The heart surgery forum
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The heart surgery forum · Jan 1999
Surgical treatment of patients with ischemic cardiomyopathy: the significance of right ventricular function.
Patients with ischemic cardiomyopathy (ICMP) awaiting heart transplantation (HT) have a high mortality rate, in part because of the lack of donor organs. Given this limitation, we propose to broaden the indications for coronary artery bypass grafting (CABG) in this group and to more accurately select patients with ICMP requiring myocardial revascularization or HT. In this study, we assessed the short and long-term results of CABG in patients with ICMP. We also assessed the role of the right ventricle and the diastolic function of both ventricles in patients with ICMP. Using this information, we propose indications for CABG and/or HT in patients with ICMP. ⋯ CABG in the patients with ICMP significantly increases the functional reserves of the myocardium of both ventricles, mostly because of the improvement in the diastolic function of the LV. In the RV, the systolic function could restore even in the early postoperative period. Preoperative analysis of the parametric images made after orthostatic test and nitroglycerin intake allow prediction, with 85 % sensitivity and 95% specificity, of the areas of the myocardium which will restore their function immediately after CABG ("hibernated myocardium"). The recovery of regional wall motion amplitude and of the response of the myocardium to coronary revascularization could continue during the first year after revascularization ("stunned myocardium "), most often beginning in the LV. The decrease of the EF of the RV as a response to the "unloading" tests could be a result of the disturbance of the ventricles' interaction as well as the spreading of the scarring of the RV myocardium. This decrease could be a predictor of the possible development of the low cardiac output syndrome after CABG.
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We retrospectively analyzed our early results with minimally invasive aortic root replacement. ⋯ Minimally invasive aortic root replacement is feasible for a broad range of aortic valve pathology, can incorporate full root, hemiroot and subcoronary techniques, can be used for homografts and "Freestyle" valves as well as valved conduits, and can be accomplished with acceptable morbidity and mortality. However, the operation takes longer through the smaller incision and therefore requires more careful attention to myocardial protection.
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The heart surgery forum · Jan 1999
Case ReportsLow flow veno-venous ECMO via subclavian dialysis catheter for severe respiratory failure.
We present the case of a 12-year-old female with severe postoperative bacterial pneumonia unresponsive to conventional treatment following a failed renal transplant. ⋯ Low flow veno-venous ECMO represents a new therapeutic alternative for critically ill patients whose condition does not meet the conventional ECMO criteria. Further clinical experience is still needed.
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The heart surgery forum · Jan 1998
Clinical TrialPreoperative 3D-reconstructions of ultrafast-CT images for the planning of minimally invasive direct coronary artery bypass operation (MIDCAB).
The direct left internal mammary artery (LIMA) bypass to the left anterior descending (LAD) without the use of extracorporal circulation through a small anterolateral thoracotomy has become established among the minimally invasive techniques in cardiac surgery. Technical difficulties may occur in patients with an enlarged left ventricle and subsequent lateral positioning of the LAD, a small LAD, or a small LIMA. We used electron beam tomography (EBT) for preoperative visualization of the topographical structures to seek out patients with potential technical difficulties. ⋯ For minimally invasive direct coronary artery bypass (MIDCAB) the topography of the LIMA, LAD and intercostal spaces is of major importance. Using the ECG-triggered EBT with subsequent three-dimensional reconstruction these relationships can be visualized. This enables an individual planning of the operation and a minimalization of the skin incision.