Save a Child's Heart: We Can and We Should-A Generation Later.

The Annals of Thoracic Surgery published a seminal article by the late Dr Amram ("Ami") Cohen and his associates entitled "Save a Child's Heart: We Can and We Should" in 2001. It stressed the moral imperative and challenge of pediatric heart care in the developing world. The current article presents an update of the past 25 years of the history, experience, and international ramifications of 1 institution and 1 UN-recognized Israeli organization.

Nitric oxide synthase inhibitor (MTR-105) during open-heart surgery. A pilot double-blind placebo-controlled study of hemodynamic effects and safety.

Objectives: Hypotension is common immediately following cardiopulmonary bypass. Experimentally, MTR-105 (S-ethylisothiuronium diethylphosphate), a fast-acting synthetic nitric oxide synthase inhibitor, rapidly increases blood pressure. The purpose of the current study was to assess the influence of MTR-105 on hemodynamics early after cardiopulmonary bypass in patients undergoing open-heart surgery.

Quadrivalvular heart disease: transition from congenital pulmonary stenosis to rheumatic disease.

The case is reported of a 36-year-old male patient suffering from congenital pulmonary stenosis who previously had undergone pulmonary balloon valvuloplasty. During the past nine years, he had experienced recurrent attacks of rheumatic fever that gradually damaged all four heart valves. The patient underwent aortic, mitral and pulmonary valve replacement with tricuspid valve annuloplasty and pulmonary artery reconstruction.

Ruptured sinus of Valsalva aneurysm complicated by myocardial ischemia: pathogenetic mechanisms.

Significant left-to-right shunt in combination with severe aortic regurgitation (AR) accelerates the development of symptoms after rupture of congenital sinus of Valsalva aneurysm (SVA) in spite of intact coronary arteries. We depict a rare description of a situation where acute coronary syndrome was the first manifestation of such an occurrence. We believe that the progress of the myocardial ischemia after ruptured SVA depends on the severity of AR and the quantity of the left-to-right shunt.

Indications for tricuspid valve detachment in closure of ventricular septal defect in children.

Background: Different techniques have been described for tricuspid valve detachment to improve visualization in ventricular septal defect repair. Our hypothesis was that preoperative echocardiographic criteria are important in deciding which patients should undergo ventricular septal defect repair by tricuspid valve detachment, and patients who undergo this procedure may have a better surgical outcome than those who fulfilled the criteria but were actually operated on with the standard surgical approach.

Methods: Between January 2000 and December 2004 we prospectively studied 179 patients scheduled for ventricular septal defect repair and criteria for tricuspid valve detachment were established.

Nonocclusive mesenteric ischemia after off-pump coronary artery bypass surgery: a word of caution.

We present a series of five cases of off-pump coronary artery bypass surgery complicated with fatal nonocclusive mesenteric ischemia. We review a total of 489 patients aged 65 and older (mean age 74.9 +/- 3.

Initial experience with the Heartstring proximal anastomotic system.

Objective: Manipulation of the aorta has been shown to be associated with postoperative neurologic events after surgical myocardial revascularization when the aorta is diseased. The Heartstring proximal anastomotic system (Guidant, Indianapolis, Ind) is a device designed to assist in the performance of proximal anastomoses with minimal aortic manipulation. We describe our initial experience with this product.

Milrinone and nitric oxide: combined effect on pulmonary artery pressures after cardiopulmonary bypass in children.

Objective: To investigate the effect of milrinone combined with nitric oxide (NO) on the pulmonary artery pressures (PAP) after cardiopulmonary bypass (CPB), for repair of congenital heart defects (CHD) in children.

Design: Prospective, randomized, double-blind study.

Setting: University affiliated community hospital.

Long-term beneficial effect of coronary artery bypass grafting in patients with COPD.

Objective: This study assesses the impact of COPD on the long-term outcome of patients undergoing coronary artery bypass grafting (CABG).

Methods: Between 1991 and 1993, 37 patients (5.68%) undergoing CABG had significant clinical COPD.

Preoperative use of enoxaparin is not a risk factor for postoperative bleeding after coronary artery bypass surgery.

Background: The purpose of this study was to determine whether the use of low-molecular-weight heparin before coronary artery bypass surgery would be associated with an increase in bleeding and use of blood products after the operation.

Methods: Sixty-four patients (48 men and 16 women) aged 64 +/- 10 years who were undergoing primary coronary artery bypass surgery were prospectively studied. Forty-one patients were treated with either subcutaneous enoxaparin 1 mg/kg twice daily (n = 21; enoxaparin group) or intravenous heparin (n = 20; heparin group).

Removal of deadspace volume from arterial catheter: How muchis enough?

OBJECTIVE: To evaluate the amount of volume needed to be removed from arterial catheter systems to compensate for "deadspace" and to allow an accurate measurement of pH and hemoglobin (Hb). DESIGN: Twenty patients undergoing heart surgery were evaluated in a steady state after the induction of anesthesia before surgery. Six blood samples were removed from the arterial catheter, the total volume of which was 1.

Tranexamic acid reduces bleeding and the need for blood transfusion in primary myocardial revascularization.

Background: The objective of this study was to study the effect of low-dose tranexamic acid (TA) on postoperative bleeding and coagulation variables after coronary artery bypass grafting operation.

Methods: Fifty patients undergoing primary coronary artery bypass grafting were randomly assigned to receive either placebo (0.9% NaCl; n = 25) or 10 mg/kg TA followed by infusion of 1 mg/kg per hour during the operation (n = 25).

Decreased sternal vascularity after internal thoracic artery harvesting resolves with time: an assessment with single photon emission computed tomography.

Objective: We sought to prospectively evaluate the long-term effect of left internal thoracic artery harvesting on sternal vascularity.

Methods: Twelve consecutive patients undergoing primary coronary artery bypass grafting were studied. In all patients a pedicled left internal thoracic artery was harvested.