Scandinavian cardiovascular journal : SCJ
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Scand. Cardiovasc. J. · Jan 1999
Case ReportsCardiac arrest during exercise: anomalous left coronary artery from the pulmonary trunk.
Anomalous origin of the left coronary artery from the pulmonary trunk is associated with high mortality in infancy but in rare cases the condition is diagnosed in adults. The present report describes three adult cases of this anomaly. ⋯ In all patients, coronary arteriography revealed a large right coronary artery with collateral filling of the left coronary artery, which originated from the pulmonary trunk. A successful surgical correction of the anomalous coronary artery was performed in two of the patients.
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Scand. Cardiovasc. J. · Jan 1999
Randomized Controlled Trial Comparative Study Clinical Trial"No-touch" technique using saphenous vein harvested with its surrounding tissue for coronary artery bypass grafting maintains an intact endothelium.
Spasm and consequent dilation of the saphenous vein (SV) for coronary artery bypass grafting (CABG) can be avoided if the vein is harvested with its surrounding tissue. Morphologic techniques, including scanning and transmission electron microscopy, were used to compare endothelial cell integrity using three SV harvesting procedures: conventional (adventitial stripping of the vein, manual distention and storing in saline); intermediate (after adventitial stripping, the vein was left in situ, covered with a papaverine-soaked compress, and stored in heparinized blood); and "no-touch" (SV dissected with its surrounding tissue was left in situ, covered with a saline-soaked compress and stored in heparinized blood). Preservation of endothelial cell integrity was greater with the "no-touch" procedure than with the other methods. Since endothelial cell integrity of SV grafts may affect the patency rate, we conclude that the "no-touch" preparation should improve the results of CABG.
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The surgical management of pleural empyema and post-traumatic clotted haemothorax is described. The study included 15 cases of post-thoracotomy empyema, 23 of empyema of other aetiology and five of post-traumatic haemothorax. Chest-tube drainage was the first measure in most cases. ⋯ One patient with VATS debridement subsequently required thoracotomy and lobectomy for lung abscess. All the others with VATS or decortication recovered without complications. During follow-up there was no mortality or recurrence of empyema.
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Scand. Cardiovasc. J. · Jan 1999
Pulmonary blood flow distribution in lobar hypoxia--influence of cardiac output and nitric oxide inhalation.
Inhaled NO is reported to be less effective in patients with ARDS if cardiac output is high (> 10 L/min). It has also been demonstrated that increased blood flow and increased shear stress cause an enhancement of endogenous NO production. In one-lung ventilation and regional hypoxia, nitric oxide (NO) delivered to the ventilated lung may decrease blood flow to the nonventilated lung and improve arterial oxygenation. ⋯ The decrease in mean pulmonary artery pressure and PaO2 seen during NO inhalation to the hypoxic lobe did not correlate with the level of cardiac output. When NO was delivered to the oxygenated parts of the lungs, no significant effect on relative lobar perfusion or arterial oxygenation was observed, either at raised or at lowered cardiac output. The findings give no further evidence to show that variations in cardiac output alter the effect of NO inhalation.
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Scand. Cardiovasc. J. · Jan 1999
Randomized Controlled Trial Comparative Study Clinical TrialIntraluminal papaverine with pH 3 doubles blood flow in the internal mammary artery.
Seventy-five patients undergoing coronary artery bypass grafting were randomized to receive injections of papaverine solution or isotonic saline or no injection into the left internal mammary artery (LIMA) used as graft. Blood flow in the LIMA was measured twice-after dissection of the pedicle and before anastomosis to the coronary artery. ⋯ The pH of the papaverine solution was only 3, and we advise that surgeons check and correct pH in the papaverine solutions they use, in order to avoid endothelial damage to the LIMA. Based on these results we can recommend papaverine injection into the arterial graft only if the initial flow is low.