The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jul 2013
Complications of cerebrospinal fluid drainage after thoracic aortic surgery: a review of 504 patients over 5 years.
Cerebrospinal fluid drainage, a well-established means of preventing paraplegia after thoracic aortic aneurysm surgery, can result in serious, sometimes lethal complications. In a large group of patients who underwent surgical thoracic aortic aneurysm repair with cerebrospinal fluid drainage, we examined the incidences of and potential risk factors for these outcomes. ⋯ Cerebrospinal fluid drainage, as performed by our method, seems to be associated with a modest rate of intracranial bleeding in patients who undergo surgical thoracic aortic aneurysm repair. In contrast, postdural puncture headache is not uncommon, particularly in patients with connective tissue disease. Clinicians caring for these patients should consider the likelihood of postdural puncture headache, and any such patient with postoperative headache should be assessed for epidural blood patch placement.
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J. Thorac. Cardiovasc. Surg. · Jul 2013
A refined hemispheric model of normal human aortic valve and root geometry.
Better understanding of aortic root geometry could improve diagnosis and reconstruction of pathologic aortic valves. In this study, a previous model of hemispheric aortic valve leaflets nested within a cylindrical aorta was refined in humans with normal aortic valves. ⋯ The normal human aortic valve is an elliptical structure, and ellipsoidal refinements improve representation of leaflet geometry. The left and noncoronary cusps commissure is located posteriorly; the right coronary cusp is located anteriorly. This model could be useful in quantifying pathologic geometry and in engineering devices for aortic valve reconstruction.
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J. Thorac. Cardiovasc. Surg. · Jul 2013
Noninvasive estimation of central venous pressure after Fontan procedure using biochemical markers and abdominal echography.
Patients may develop liver dysfunction, including liver fibrosis, over the long term following Fontan procedure. Therefore, early detection of liver dysfunction is essential to identify those patients who are at risk. We evaluated various laboratory parameters, including liver biochemical markers, hepatic echography findings, and cardiac catheterization outcomes, at an early stage after undergoing Fontan procedure. ⋯ Our study showed that we can predict inferior vena cava pressure using noninvasive abdominal echography and biochemical markers at an early stage after Fontan procedure.
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J. Thorac. Cardiovasc. Surg. · Jul 2013
Newly created animal model of human postoperative junctional ectopic tachycardia.
Junctional ectopic tachycardia complicates the postoperative recovery from open heart surgery in children. The reported risk factors include younger age, prolonged cardiopulmonary bypass times, and administration of inotropic agents. Junctional ectopic tachycardia occurs early after open heart surgery, in the setting of relative postoperative sinus node dysfunction, and exhibits QRS morphology consistent with an origin from the atrioventricular node or proximal conduction system. Our goal was to develop a reproducible animal model for postoperative junctional ectopic tachycardia. ⋯ Experimental junctional ectopic tachycardia or fascicular tachycardia can occur in the intraoperative setting of sinus node dysfunction, prolonged cardiopulmonary bypass, and enhanced conduction system automaticity. Conduction system automaticity occurred after either physical injury (ablation or tricuspid valve stretch) or measures to augment the transient inward current of the conduction system (isoproterenol and digoxin). This animal model can serve as the basis to assess new treatments of postoperative junctional ectopic tachycardia.
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J. Thorac. Cardiovasc. Surg. · Jul 2013
Single-center experience using the Freedom SOLO aortic bioprosthesis.
This study reviews a single institution experience with the Freedom SOLO (Sorin Group, Saluggia, Italy) aortic bioprosthesis. ⋯ The Freedom SOLO stentless aortic valve has excellent early and intermediate-term results.