The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Nov 2002
Comparative StudyManagement of patients with intramural hematoma involving the ascending aorta.
Although intramural hematoma of the aorta is considered a unique pathologic entity, the management of intramural hematoma involving the ascending aorta (type A) has not been well established. The purpose of this study was to establish the optimal mode of management of type A intramural hematoma. ⋯ We concluded that about 70% of type A intramural hematomas could be managed expectantly, and more than 50% could be treated medically alone.
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J. Thorac. Cardiovasc. Surg. · Oct 2002
Randomized Controlled Trial Clinical TrialIntrapulmonary shunt after cardiopulmonary bypass: the use of vital capacity maneuvers versus off-pump coronary artery bypass grafting.
It has been proved in human subjects and animals that atelectasis is a major cause of intrapulmonary shunting and hypoxemia after cardiopulmonary bypass. Animal studies suggest that shunting can be prevented entirely by a total vital capacity maneuver performed before termination of bypass. This study aimed to test this theory in human subjects and to evaluate possible advantages of off-pump coronary artery bypass grafting. ⋯ The development of intrapulmonary shunting and hypoxemia after coronary artery bypass grafting can be substantially reduced by performance of total vital capacity maneuvers while patients are mechanically ventilated. However, off-pump coronary artery bypass surgery is superior in preventing shunting and hypoxemia after bypass grafting in the immediate and early postoperative periods, probably leading to substantially shorter intensive care unit and hospital stays.
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J. Thorac. Cardiovasc. Surg. · Oct 2002
ReviewCavoatrial tumor thrombus: single-stage surgical approach with profound hypothermia and circulatory arrest, including a review of the literature.
In recent years, heart surgery has been used more frequently to treat diseases that are not primarily of cardiac origin. This is the case for intracardiac extension of infradiaphragmatic tumors, such as renal cell carcinoma, Wilms tumor, uterine tumors, and adrenal tumors, which require radical surgery associated with cavoatrial thrombectomy. ⋯ The use of extracorporeal circulation and deep circulatory arrest provide an optimal technique for removing the tumor thrombus in a bloodless field, even in the presence of metastatic disease, and has good early and long-term results.