The Journal of thoracic and cardiovascular surgery
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J. Thorac. Cardiovasc. Surg. · Jul 1982
Hydroxyethyl starch in priming fluid for cardiopulmonary bypass.
The physiochemical characteristics of hydroxyethyl starch make it suitable for use as a colloidal blood plasma substitute. In high doses, this drug may interfere with blood coagulation. Because of its effectiveness and low cost, we have used hydroxyethyl starch rather than albumin in the priming fluid for cardiopulmonary bypass: 500 ml of 6% hydroxyethyl starch and 2,000 ml of lactated Ringer's solution. ⋯ These results compare favorably with other recently published series in which hydroxyethyl starch was not used in the pump prime. Thus the dose of hydroxyethyl starch in our priming fluid does not appear to be associated with excessive bleeding. In view of its safety and low cost, hydroxyethyl starch is a suitable colloidal blood plasma substitute for use during cardiopulmonary bypass.
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J. Thorac. Cardiovasc. Surg. · May 1982
Aneurysms of the ascending aorta and transverse arch: surgical experience in 80 patients.
Aneurysms of the ascending aorta and transverse arch constitute formidable surgical challenges. To assess the impact of surgical techniques on operative morbidity and mortality and late results, we reviewed 80 consecutive patients operated from 1976 through 1980. Average age was 52 years and 81% were male. ⋯ Aortic valve resuspension was done in six patients, with three undergoing subsequent aortic valve replacement for insufficiency. Aneurysms of the transverse arch treated with profound hypothermia and circulatory arrest were associated with fewer neurologic complications, and the operations were more expeditiously completed. Eleven of 80 patients (14%) had or subsequently needed additional surgical procedures on the aortic valve (insufficiency) or the distal aorta.
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J. Thorac. Cardiovasc. Surg. · Oct 1981
Primary definitive repair of type B interrupted aortic arch, ventricular septal defect, and patient ductus arteriosus. Early and late results.
Since March, 1974, eight patients, aged 7 days to 5 months, with type B interrupted aortic arch (IAA), ventricular septal defect (VSD), and patent ductus arteriosus (PDA) were treated at the Columbus-Presbyterian Medical Center and the University of Maryland Hospital. Six of these patients underwent definitive repair utilizing deep hypothermia and circulatory arrest. Correction involved resection of all ductal tissue, primary anastomosis of the aortic arch, closure of the foramen ovale, and patch closure of the VSD. ⋯ Three patients are alive and well 3 to 6 years after repair. Two have undergone repeat cardiac catheterization which demonstrated good growth of the anastomosis and no residual gradient. Primary definitive correction of type B IAA with VSD and PDA provides distinct advantages over palliative or other surgical procedures with excellent long-term results.
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J. Thorac. Cardiovasc. Surg. · Oct 1981
Case ReportsUse of the silicone tracheal T-tube for the management of complex tracheal injuries.
This paper reports on the use of the silicone Montgomery T-tube for the management of 18 patients with complex tracheal injuries. Our use of the tube was as follows: prior to definitive resection, as a better alternative to tracheostomy tube, while we were awaiting the most appropriate time for resection; at the time of resection, as an adjunct to segmental subglottic resection, used to stent residual abnormal laryngeal mucosa: following tracheal resection for uncertain or unsatisfactory healing: as sole treatment, when resection was deemed unsuitable or inappropriate. ⋯ In contrast to a tracheostomy tube, the T-tube provides respiration through the the nasopharynx, so that humidification and phonation are maintained. It is generally trouble free, requires little if any maintenance, and can remain in place for a year or more when necessary.