Bleeding following coronary surgery after preoperative low-molecular-weight heparin.

Low-molecular-weight heparin and acetyl salicylic acid have become an established treatment for unstable angina. A retrospective study on our database of one year was carried out to see what impact preoperative low-molecular-weight heparin versus none had on the postoperative course of 473 patients having coronary surgery exclusively. Apart from the fact that the low-molecular-weight heparin patients had a higher New York Heart Association classification and marginally more grafts, longer bypass and cross-clamp time, the preoperative characteristics and surgery of the two groups were similar.

A prospective survey of patients with valvular heart disease in Europe: The Euro Heart Survey on Valvular Heart Disease.

Aims: To identify the characteristics, treatment, and outcomes of contemporary patients with valvular heart disease (VHD) in Europe, and to examine adherence to guidelines.

Methods And Results: The Euro Heart Survey on VHD was conducted from April to July 2001 in 92 centres from 25 countries; it included prospectively 5001 adults with moderate to severe native VHD, infective endocarditis, or previous valve intervention. VHD was native in 71.

[Surgical treatment of carcinoid bronchial tumor].

During the period 1977-95, 20 patients underwent surgery for carcinoid tumour in the bronchus at the University Hospital of Trondheim (n = 16) and Innherred County Hospital (n = 4). All the tumours were typical carcinoid tumours. Median age of the patients was 41 years (range 16-78 years).

[Mitral valve plasty. A 12-year material].

46 patients underwent mitral valve repair at the Regional Hospital in Trondheim/St. Elisabeth Heart Clinic, during the period 1983-95. There were 20 female patients.

Effects of thoracic epidural analgesia on pulmonary function after coronary artery bypass surgery.

Objective: A substantial reduction in lung volumes and pulmonary function follows cardiac surgery. Pain may prevent effective breathing and coughing, and as thoracic epidural analgesia may reduce postoperative pain, we investigated the effect of epidural analgesia on pulmonary function.

Methods: Fifty-four male patients, under 65 years and with an ejection fraction of more than 0.

Procaine is effective for minimizing postischemic ventricular fibrillation in cardiac surgery.

Procaine hydrochloride was added to cardioplegia and studied for its efficacy in stabilizing the postischemic rhythm after aortic declamping in cardiac surgery. Fifty-six patients scheduled for coronary artery bypass grafting (CABG), were included in a randomized, double-blind study. The patients were anesthetized with isoflurane, low-dose fentanyl, diazepam, and pancuronium.

Effects of thoracic epidural analgesia on coronary hemodynamics and myocardial metabolism in coronary artery bypass surgery.

Objective: A possible influence of thoracic epidural analgesia on coronary hemodynamics and myocardial metabolism in coronary artery bypass grafting was investigated.

Design: The study was prospective and randomized.

Setting: The study was performed in a university hospital.

Post-infarction left ventricle to right atrium fistula diagnosed by transthoracic Doppler echocardiography.

This is a report of a 63-year-old man who in the course of an inferior wall myocardial infarction developed a left ventricular aneurysm with communication to the right atrium and a haemodynamically significant intracardiac shunt. The unusual complication of a myocardial infarction was correctly diagnosed by transthoracic Doppler echocardiography, and later a successful surgical repair was done.

Thoracic epidural analgesia in aortocoronary bypass surgery. II: Effects on the endocrine metabolic response.

Thoracic epidural analgesia (TEA) may offer haemodynamic benefits for patients with coronary heart disease going through major surgery. This may-in part-be secondary to an effect on the endocrine and metabolic response to surgery. We therefore investigated the effect of TEA on the endocrine metabolic response to aortocoronary bypass surgery (ACBS).

Thoracic epidural analgesia in aortocoronary bypass surgery. I: Haemodynamic effects.

Tachycardia and hypertension may cause myocardial ischaemia in patients with coronary heart disease going through major surgery. Thoracic epidural analgesia (TEA) has been reported to be beneficial in this situation. The haemodynamic effects of TEA in aortocoronary bypass surgery were investigated in 30 male patients < 65 years old and with ejection fraction > 0.

Angiographic findings of silent ischaemia following aortocoronary bypass surgery.

Silent ischaemia, defined as ST-depression > or = 1 mm without chest pain, was found on exercise testing in 22 (10.7%) of 206 patients who underwent aortocoronary bypass surgery in the period from March 1983 to November 1985. Exercise testing was performed 4.

Heparin-coated circuit during cardiopulmonary bypass. A clinical study using closed circuit, centrifugal pump and reduced heparinization.

A prospective randomized study was performed to investigate the effect of surface coating with covalently endpoint-attached heparin (Carmeda Bio Active Surface) and reduced general heparinization on haematological indices and complement C5 activation. Care was taken to optimize the rheological design of the system using centrifugal pump and a closed system without venting or machine suction. Twenty patients scheduled for aortocoronary bypass grafting (EF > 0.

The relationship between preoperative coronary angiography and clinical outcome of aortocoronary bypass surgery.

Two hundred and fifty preoperative coronary cineangiograms were reviewed. All observed stenoses were evaluated with regard to location, severity and suitability for bypass grafting. The angiographic prediction for a successful surgical result was classified as "doubtful", "acceptable", "good" and "very good".

The influence of thoracic epidural analgesia alone and in combination with general anesthesia on cardiovascular function and myocardial metabolism in patients receiving beta-adrenergic blockers.

Thoracic epidural analgesia combined with chronic beta-adrenergic blocker medication may cause cardiac depression. We investigated the cardiovascular and myocardial metabolic effects of a T1-T12 epidural block in 18 patients (age < 65 yr, ejection fraction > 0.5), receiving chronic beta-adrenergic blocker medication and scheduled for aortocoronary bypass surgery.

Exercise hemodynamics in small (< or = 21 mm) aortic valve prostheses assessed by Doppler echocardiography.

Exercise Doppler echocardiography was used to assess hemodynamics in 25 patients with a < or = 21 mm aortic valve prosthesis (14 with a Medtronic-Hall 21 mm valve, three with a Medtronic-Hall 20 mm valve, three with a Sorin 21 mm valve, one with a Duromedics 21 mm valve, and four with a Carpentier-Edwards 21 mm valve). A symptom-limited upright bicycle exercise test was performed, and Doppler gradients were recorded during exercise. Gradients increased with exercise from 30 +/- 8/16 +/- 4 mm Hg (peak/mean) at rest to 46 +/- 12/24 +/- 7 mm Hg during exercise; both p < 0.

Two-dimensional echocardiography for prediction of aortic valve prosthesis size. A comparative study of Medtronic-Hall and Carpentier-Edwards supra-annular valves.

To assess the value of two-dimensional echocardiography (2D ECHO) for predicting prosthetic aortic valve size, the diameter of the aortic annulus was measured before implantation of a Medtronic-Hall valve in 24 patients and a Carpentier-Edwards supra-annular valve in 34. In the Medtronic-Hall group, the average prosthesis size was similar to the average annulus diameter, i.e.

Hemodynamic evaluation by Doppler echocardiography of small (less than or equal to 21 mm) prostheses and bioprostheses in the aortic valve position.

To assess resting hemodynamics of an unselected group of patients with prostheses or bioprostheses sized less than or equal to 21 mm implanted into the aortic valve position during a 7-year period, 46 of 50 eligible patients were examined by Doppler echocardiography. The valves were Carpentier-Edwards (CE) supraannular 21 mm (n = 8), Medtronic-Hall (MH) 20 mm (n = 8) and 21 mm (n = 21), and the rest (n = 9) were other valves with only 1 to 3 patients in each group. Gradients, valve areas and dimensionless obstruction indexes (ratio of subvalvular/valvular velocities and velocity time integrals) were compared.

Factors influencing return to work after aortocoronary bypass surgery.

Factors influencing the effect on employment status were investigated in 250 patients (males: females 224:26) who underwent coronary artery bypass surgery between March 1983 and November 1985. The median age at operation was 57.9 (range 36.

Thrombotic disc impediment in a Medtronic-Hall aortic valve prosthesis diagnosed by Doppler echocardiography followed by successful reoperation.

A case with impeded disc movement caused by thrombus formation in a Medtronic-Hall aortic valve prosthesis is reported. A correct diagnosis, including both mechanism and severity of the prosthesis failure, was established by Doppler echocardiography. The patient was promptly referred for surgery without invasive or other supplementary investigations.

MRI: a method to detect minor brain damage following coronary bypass surgery?

In order to assess the occurrence of minor focal brain lesions after coronary bypass surgery, magnetic resonance imaging (MRI) was used. Nine male patients (age 42-63) with angina pectoris were investigated at 0.5 Tesla.

[Cardiogenic cause of cerebral embolism].

Cerebral insults of cardiac origin are often of great functional importance. The most common cause is atrial fibrillation. Other sources of cerebral embolies, even if rare, such as cardiac tumors, must not be ignored.

[Surgical treatment of angina pectoris in elderly patients].

Twenty-eight patients, age 65 years or more, received aortocoronary bypass surgery during the period 1983-85. There was one early death. There were no serious complications connected with the operation, but increased risk of complications is to be expected with higher age.

The influence of thoracic epidural analgesia on transcapillary fluid balance in subcutaneous tissue. A study in patients undergoing aortocoronary bypass surgery.

Clinical observation and calculation of fluid balance have shown that patients undergoing aortocoronary bypass surgery with thoracic epidural analgesia (TEA) in addition to general anesthesia retain less fluid than patients having general anesthesia only. The present study was designed to investigate whether this effect could be explained by thoracic epidural analgesia influencing the transcapillary fluid balance, i.e.