Objective In this study, the authors used a continuous infusion of either levosimendan or milrinone as inotropic support after corrective congenital cardiac surgery. The hemodynamic and biochemical ...parameters were compared. Design A prospective, randomized, double-blind clinical study. Setting A university hospital. Participants Forty-one patients between 0 and 5 years old requiring inotropic support for corrective congenital heart surgery under cardiopulmonary bypass (CPB) were enrolled in this trial. Thirty-six patients completed the study. Interventions Patients were randomized in a double-blind fashion to a continuous infusion of either levosimendan at 0.05 μg/kg/min or milrinone at 0.4 μg/kg/min started at the onset of CPB. Epinephrine was started at 0.02 μg/kg/min after aortic cross-clamp release in both groups. Measurements and Main Results There was no significant difference between serum lactate levels of groups. The rate-pressure index (the product of heart rate and systolic blood pressure), which is an indicator of myocardial oxygen demand, was significantly lower at 24 hours and 48 hours postoperatively in the levosimendan group ( p < 0.001) in comparison to the milrinone group. Although not significantly different, the troponin values in the levosimendan group were less at 1 hour (median P25 -P75 : 20.7 15.3- 48.3 v 34.6 23.8- 64.5 ng/mL and 4 hours postoperatively: 30.4 17.3-59.9 v 33.3 25.5-76.7 ng/mL). Conclusion Levosimendan is at least as efficacious as milrinone after corrective congenital cardiac surgery in neonates and infants.
A double-located mediastinal and intrapulmonary cystic teratoma is a rare condition to be considered by thoracic surgeons. Clinical or radiologic diagnosis of a ruptured mediastinal teratoma into ...adjacent structures may be highly suggestive. An atypical presentation may indicate cautiousness for complete surgical excision. We report the case of a 14-year-old girl presenting with chronic chest pain. The radiologic work-up showed a large cystic mediastinal tumor and a heterogeneous intrapulmonary left upper-lobe lesion. We discuss the radiologic differential diagnosis of this atypical double-located thoracic tumor and the surgical strategy for complete excision.
One drawback of the arterial switch operation for treating transposition of the great arteries is the occurrence of coronary lesions, found during follow-up in about 5% of (a)symptomatic children. ...The established corrective procedures include coronary artery proximal patch arterioplasty or coronary artery bypass grafting (CABG). To avoid aortic manipulations and extracorporeal circulation, off-pump coronary artery bypass (OPCAB) has become increasingly used in the adult population. We report a case of OPCAB revascularization in a symptomatic 2-year-old child.
Objectives: To evaluate a simple treatment algorithm in sternal wound infection (SWI) allowing for primary closure and to describe the different surgical techniques and their associated morbidity and ...mortality. Methods: A retrospective analysis of all patients operated on between 1996 and 2004 in a single tertiary care institution. All epidemiological and surgical data were prospectively collected in our database. Univariate and multivariate analysis were used to determine preoperative and perioperative risks factors for 90-day and long-term mortality. Results: Out of 5905 procedures, 146 sternal wound infections were documented (2.4%). The respective incidence of SWI for CABG, isolated valve, or combined procedures were 2.8%, 1.1%, and 3.2%. Pathogens involved were S. epidermidis (44.5%), S. aureus (31.5%), and gram-negative rods (19.2%). Re-operation was required in 131/146 patients. Mean time to the first re-operation was 17.3 ± 12 days. Modalities of treatment consisted of drainage alone (44 patients), rewiring (25 patients), debridement, rewiring and mediastinal lavage (52 patients), and partial/complete sternal resection (10 patients). Additional procedures were required in 49 patients (37.7%). The 90-day mortality for uninfected patients and patients with superficial SWI were 4.4% and 2.8% (p = 0.78) whereas for patients with deep SWI, 90-day mortality was 14.5% (DSWI vs others, p < 0.0001). Conclusions: Deep sternal wound infection (DSWI) remains a dreadful complication in contemporary cardiac surgery while risk factors are currently well defined. Using a simple approach of primary closure together with liberal use of vascularized flaps has allowed us to achieve satisfactory short-term outcome in this subset of patients.
Abstract
Objective: To date, quality of life (QoL) after extensive chest wall resection is not known. This study analyses QoL in long-term survivors after extensive resection. Methods: Retrospective ...analysis of 51 patients operated for non-small-cell lung cancer (NSCLC)/mediastinal tumour invading the chest wall, primary/secondary chest wall tumours. QoL and functional status of long-term survivors (>36 months) were studied using Borg scale, Mahler dyspnoea index, Functional Autonomy Measuring System (SMAF) and 36-item Short Form Health Survey (SF-36) questionnaire. Out of the 51 patients, pulmonary function tests were available before and after resection in 24 patients and were subjected to analysis. Results: Five-year survival was 50%, 26 patients survived >36 months. At follow-up, 22/28 deaths were cancer related. Compared to baseline, the reduction of flow expiratory volume in 1 s (FEV1) and forced vital capacity (FVC) were 18% and 15%, respectively (p ≪ 0.001). The QoL study included 23 long-term survivors. A moderate/severe dyspnoea was present in 5/23 patients (21%). The SF-36 questionnaire revealed that, compared to controls, patients with chest wall resection experienced impaired QoL in physical functioning, in role physical, in body pain, in social functioning and in mental health. Objective measurements of pulmonary function correlated poorly with QoL, whereas subjective assessment of dyspnoea was significantly associated with QoL. Conclusions: This study shows that long-term survivors after extensive chest wall resection experienced moderate impairments in several QoL subscales. As previously reported in patients after pulmonary resection, subjective assessment such as dyspnoea correlated well with patient-perceived QoL.
Abstract
Over the last decade, the shortage of donors has led to increased waiting time prior to transplantation and its related mortality. Therefore, extended criteria for donor hearts have been ...proposed. In this report, we describe a successful transplantation despite a diagnosis of partial abnormal pulmonary venous return associated with an atrial septal defect sinus venosus and persisting left-sided superior vena cava. Knowledge in congenital cardiac disease can broaden the definition of ‘marginal’ donor hearts and allow their use without increasing the risk of transplantation.
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