The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 2008
Comparative StudyThe bidirectional Glenn operation: a risk factor analysis for morbidity and mortality.
Patients with single ventricle heart defects often undergo a palliative bidirectional Glenn operation. For this operation, we analyzed potential risk factors for morbidity and mortality. We also evaluated the effects of a persistent left superior vena cava by comparing the outcomes of unilateral and bilateral operations. ⋯ Outcomes were adversely affected primarily by prolonged cardiopulmonary bypass time, elevated central venous pressure and transpulmonary gradient, and right ventricular morphology. Specifically, outcomes were unaffected by the presence of a left superior vena cava, cannulation strategy, or antegrade pulmonary blood flow. There were few differences between the unilateral and bilateral groups, none of which were postoperative outcomes.
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J. Thorac. Cardiovasc. Surg. · Nov 2008
Comparative StudyMultidetector computed tomographic characteristics of nonabsorbable polymer versus titanium ligature clips in a vascular model.
Multidetector cardiac computed tomography is commonly performed to evaluate coronary bypass grafts, but titanium clips result in significant image artifact. Multidetector cardiac computed tomographic characteristics of newly developed nonabsorbable polymer clips are unknown. This study was undertaken to compare the image characteristics of polymer clips and titanium clips applied to a vascular model. ⋯ The use of polymer clips in coronary bypass grafts should result in significantly improved multidetector cardiac computed tomographic image quality.
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J. Thorac. Cardiovasc. Surg. · Nov 2008
Carbon dioxide--a complex gas in a complex circulation: its effects on systemic hemodynamics and oxygen transport, cerebral, and splanchnic circulation in neonates after the Norwood procedure.
Carbon dioxide is suggested to increase oxygen delivery after the Norwood procedure. We sought to quantitatively define the effects of stepwise increases in arterial carbon dioxide tension on systemic oxygen transport and cerebral and splanchnic circulation after the Norwood procedure. ⋯ Moderate hypercapnia increases systemic blood flow because of its effect on systemic vascular resistance after the Norwood procedure. The increase in systemic blood flow is primarily a consequence of increased cerebral blood flow that compromises splanchnic circulation. The decrease in oxygen consumption improves oxygen transport, but the increase in catecholamines may be undesirable. Clinical use of carbon dioxide aiming to improve oxygen delivery should be with caution.
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J. Thorac. Cardiovasc. Surg. · Nov 2008
Comparative StudyComplete heart block associated with device closure of perimembranous ventricular septal defects.
The development of the Amplatzer Membranous VSD Occluder (AGA Medical Corp, Plymouth, Minn) for closure of the perimembranous ventricular septal defect has ameliorated many of the technical difficulties of previous devices. Application of this new technology requires comparative evaluation with the current standard of surgical repair. We report our experience of complete heart block associated with device closure of a large perimembranous ventricular septal defect with unequivocal indications for intervention. ⋯ Device closure of large perimembranous ventricular septal defects in infants and children with the Amplatzer Membranous VSD Occluder resulted in excellent closure rates but an unacceptably high rate of complete heart block.
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J. Thorac. Cardiovasc. Surg. · Nov 2008
Inflammatory lung injury after cardiopulmonary bypass is attenuated by adenosine A(2A) receptor activation.
Cardiopulmonary bypass has been shown to exert an inflammatory response within the lung, often resulting in postoperative pulmonary dysfunction. Several studies have shown that adenosine A(2A) receptor activation attenuates lung ischemia-reperfusion injury; however, the effect of adenosine A(2A) receptor activation on cardiopulmonary bypass-induced lung injury has not been studied. We hypothesized that specific adenosine A(2A) receptor activation by ATL313 would attenuate inflammatory lung injury after cardiopulmonary bypass. ⋯ The addition of a potent adenosine A(2A) receptor agonist to the normal priming solution before the initiation of cardiopulmonary bypass significantly protects the lung from the inflammatory effects of cardiopulmonary bypass and reduces the amount of lung injury. Adenosine A(2A) receptor agonists could represent a new therapeutic strategy for reducing the potentially devastating consequences of the inflammatory response associated with cardiopulmonary bypass.