The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Sep 2000
The effects of retrograde cardioplegia technique on myocardial perfusion and energy metabolism: a magnetic resonance imaging and localized phosphorus 31 spectroscopy study in isolated pig hearts.
The present work was designed to study the myocardial perfusion and energy metabolism during retrograde cardioplegia performed with different methods, including deep coronary sinus cardioplegia, coronary sinus orifice cardioplegia, and right atrial cardioplegia. ⋯ Deep coronary sinus cardioplegia results in myocardial ischemia in the posterior wall of the left ventricle and the posterior portion of the interventricular septum, as well as in the right ventricular free wall. Coronary sinus orifice cardioplegia improves cardioplegic distribution in these regions. Relative to deep coronary sinus cardioplegia and coronary sinus orifice cardioplegia, right atrial cardioplegia provides the most homogeneous perfusion.
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J. Thorac. Cardiovasc. Surg. · Sep 2000
Aortic arch branches are no longer a blind zone for transesophageal echocardiography: a new eye for aortic surgeons.
Branch arteries of the aortic arch have been a blind zone for transesophageal echocardiography. Information regarding blood flow, which is important in both planned and emergency operations on the aorta, has therefore been limited. We have established a technique for visualizing these arteries in nearly all cases. ⋯ The branch arteries of the aortic arch, including the vertebral artery, are no longer a blind zone for transesophageal echocardiography. The information obtained with our new transesophageal echocardiography technique is helpful for diagnosis, monitoring, and decision making during aortic surgery and in critical care medicine. Visualizing these vessels is worth the effort.
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J. Thorac. Cardiovasc. Surg. · Sep 2000
Primary endoleakage in endovascular treatment of the thoracic aorta: importance of intraoperative transesophageal echocardiography.
Endovascular treatment of the thoracic aorta has developed as an efficacious alternative to open surgical repair. However, despite the high primary success rate, perigraft leakage constitutes the major concern in long-term follow-up. Endoleaks are widely reported both in abdominal and thoracic endovascular series and are usually identified by intraoperative angiography. Transesophageal echocardiography is a sensitive imaging technique in the evaluation of aortic diseases, widely used to monitor cardiac surgery. The aim of this study was to evaluate the efficacy of transesophageal echocardiography in leakage detection during endovascular stent procedures of the thoracic aorta. ⋯ During implantation of a stent-graft in the descending thoracic aorta, transesophageal echocardiography provides information in addition to that provided by angiography, improving immediate and late procedural results.
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J. Thorac. Cardiovasc. Surg. · Sep 2000
Randomized Controlled Trial Comparative Study Clinical TrialTranexamic acid compared with high-dose aprotinin in primary elective heart operations: effects on perioperative bleeding and allogeneic transfusions.
Since excessive fibrinolysis during cardiac surgery is frequently associated with abnormal perioperative bleeding, many authors have advocated prophylactic use of antifibrinolytic drugs to prevent hemorrhagic disorders. We compared the effects of tranexamic acid (a synthetic antifibrinolytic drug) with aprotinin (a natural derivative product with antifibrinolytic properties) on perioperative bleeding and the need for allogeneic transfusions. ⋯ Tranexamic acid and aprotinin show similar clinical effects on bleeding and allogeneic transfusion in patients undergoing primary elective heart operations. Since tranexamic acid is about 100 times cheaper than aprotinin, its use is preferable in this type of patient.
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J. Thorac. Cardiovasc. Surg. · Sep 2000
Randomized Controlled Trial Clinical TrialTriiodothyronine repletion in infants during cardiopulmonary bypass for congenital heart disease.
Cardiopulmonary bypass suppresses circulating thyroid hormone levels. Although acute triiodothyronine repletion has been evaluated in adult patients after cardiopulmonary bypass, triiodothyronine pharmacokinetics and effects have not previously been studied in infants undergoing operations for congenital heart disease. We hypothesized that triiodothyronine deficiency in the developing heart after bypass may adversely affect cardiac function reserve postoperatively. ⋯ These data imply that (1) triiodothyronine in the prescribed dose prevents circulating triiodothyronine deficiencies and (2) triiodothyronine repletion promotes elevation in heart rate without concomitant decrease in systemic blood pressure. Elevation of peak systolic pressure-rate product implies that triiodothyronine repletion improves myocardial oxygen consumption and may enhance cardiac function reserve after cardiopulmonary bypass in infants.