Enhanced recovery of ischemic myocardium by combining percutaneous bypass with intraaortic balloon pump support.

Although percutaneous bypass (PB) can support the failing myocardium, regional ischemic damage may still occur beyond a coronary occlusion. This study sought to determine whether the addition of intraaortic balloon pump (IABP) support to PB would result in more optimal salvage of ischemic myocardium. In 30 pigs, the second and third diagonal vessels were occluded with snares for 90 minutes followed by 30 minutes of cardioplegic arrest and 3 hours of reperfusion with the snares released.

Internal closure of an aspergilloma cavity: report of a new technique and review of the literature.

We have described a case in which closure of an aspergilloma cavity was done internally when it was determined that pulmonary resection was too hazardous. There was an intense inflammatory reaction surrounding the aorta and pulmonary artery. In the absence of gross purulence and underlying parenchymal infection, this technique may be used to avoid the prolonged hospitalization and bronchopleural fistulas associated with external drainage procedures.

Two-dimensional echocardiography in the evaluation of penetrating intrapericardial injuries.

Patients with penetrating pericardial trauma whose vital signs stabilize after fluid administration may present a therapeutic dilemma. Two-dimensional echocardiography has emerged as a diagnostic technique to help determine whether surgical intervention may be required. We present 5 patients with penetrating pericardial trauma whose vital signs stabilized after fluid administration and who had minimal clinical findings.

Unusual presentation of a large tension bronchogenic cyst in an adult.

A routine chest radiograph in a 20 year old man revealed a giant air filled cavity of the left hemithorax under tension. At thoracotomy a large left lower lobe intraparenchymal cyst required lobectomy and the pathological findings were consistent with a bronchogenic cyst. Although tension bronchogenic cysts are common in infants, this case demonstrates their unusual presentation in an adult.

Detrimental effects of interrupting warm blood cardioplegia during coronary revascularization.

Warm blood cardioplegia has emerged as a substitute for cold blood cardioplegia as a method of myocardial protection. However, the continuous infusion of blood in this technique may obscure the operative field and necessitate interruption of warm blood cardioplegia. This experimental study was therefore undertaken to determine whether interrupting warm blood cardioplegia during coronary revascularization would increase myocardial damage.

Warm versus cold blood cardioplegia--is there a difference?

This experimental study sought to compare the effectiveness of warm blood cardioplegia versus cold blood cardioplegia in protecting areas of ischemic myocardium during urgent coronary revascularization. In 40 adult pigs, the second and third diagonal vessels were occluded with snares for 90 minutes. All animals were then placed on cardiopulmonary bypass and underwent 45 minutes of cardioplegic arrest followed by 3 hours of reperfusion during which time the coronary snares were released.

Reduction of infarct size with coronary venous retroperfusion.

Background: The purpose of this study was to determine whether coronary venous retroperfusion with pressure-controlled intermittent coronary sinus occlusion (PICSO) alone and in combination with coronary venous substrate enhancement using L-glutamate would decrease ischemic damage after surgical revascularization for an acute coronary occlusion.

Methods And Results: In 40 pigs, the second and third diagonal vessels were occluded with snares for 90 minutes followed by 30 minutes of cardioplegic arrest and 180 minutes of reperfusion with the coronary snares released. During the period of coronary occlusion, 10 pigs received PICSO using a balloon-tipped triple-lumen catheter in the coronary sinus; 10 pigs received PICSO plus oxygenated blood transfused retrograde via the PICSO catheter (7 ml/min), 10 pigs received PICSO plus an oxygenated blood L-glutamate (13 mM) solution, and 10 pigs received neither PICSO, blood, nor L-glutamate through the coronary sinus (unmodified).

Retroperfusion and balloon support to improve coronary revascularization.

Coronary venous retroperfusion and Intra-Aortic Balloon Pump (IABP) support are methods currently utilized to reduce ischemic damage prior to revascularization of acutely ischemic myocardium. This study was undertaken to determine whether combining coronary venous retroperfusion using Pressure Controlled Intermittent Coronary Sinus Occlusion (PICSO) with the IABP would result in improved salvage of ischemic myocardium. In 40 adult pigs, the second and third diagonal vessels were occluded with snares for 1 1/2 hours followed by 1/2 hours of cardioplegic arrest and 3 hours of reperfusion with the snares released.

Bacillus cereus endocarditis: report of a case and review.

Bacillus cereus is a ubiquitous organism that infrequently causes serious infections. We report a patient with B. cereus endocarditis involving a mechanical aortic valve.

Changing profiles of failed coronary angioplasty patients: impact on surgical results.

As more high-risk patients undergo percutaneous transluminal coronary angioplasty (PTCA), the changing profiles of PTCA patients who may require emergent coronary artery bypass grafting may alter operative morbidity and mortality. This study compared profiles of recent patients undergoing emergent coronary artery bypass grafting after a failed PTCA with earlier patients to determine their impact on operative results. From 1980 to 1988, 53 patients underwent emergent coronary artery bypass grafting after a failed PTCA at the Boston University Medical Center.

Role of percutaneous bypass in reducing infarct size after revascularization for acute coronary insufficiency.

This study compares the effectiveness of percutaneous bypass (PB) with that of the intra-aortic balloon pump (IABP) in reducing infarct size and ischemic damage after revascularization for acute coronary occlusion. In 30 adult pigs, the second and third diagonal vessels were occluded with snares for 1 1/2 hours, followed by 1/2 hour of cardioplegic arrest and 3 hours of reperfusion with the snares released. During the period of coronary occlusion before the institution of cardiopulmonary bypass, 10 pigs were placed on PB, 10 pigs received IABP, and 10 others received no intervention (unmodified).

Continuous versus intermittent cardioplegia in the presence of a coronary occlusion.

Coronary artery occlusions can alter the distribution of cardioplegia and result in ischemic damage. This study was undertaken to determine whether continuous antegrade cardioplegia delivery would result in colder temperatures and provide better washout of acid metabolites than is possible with intermittent antegrade cardioplegia when coronary occlusions are present. Twenty pigs were placed on cardiopulmonary bypass and underwent 2 hours of ischemic arrest with occlusion of the middle left anterior descending coronary artery followed by 1 hour of reperfusion without occlusion of that artery.

Pulmonary hyalinizing granuloma: a rare cause of a solitary pulmonary nodule.

Pulmonary hyalinizing granulomata are unusual, noninfectious lesions of the lung of uncertain etiology that probably represent an exaggerated immune response. They present radiographically as noncalcified solitary or multiple pulmonary nodules, thereby mimicking primary or metastatic malignancy. The article discusses a case of this rare entity that presented as a solitary pulmonary nodule.

Superiority of retrograde cardioplegia after acute coronary occlusion.

Because antegrade cardioplegia may limit the distribution of cardioplegia beyond a coronary occlusion, this study was undertaken to determine whether retrograde coronary sinus cardioplegia provides superior myocardial protection during revascularization of an acute coronary occlusion. In 20 adult pigs, the second and third diagonal branches were occluded with a snare for 1 1/2 hours. Animals were then placed on cardiopulmonary bypass and underwent 30 minutes of ischemic arrest with multidose, potassium, crystalloid cardioplegia.

Intraoperative echocardiography.

Intraoperative echocardiography has emerged as a new technique by which the cardiac surgeon can more precisely define the operative anatomy and physiology, immediately evaluate the results, and more accurately monitor left ventricular function in the operating room. This review summarizes the current applications of intraoperative two-dimensional and Doppler echocardiography in both the epicardial and transesophageal forms, and discusses the advantages and possible limitations of these methods in the practice of clinical cardiac surgery.

Superiority of substrate enhancement over oxygen free-radical scavengers during extended periods of cold storage for cardiac transplantation.

When cold storage techniques used in cardiac transplantation are extended beyond 3 hours, there is significant depression in ventricular function. This study was undertaken to determine whether the addition of the amino acid L-glutamate or the oxygen free-radical scavengers superoxide dismutase (SOD) and catalase (CAT) during extended periods of cold storage would improve ventricular function. Fifteen rabbit hearts were placed on a Langendorff apparatus, arrested with crystalloid potassium cardioplegia, stored in iced saline solution (3 degrees C) for 5 hours, and then reperfused at 37 degrees C for 1 hour.

Improved myocardial preservation during cold storage using substrate enhancement.

This study was undertaken to determine whether substrate enhancement with L-glutamate during periods of cold storage would improve ventricular function in transplanted hearts. Thirty-one rabbit hearts were rapidly excised and perfused with Krebs-Henseleit buffer (37 degrees C) on a Langendorff apparatus. They were arrested with hypothermic (4 degrees C), crystalloid, potassium (25 mEq/L) cardioplegia and stored at 3 degrees C for three hours, followed by reperfusion with Krebs-Henseleit buffer for one hour.

Effects of coronary revascularization on regional wall motion. An intraoperative two-dimensional echocardiographic study.

Although coronary artery bypass grafting effectively reduces the symptoms of myocardial ischemia, its immediate effect on regional wall motion dysfunction is not well defined. This intraoperative study was undertaken to determine whether bypass grafting improves regional wall motion in areas of preoperative ischemic dysfunction. In 17 patients undergoing coronary bypass, short-axis echocardiograms were obtained with the chest open 30 minutes before and after cardiopulmonary bypass.

Importance of topical hypothermia during heterogeneous distribution of cardioplegic solution.

Recent studies have suggested that topical hypothermia may be unnecessary during coronary bypass operations because of possible pulmonary complications resulting from phrenic nerve damage. This study was undertaken to determine whether topical hypothermia is necessary for optimal myocardial protection when distribution of the cardioplegic solution is heterogeneous because of coronary occlusions. Twenty pigs were subjected to 120 minutes of ischemic arrest with multidose potassium crystalloid cardioplegia (4 degrees C).

Malignant fibrous histiocytoma obstructing the thoracic aorta.

Neoplasms of the aorta are rare. In this report, we present a case of a malignant fibrous histiocytoma that nearly obliterated the lumen of the thoracic aorta. The neoplasm was resected and aortic continuity was reestablished with an interposition graft.

Coronary sinus interventions during cardiac surgery.

There is renewed interest in protecting jeopardized myocardium during regional and global ischemia by coronary sinus retroperfusion. Advances in catheter design and imaging techniques have made access to the coronary sinus easier and safer. Retrograde coronary sinus perfusion, aortovenous bypass, pressure-controlled intermittent coronary sinus occlusion, and synchronized retrograde perfusion have emerged as new techniques by which blood can be redirected through the coronary sinus to nourish ischemic myocardium beyond a coronary occlusion.

Improved distribution of cardioplegia with pressure-controlled intermittent coronary sinus occlusion.

Coronary occlusions may alter the distribution of antegrade cardioplegia and result in ischemic damage. This study was undertaken to determine whether pressure-controlled intermittent coronary sinus occlusion (PICSO) could improve antegrade cardioplegic delivery when coronary occlusions are present. Twenty pigs were subjected to 120 minutes of ischemic arrest with antegrade, multidose, potassium crystalloid cardioplegia.

Reversal of reperfusion injury after ischemic arrest with pressure-controlled intermittent coronary sinus occlusion.

Recent experimental studies have shown that pressure-controlled intermittent coronary sinus occlusion effectively reduces both infarct size and myocardium at risk after coronary artery occlusion. This study was undertaken to determine whether this modality was equally effective in altering reperfusion damage after a period of ischemic arrest. Fourteen pigs were placed on cardiopulmonary bypass and subjected to 2 hours of ischemic arrest with multidose potassium crystalloid cardioplegia supplemented with topical and systemic hypothermia (28 degrees C).