The heart surgery forum
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The heart surgery forum · Jan 2006
Comparative StudyComparison of the usage of intravenous iloprost and nitroglycerin for pulmonary hypertension during valvular heart surgery.
Pulmonary hypertension secondary to valvular heart disease is a cause of acute right heart failure during valve replacement operations. This study compares the hemodynamic effects of intravenous use of iloprost and nitroglycerin in patients with pulmonary hypertension undergoing valvular replacement surgery. We sought to determine the acceptable doses of these medications for use in surgery to decrease mean pulmonary artery pressure to <30 mmHg without causing systemic side effects. The plasma nitric oxide levels that were obtained from pulmonary mixed venous blood have been compared to demonstrate the difference in the action mechanism of these drugs. ⋯ Intravenous use of both iloprost and nitroglycerin effectively reduces mean pulmonary artery pressure, although only the iloprost group was accompanied by an increase in cardiac output. During operation, where abrupt management of pulmonary hypertension is required, systemic use of iloprost or nitroglycerin at appropriate doses via a pulmonary artery catheter offers adequate relief of hypertension and is well tolerated without any significant adverse effects. The plasma nitric oxide levels did not rise with the use of iloprost.
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The heart surgery forum · Jan 2006
Clinical TrialThe progress of mitral regurgitation after isolated coronary artery bypass in cases of ischemic mitral regurgitation.
Mitral valve intervention combined with coronary artery bypass surgery is inevitable in the case of severe mitral regurgitation in patients with coronary artery disease because the prognosis is poor without mitral correction. The best treatment protocol for patients with a moderate degree of mitral regurgitation is under debate. To clarify the optimal management for these patients, we evaluated the progress of mitral regurgitation after isolated coronary artery bypass surgery in cases of ischemic mitral regurgitation. METHODS; The study was conducted between March 2001 and April 2003. Forty-seven patients (70% men, with a mean age of 61 years, a mean ejection fraction of 43.7%, and a mean New York Heart Association class of 2.53) with preoperative diagnoses of moderate degree ischemic mitral regurgitation (Grade 3 mitral regurgitation on a scale of 0 to 4) and coronary artery disease, without leaflet pathology, underwent isolated coronary artery bypass surgery. Patients were followed-up at a mean of 22 months and an echocardiographic evaluation was done to determine the progress of the mitral disease. ⋯ Patients with moderate ischemic mitral regurgitation and coronary artery disease who underwent coronary artery bypass surgery alone had acceptable results. We are of the opinion that isolated coronary artery bypass surgery might be a good treatment choice for moderate degree ischemic mitral regurgitation.
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The heart surgery forum · Jan 2006
Case ReportsAorto-carotid bypass for cerebral malperfusion after aortic dissection surgery: a case report.
Malperfusion syndrome may complicate the postoperative course in patients who have undergone surgery for aortic dissection. In these cases, open surgery or endovascular intervention may be required. We present a case of postoperative onset of intermittent severe neurological symptoms after surgery for type A aortic dissection. ⋯ All neurological symptoms were completely resolved. We advocate a high degree of vigilance for signs of cerebral malperfusion in the intensive care unit. Early intervention can result in a successful outcome, as illustrated by this case report.
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The heart surgery forum · Jan 2006
Randomized Controlled TrialPentoxifylline affects cytokine reaction in cardiopulmonary bypass.
Cardiac surgery is associated with an inflammatory response that may cause myocardial dysfunction after cardiopulmonary bypass. We examined the efficacy of pentoxifylline to attenuate the cardiopulmonary bypass-induced inflammatory response during heart operations. ⋯ Our results indicate that pentoxifylline infusion during cardiac surgery inhibits the proinflammatory cytokine release caused by cardiopulmonary bypass.
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The heart surgery forum · Jan 2006
Case ReportsRobotic-assisted left atrial ligation for stroke reduction in chronic atrial fibrillation: a case report.
Patients with atrial fibrillation are at significant risk for sustaining a thromboembolic stroke. More than 90% of thromboemboli form in the left atrial appendage. ⋯ We report a case of port-access robotic-assisted left atrial ligation as a stand-alone procedure in a patient with chronic atrial fibrillation in whom anticoagulation was a contraindication. To our knowledge, this is the first reported case of stand-alone robotic-assisted left atrial ligation in the literature.