Kyobu geka. The Japanese journal of thoracic surgery
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A 60-year-old man, who had undergone open mitral commissurotomy 6 years ago, underwent re-do surgery (mitral valve replacement) with minimally invasive cardiac surgery (MICS), using lower partial sternotomy to the height of the right side second intercostal space. Cannulation of the heart was carried out placing a cannula directly into the superior vena cava and a second cannula in the inferior vena cava via the right atrium. ⋯ Cardioplegia was administered directly into the ascending aorta with intermittent perfusion. Valve replacement was performed by opening directly right side left atrium.
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The management of persistent postoperative pleural effusion is still considered difficult. We report here our experience with such a case, successfully managed with fenestration of the diaphragm-the first of it's kind. Clinical Experience: A two-year-old boy with double outlet right ventricle, underwent right heart bypass procedure. Due to low output and high venous pressure, he was on ventilator until the 26th postoperative day. The pericardial and right pleural effusion persisted till the 60th postoperative day. Right phrenic nerve palsy and atelectasis of right lower lobe were suspected to contribute to it. We performed a plication of the right diaphragm and fenestration of the pericardium and right diaphragm. A T-shaped incision was made on the right diaphragm and the edges were trimmed and strengthened with non-absorbable suture into a circular shaped defect of 1.5 cm diameter. The defect was closed with a Dacron mesh allowing passage of fluid across. Pleural effusion decreased immediately and he was discharged a month after the procedure. Experimental Study: The above procedure was experimented in rabbits in whom a contrast medium injected into the pleural cavity could easily drain into the peritoneum through the fenestation, proved by fluoroscopy. ⋯ Fenestration of the diaphragm is an effective procedure to manage persistent pleural effusion.
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Despite the reducing exposure to allogeneic blood in cardiac surgery, most of patients with anemia still require allogeneic blood. In this study, we have attempted to harvest the blood from cardiac patients with baseline hemoglobin levels below 11.0 g/dl using recombinant human erythropoietin (rHuEPO). 29 anemic patients undergoing cardiac surgery at our hospital between January 1994 and March 1997 were divided into two groups: 3 weeks' treatment with recombinant human erythropoietin (rHuEPO) and blood donation (group 1, n = 15) and iron supplementation alone (group 2, n = 14). There were no statistically significant differences among the two groups in patients characteristic and surgical data. ⋯ In 75% of group 1, allogeneic blood transfusion could be avoided, while all patients in group 2 received allogeneic blood transfusion. This study suggests that the combination of rHuEPO administration and autologous blood donation would be beneficial for anemic patients in elective cardiac surgery. The use of rHuEPO should not be restricted to anemic patients.
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Objective of this study is to evaluate influence of acute aortic dissection on long-term results of aortic root reconstruction in patients with Marfan's syndrome. 19 patients who underwent consecutive aortic root reconstruction between 1985 May to 1998 February were retrospectively reviewed. Patients who associated acute aortic dissection at the time of operation (group D, n = 7) were compared long-term results with those who did not (group non-D, n = 12). Mean follow-up period was 5.1 +/- 3.2 years and longest follow-up term was 12.5 years. ⋯ On the other hand, excellent long-term results after aortic root reconstruction were found in non-dissection Marfan's syndrome. Considering high incidence of late dilatation of residual aorta, simultaneous total arch replacement with aortic root reconstruction is recommended in acute dissecting Marfan's syndrome. Whereas, preventive simultaneous arch replacement is not required in non-dissecting Marfan's syndrome because of less postoperative vascular events.
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After right heart bypass operation, dopamine was continuously infused at 5 micrograms/kg/min. The patients had a stable hemodynamic status but relatively low SvO2, low urine output and peripheral insufficiency. Amrinone was continuously infused at 10 micrograms/kg/min in 5 patients (Group A), or milrinone was continuously infused at 0.5 microgram/kg/min in 5 patients (Group M). ⋯ These patients treated using temporary antiarrhythmia drug or temporary pacing. When the patients discharged, they recovered the normal sinus rhythm. In conclusion, after right heart bypass operation in infants, infusion of amrinone or milrinone appears to be effective and safe combining with dopamine.