Is There a Need for a Pulmonary Artery Catheter in Cardiac Surgery Today?

Pulmonary artery catheters are a useful tool for hemodynamic monitoring in high-risk patients during surgery and while in intensive care. However, there are major risks inherent to the device, and with modern day technology, their routine use has decreased. We discuss the need for routine insertion of pulmonary artery catheters in cardiac surgery.

Isolated right coronary lesion and anterolateral papillary muscle rupture--case report and review of the literature.

Ischemic rupture of the anterolateral papillary muscle is uncommon due to its dual blood supply. It usually follows an ischemic event involving branches of the left circumflex or left anterior descending arteries. We present a case of a patient admitted with an acute inferior wall myocardial infarction and an isolated distal right coronary artery occlusion.

Mitochondrial function and tissue vitality: bench-to-bedside real-time optical monitoring system.

Background: The involvement of mitochondria in pathological states, such as neurodegenerative diseases, sepsis, stroke, and cancer, are well documented. Monitoring of nicotinamide adenine dinucleotide (NADH) fluorescence in vivo as an intracellular oxygen indicator was established in 1950 to 1970 by Britton Chance and collaborators. We use a multiparametric monitoring system enabling assessment of tissue vitality.

Fever of unknown origin as a primary presentation of chronic aortic dissection.

Fever of unknown origin is rare as a primary presentation of aortic dissection. We describe a 69-year-old female presenting with a sustained fever. A diagnosis of chronic type A aortic dissection was established by computed tomography.

Anomalous origin of the right coronary artery from the left coronary sinus.

Surgical treatment for the anomalous origin of the right coronary artery from the left coronary sinus remains a topic of debate. A 61-year-old male patient, presenting with a single episode of chest pain, was diagnosed with anomalous origin of the right coronary artery from the left coronary sinus. The patient underwent right internal mammary artery coronary bypass surgery without ligating the proximal right coronary artery.

Aortic aneurysm-induced disseminated intravascular coagulopathy: successful surgical repair.

Aortic aneurysm is a rare cause of disseminated intravascular coagulopathy (DIC). We present the developmental course of DIC in a 70-year-old male patient who had a thoracoabdominal aortic aneurysm characterized by a progressive descending aortic aneurysm presenting as subcutaneous hemorrhage of acute onset. He was diagnosed as having aortic aneurysm-induced DIC.

Acute onset of chronic aortic dissection presenting as abdominal pain.

A 54-year-old male patient developed acute onset of chronic aortic dissection manifesting as primarily abdominal pain. A prompt diagnosis was made and urgent surgery was carried out successfully under profound hypothermic circulatory arrest. Prompt surgery is mandatory for such patients in order to prevent abrupt rupture.

Risk factors for failed "fast-tracking" after cardiac surgery in patients older than 70 years.

Objective: "Fast-track" pathways have been successfully used in low-risk, relatively young patients after all types of surgical procedures including cardiac surgery. An increase in the number of referrals of older patients for cardiac surgery prompted the present study on the use of a "fast-track" pathway in septuagenarians and octogenarians. Risk factors for the unsuccessful application of the "fast-track" pathway in these elderly patients were determined.

Aortic root surgery in Marfan syndrome.

Background: As the shortcomings of the Bentall operation and its variants in the Marfan syndrome have become apparent, the recent cusp-sparing techniques (remodeling or reimplantation) bear promise of better mid-term and long-term outcomes.

Objective: To examine the results of aortic root surgery in patients with Marfan syndrome.

Methods: During the period March 1994 to September 2007, 220 patients underwent aortic valve-sparing surgery; 20 were Marfan patients (group 1) who were compared with another 20 Marfan patients undergoing composite aortic root replacement (group 2).

Onset of neoaortic root dilation 18 years after an arterial switch operation.

It has been claimed that neoaortic root dilatation or enlargement with aortic regurgitation is progressive until 11 years after an arterial switch operation. We report a case of neoaortic root dilatation onset occurring 18 years after operation and discuss the pathological features and the possible acting mechanisms.

[Aortic valve sparing surgery].

Background: Over the past 20 years, a series of procedures have been designed to reconstruct the aortic root of patients with aortic insufficiency, in whom the pathology and hence, the surgery, spares the valve leaflets. The objective of this current study was to evaluate our midterm results comparing the reimplantation technique with the remodeling technique in patients with aortic regurgitation due to aortic dissection, aortic root and ascending aortic aneurysms.

Patients And Methods: During the years 1993 and 2006 we operated on 209 patients with aortic regurgitation secondary to dilatation of the aortic root or ascending aorta with or without aortic dissection.

Current strategies of mitral valve repair.

Background: During the last decade new surgical techniques for mitral valve repair were developed. We have been using those techniques in order to widen the spectrum of patients eligible for MV repair.

Objectives: To assess the operative and mid-term results a wide variety of surgical techniques.

Modifications of composite grafts for coronary bypass surgery.

We herein describe four modifications of graft construction in coronary bypass surgery, including composite left mammary arterial T graft, arterial-venous I, and U grafts, and coronary-coronary vein graft and discuss their indications.

Timing of chest tube removal after coronary artery bypass surgery.

Aim: Assessing the impact of chest tube removal timing following a coronary artery bypass grafting surgery on the clinical outcome.

Methods: Eighty-three consecutive patients were randomly assigned to either have the chest tube removed 24 hours (Group A) or 48 hours (Group B) postoperatively. Chest tubes were removed on the condition that drainage was less than 100 cc for the last 8 hours.

Should we give prophylactic renal-dose dopamine after coronary artery bypass surgery?

Objective: A prospective double-blind randomized study undertaken to assess the effect of postoperative prophylactic "renal-dose" dopamine on post-coronary artery bypass grafting surgery's clinical outcome.

Methods: Eighty-five consecutive patients undergoing CABG operation were randomized to receive either 3-5 microg/kg/min dopamine (group D, n = 41) or saline as placebo (group P, n = 45) for 48 postoperative hours. Clinical outcome parameters were collected for four postoperative days.

[Anticoagulation in pregnant women with prosthetic heart valve--a new approach for therapy].

The treatment of women in childbearing age with a mechanical heart valve is a challenge for the medical staff. Warfarin (Coumadin) is considered to be a safe and effective anticoagulant for patients with prosthetic heart valves. However, treatment during pregnancy poses many difficulties, especially during the first trimester, due to its ability to cross the placenta and its associated fetotoxicity.