20 мая 2002 00:00 |
Catheter pericardiocentesis for delayed tamponade after cardiac valve operation
Background. Late tamponade is a rare cause of morbidity and mortality after cardiac valve operation. We describe our recent experience with this entity.
Methods. This is a single institution,
Results. Pericardiocentesis for delayed tamponade was performed in 43 of 9,612 patients. Although isolated valve operation accounted for 17% of all patients overall, 76% of patients undergoing pericardiocentesis (33 of 43) had undergone isolated valve operation. The average age in this group was 58 years, compared to an average of 68 years in all patients. Patients presented with tamponade an average of 18 days after operation. Positive predictors included elevated prothrombin time on presentation. Of the patient cohort 75% presented with dyspnea, 61% with inability to diurese, and 61% with hypotension. Echocardiography detected effusions in all patients, but specific echocardiographic signs of tamponade were present in only 30%. Of the patients, 97% were successfully treated by pericardiocentesis. All were safely restarted on warfarin. One patient required pericardial window.
Conclusions. Delayed cardiac tamponade is more common after isolated valve operation, as opposed to coronary artery bypass grafting and valve/coronary artery bypass grafting. It tends to occur in the third postoperative week in younger patients who are aggressively anticoagulated. Pericardiocentesis with catheter placement is highly effective, and patients can be reanticoagulated safely. This series underestimates the incidence of late tamponade, as some patients may present to outside facilities. The diagnosis is aided by a high degree of suspicion.
20 мая 2002 | 00:05Treatment of end-stage heart disease with outpatient ventricular assist devices
Background. Initiating outpatient therapy with ventricular assist devices (VAD) was important in the progress of mechanical circulatory support. This article reviews our experience with VAD therapy
20 мая 2002 | 00:05Pretreatment with angiotensin-converting enzyme inhibitors attenuates ischemia-reperfusion injury
Background. The Heart Outcomes Prevention Evaluation (HOPE) trial demonstrated that ischemic events are decreased in patients receiving angiotensin-converting enzyme (ACE) inhibitors. This study
20 мая 2002 | 00:05Myocardial infarction scar plication in the rat: cardiac mechanics in an animal model for surgical procedures
Backgund. The immediate effects of surgical reduction of left ventricle cavity on cardiac mechanics have not been well defined. Methods. Cardiac mechanics were analyzed before and after myocardial
20 мая 2002 | 00:05BioGlue surgical adhesive impairs aortic growth and causes anastomotic strictures
Background. BioGlue surgical adhesive (CryoLife, Inc, Kennesaw, GA) is currently being used to secure hemostasis at cardiovascular anastomoses in adults. Interference with vessel growth would
20 мая 2002 | 00:05Myocardial preservation using celsior solution in cardiac transplantation: early results and 5-year follow-up of a multicenter prospective study of 70 cardiac transplantations
Background. Several storage methods using a wide variety of extracellular or intracellular solutions applied either as continuous perfusion, intermittent perfusion, or simple immersion of the