The Journal of thoracic and cardiovascular surgery
-
J. Thorac. Cardiovasc. Surg. · Sep 2002
Comparative StudyTreatment strategy for chylothorax after pulmonary resection and lymph node dissection for lung cancer.
We reviewed our experience with iatrogenic chylothorax after pulmonary resections for lung cancer to evaluate our treatment strategy and to identify factors that predict the need for reoperation. ⋯ Although most cases of chylothorax after pulmonary resection with systematic mediastinal lymph node dissection can be cured with a conservative strategy, early surgical intervention may be indicated if chest tube drainage is more than 500 mL during the first 24 hours after complete oral intake cessation and total parenteral nutrition.
-
J. Thorac. Cardiovasc. Surg. · Sep 2002
Comparative StudyMicroflow fields in the hinge region of the CarboMedics bileaflet mechanical heart valve design.
The design of bileaflet mechanical heart valves includes some degree of leakage flow on valve closure for the reverse flow to wash the hinge and pivot region of the valve. It is believed that this reverse flow helps to prevent areas of stasis and inhibit microthrombus formation. However, the magnitude of this retrograde flow may also give rise to unacceptable levels of blood element damage and lead to platelet activation or hemolysis as a result of the increased flow velocities through the hinge region. The purpose of this study was to evaluate the hinge flow dynamics of a 23-mm CarboMedics bileaflet mechanical valve (Sulzer CarboMedics Inc, Austin, Tex) and then to compare the results with those of the St Jude Medical 23-mm Regent (St Jude Medical Inc, Minneapolis, Minn) and Medtronic Parallel (Medtronic, Inc, Minneapolis, Minn) valves studied earlier. This comparison allows new insight into the microflow fields within the hinge region of the CarboMedics bileaflet mechanical valve, which have not been previously assessed during its clinical history. ⋯ The hinge flow dynamics of the CarboMedics bileaflet design lie somewhere in between those of the St Jude Medical and the Medtronic Parallel valve designs. The fluid dynamics of the investigated valve were found to be similar to those of the St Jude Medical valves, although with slightly higher leakage velocities and turbulent shear stresses. This discrepancy may be a result of the sharper corners associated with the hinge design of the CarboMedics valve. It could also be due to the incremental enlargement of the internal orifice area of the St Jude Medical Regent design.
-
J. Thorac. Cardiovasc. Surg. · Sep 2002
Comparative StudySurgical options and results of repeated aortic root replacement for failed aortic allografts placed in childhood.
This report reviews our experience with repeated aortic root replacement after failure of cryopreserved aortic allografts placed during childhood and compares replacement with aortic allografts, pulmonary autografts, and mechanical valved conduits in these patients. ⋯ Replacement of cryopreserved aortic root allografts placed during childhood is safe. Five-year pulmonary autograft durability is excellent, although the risk of early failure may be increased. Differences in 5-year conduit longevity were not detectable.
-
J. Thorac. Cardiovasc. Surg. · Sep 2002
Comparative StudyA respiratory gas exchange catheter: in vitro and in vivo tests in large animals.
Acute respiratory failure is associated with a mortality of 40% to 50%, despite advanced ventilator support and extracorporeal membrane oxygenation. A respiratory gas exchange catheter (the Hattler Catheter) has been developed as an oxygenator and carbon dioxide removal device for placement in the vena cava and right atrium in the treatment of acute respiratory failure to improve survival. ⋯ Progress has been made toward developing an intravenous gas exchange catheter to provide temporary pulmonary support for patients in acute respiratory failure.