not reduce the oxidative burst activity or the expression of adhesion molecules on granulocytes following CPB.
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Scand. Cardiovasc. J. · Jan 1997
Outcome of cardiopulmonary resuscitation following open heart surgery.
The outcome of cardiopulmonary resuscitation (CPR) following cardiac surgery is not known to date. A retrospective analysis of all patients subjected to CPR during their hospital stay following heart surgery was conducted; 1.4% of patients required CPR 0.5-192 h following surgery. The mean duration of CPR was 42 +/- 29 min. ⋯ Twenty patients were in NYHA class I or II. Ventricular fibrillation and myocardial ischaemia are the commonest conditions leading to CPR in an average population of patients immediately after cardiac surgery. Aggressive treatment and emergency rethoracotomy in most cases results in long-term survival in 50%.
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Scand. Cardiovasc. J. · Jan 1997
Psychiatric complications of cardiac surgery postoperative delirium syndrome.
Psychiatric disturbances due to cardiopulmonary bypass, especially postoperative delirium syndrome, are among the immediate complications of open-heart surgery. In a series of 32 male and 18 female patients the prevalence of such disorders was investigated and search was made for possible risk factors for their occurrence. ⋯ The cerebral hypoperfusion persisted on day 15 in four patients, while psychiatric tests were negative. The study showed possible risk factors to be patient age, long aortic cross-clamp time, high-dose inotropic support and excessive transfusion of blood or blood products.