The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Apr 1978
Comparative StudyComparative studies of pulsatile and nonpulsatile flow during cardiopulmonary bypass. III. Response of anterior pituitary gland to thyrotropin-releasing hormone.
Previous studies have indicated that, during nonpulsatile cardiopulmonary bypass, the anterior pituitary gland fails to respond to the tropic stimulus of thyrotropin-releasing hormone (TRH). This is in contrast to the normal response seen during closed cardiac and general surgical procedures. The Stöckert pulsatile pump system described in Part I has been employed in a comparative study of TRH responses in 20 patients subjected to pulsatile or nonpulsatile perfusion during open-heart surgery. ⋯ In the pulsatile group, however, the pituitary response to TRH was normal in nine patients out of 10. The quantitative difference between the groups was statistically highly significant (p less than 0.005). These results indicate that the subnormal pituitary function seen with nonpulsatile bypass may be prevented by the use of pulsatile perfusion.
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J. Thorac. Cardiovasc. Surg. · Apr 1978
Comparative StudyComparative studies of pulsatile and nonpulsatile flow during cardiopulmonary bypass. I. Pulsatile system employed and its hematologic effects.
A new, commercially available roller pump system able to deliver pulsatile and nonpulsatile flow has been studied in patients undergoing elective open-heart surgical procedures. The pulsatile pump (Stöckert Instrumente) may be used with standard extracorporeal circuit equipment and consistently produces a peripheral arterial pulse pressure of 25 to 30 mm. Hg at mean flow rates of 3.5 to 4.0 L. per minute. ⋯ Comparative studies of the hematologic effects of pulsatile and nonpulsatile perfusion were carried out. There was no evidence of increased hemolysis with pulsatile flow, nor was there increased depletion of red blood cells (RBC's) or platelets in the pulsatile group. This pulsatile pump system may therefore be used to produce pulsatile perfusion during cardiopulmonary bypass without the fear of producing excessive blood cell trauma.
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J. Thorac. Cardiovasc. Surg. · Apr 1978
Case ReportsChylothorax and chylopericardial tamponade following Blalock-Taussig anastomosis.
A case of chylothorax following a right-sided Blalock-Taussig shunt is presented. Chylopericardial tamponade eventually developed, because the mediastinal leakage of chyle was sealed off from the pleural cavity and diverted into the pericardium. Chylopericardium is a rare cause of an enlarged cardiac silhouette on a postoperative chest roentgenogram, but the importance of differentiating it from congestive heart failure is illustrated. When chylopericardial tamponade occurs, treatment consists of (1) aspiration for immediate relief and, if there is recurrence, (2) surgical evacuation of the pericardium with tube drainage or pericardiectomy and (3) ligation of the source of chylous drainage.
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J. Thorac. Cardiovasc. Surg. · Feb 1978
Prevention of pulmonary insufficiency through prophylactic use of PEEP and rapid respiratory rates.
This study evaluated the effectiveness of prophylactic positive end-expiratory pressure (PEEP) rapid respiratory rates (RRR), and high tidal volume (HTV) in prevention of congestive atelectasis. Measurements of pulmonary hemodynamics, mechanics, gas exchange, functional residual capacity (FRC), pathology, and cinemicroscopy were performed in 45 anesthetized dogs subjected to hemorrhagic hypotension. Randomly, the animals received control ventilation, HTV (20 ml. per kilogram), RRR (32 breaths per minute), or PEEP (5 cm. of water). ⋯ RRR did not affect FRC but minimized the SPV-LA gradient. This effect on the pulmonary venules theoretically could be mediated by stimulating lymphatic flow, thereby decreasing interstitial edema. Thus PEEP and RRR are beneficial when used prophylactically but may work by widely differing mechanisms.
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J. Thorac. Cardiovasc. Surg. · Dec 1977
Extracorporeal circulation (ECMO) in neonatal respiratory failure.
Sixteen moribund newborn infants with respiratory failure were treated with extracorporeal membrane oxygenation (ECMO) for 1 to 8 days. Cannulation via the right jugular vein and carotid artery was used to establish venoarterial-cardiopulmonary bypass. High flow (80 percent of cardiac output) allowed decreasing FIO2 and airway pressure. ⋯ In a parallel series of 21 infants treated with conventional ventilator therapy, the mortality rate was 90 percent and intracranial bleeding occurred in 57 percent. ECMO provided life support and gains time in newborn respiratory failure. In high mortality risk infants, the rate of survival is higher and intracranial bleeding lower with ECMO than with optimal ventilator management.