The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Sep 2013
Importance of atrial surface area and refractory period in sustaining atrial fibrillation: testing the critical mass hypothesis.
The critical mass hypothesis for atrial fibrillation (AF) was proposed in 1914; however, there have been few studies defining the relationship between atrial surface area and AF. This study evaluated the effect of tissue area and effective refractory period (ERP) on the probability of sustaining AF in an in vivo model. ⋯ The probability of sustained AF was significantly associated with increasing tissue area and decreasing ERP. These data may lead to a greater understanding of the mechanism of AF and help to design better interventional procedures.
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J. Thorac. Cardiovasc. Surg. · Sep 2013
Comparative StudyModerate hypothermia during aortic arch surgery is associated with reduced risk of early mortality.
Selective antegrade cerebral perfusion (ACP) during hypothermic circulatory arrest (HCA) provides cerebral protection during aortic arch surgery. However, the ideal temperature for HCA during ACP remains unknown. Clinical outcomes were compared in patients who underwent moderate (nasopharyngeal temperature, ≥ 20 °C) versus deep (nasopharyngeal temperature, <20 °C) HCA with ACP during aortic arch repair. ⋯ Moderate hypothermia with ACP is associated with lower in-hospital and 30-day mortality, shorter cardiopulmonary bypass time, and fewer neurologic sequelae than deep hypothermia in patients who undergo aortic arch surgery with ACP.
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J. Thorac. Cardiovasc. Surg. · Sep 2013
Adolescents with D-transposition of the great arteries repaired in early infancy demonstrate reduced white matter microstructure associated with clinical risk factors.
Our objective was to use diffusion tensor imaging (DTI) to compare white matter microstructure in adolescents with D-transposition of the great arteries (D-TGA) who underwent the arterial switch operation in early infancy with typically developing control adolescents. We also examined correlates between patient demographic and medical risk factors and white matter as assessed by regional fractional anisotropy (FA) values. ⋯ Despite scant white matter injury evident on conventional brain MRI, adolescents with D-TGA repaired in infancy demonstrate significant white matter FA reduction that may relate to their reported neurocognitive deficits. Among adolescents with D-TGA, FA values are associated with patient and perioperative factors, some of which are modifiable.
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J. Thorac. Cardiovasc. Surg. · Sep 2013
Conservative management of postoperative bronchopleural fistulas.
A bronchopleural fistula (BPF) is a serious complication after pulmonary resection and carries a high mortality rate. It remains a therapeutic challenge. The lack of a consensus suggests that no optimal therapy is available; however, endoscopic closure of a fistula may avoid extensive and potentially risky surgery. ⋯ BPF is a severe complication in thoracic surgery. The combination of pleural drainage, adequate antibiotic treatment, and mucosal application of silver nitrate, through a flexible bronchoscope, is an efficient alternative and avoids extensive surgical intervention.