The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Aug 1992
Comparative StudySimilar endothelium-dependent relaxation, but enhanced contractility, of the right gastroepiploic artery as compared with the internal mammary artery.
The right gastroepiploic artery is an alternative coronary bypass graft. The excellent graft function of the internal mammary artery has been related to its physiologic properties, particularly to endothelial function. Isolated artery rings were suspended in organ chambers for recording of isometric tension. ⋯ The relaxation to the nitric oxide donor SIN-1 was identical in the two arteries. Thus the right gastroepiploic artery exhibits better contractility than the internal mammary artery but comparable endothelium-dependent and endothelium-independent relaxations. The good endothelial function of the gastroepiploic artery might be important for graft function and patency, whereas the enhanced contractility may facilitate vasospasm, especially in the presence of high circulating levels of catecholamines.
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J. Thorac. Cardiovasc. Surg. · Aug 1992
Complete repair of total anomalous pulmonary venous connection in infancy.
From 1983 to 1990, 20 infants underwent complete repair of isolated total anomalous pulmonary venous connection. Twelve were male; ages ranged from 1 day to 240 days (mean 32 days). The abnormal anatomic connection was supracardiac in nine, cardiac in four, mixed in five, and infradiaphragmatic in two. ⋯ Postoperative arrhythmias occurred predominantly in patients with intracardiac drainage. All survivors (mean follow-up of 42 months) are in sinus rhythm, receiving no medications, and are growing and developing normally. Surgical correction of total anomalous pulmonary venous connection in infancy can be performed at low risk with good results after aggressive preoperative stabilization and postoperative management.
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J. Thorac. Cardiovasc. Surg. · Aug 1992
Comparative StudyTransesophageal echocardiography in hypotensive patients after cardiac operations. Comparison with hemodynamic parameters.
Because it is sometimes difficult to determine the cause of hypotension in patients after cardiac operations, we assessed the value of transesophageal echocardiography in this respect, and we studied 60 consecutive patients who had hypotension despite positive inotropic medication and, in some patients, mechanical support. Echocardiographic diagnoses were compared with diagnoses based on hemodynamic parameters. Follow-up examinations were completed in all patients to confirm the final diagnoses. ⋯ Echocardiography also identified subcategories of patients at high risk of death (those with signs of right ventricular and biventricular failure). These findings suggest that transesophageal echocardiography performed on patients after cardiac operations, at the bedside in the intensive care unit, can readily elucidate the cause of hypotension in the large majority of patients and is a valuable adjunct to hemodynamic evaluation in patient management. Furthermore, it appears to be possible to identify subcategories of high-risk patients, based on these echocardiographic findings.
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J. Thorac. Cardiovasc. Surg. · Aug 1992
Case ReportsCarcinoid disease of the heart. Surgical management of ten patients.
Between 1982 and 1989, 10 patients with carcinoid heart disease underwent tricuspid valve replacement with a mechanical prosthesis at our institution. Pulmonary valvectomy was performed in nine patients and pulmonary valve replacement with a pulmonary homograft was performed in one. Two patients had carcinoid tumor metastatic to the heart, involving the right atrium in one case and both ventricles in the other. ⋯ The 4-year survival for the 38 patients undergoing tricuspid valve replacement for carcinoid heart disease was 48% +/- 13%. Symptomatic patients who have carcinoid heart disease and whose metastatic malignant disease is not an imminent threat to life should be offered valve replacement. Operating soon after the onset of increasing cardiac symptoms, before the often rapid deterioration in right ventricular failure, optimizes the benefits.
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J. Thorac. Cardiovasc. Surg. · Aug 1992
Continuous thermodilution cardiac output measurement in sheep.
A technique has been developed to continuously measure cardiac output by means of the principles of thermodilution. Pulmonary artery catheters were modified by placing a 10 cm filament near the usual injectate port. Small amounts of heat were infused according to a randomly repeating binary on-off sequence. ⋯ The technique was compared with bolus thermodilution in seven sheep. Cardiac output ranged from 1.5 to 13.2 L/min, and heart rate varied from 59 to 180 beats/min. The linear regression between the data obtained by the two methods is represented by the equation y = 1.00x + 0.13; the correlation coefficient, R, is 0.97, and the p value is less than 0.0001.