Closure of a large patent ductus arteriosus in children and adults with pulmonary hypertension.

INTRODUCTION: Surgical closure of a patent ductus arteriosus (PDA) in cases with pulmonary hypertension, a short and wide PDA, and/or calcification of the wall of the vessel can be a hazardous procedure. The use of extracorporeal circulation provides the necessary safety for effective closure. METHODS: Four patients (one male), aged 7, 22, 54 and 60 years old, underwent PDA closure. All had pulmonary hypertension (pulmonary artery pressure, PAP 55-85 mmHg, PAP-to-systemic pressure ratio 0.6-0.8) and a wide, short PDA (diameter 9-12 mm) with a calcified wall in 2 cases. The surgical technique involved transpulmonary PDA closure with a synthetic patch under extracorporeal circulation and mild hypothermia (n=2); or double ligation and purse-string suture of the PDA with extracorporeal circulation and normothermia on a beating heart (n=1), or with heart-lung machine on standby (n=1). RESULTS: Mortality was nil. The postoperative course was mild in all cases. Follow up 3 to 8 years post surgery showed effective PDA closure, PAP within normal (n=3) or at upper normal limits (n=1), and no other sequelae. CONCLUSIONS: The use of extracorporeal circulation allows safe and uncomplicated surgical closure of a PDA in "difficult" cases.

Combined epicardial and transvenous pacing in an infant with operated complex congenital heart disease and permanent epicardial DDD pacemaker as treatment of dysfunction of the epicardial ventricular lead.

A male child, 18 months old, with interrupted aortic arch, ventricular septal defect, postoperative complete heart block and an epicardial DDD pacemaker since the age of nine months, was admitted to our department because of episodes of syncope. At first the episodes were considered as epilepsy and the child was given antiepileptic drugs. Twenty-four-hour ambulatory electrocardiographic monitoring revealed dysfunction of the pacemaker due to exit block in the ventricular lead, while the atrial lead was functioning properly. The young patient was treated by preservation of the epicardial atrial lead and implantation of the ventricular lead via the transvenous route. The ventricular lead was then connected through a subcutaneous channel to the pulse generator in an abdominal pocket.

WITHDRAWN: Tropical plant needle: cause of unknown recurrent tamponade.

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Effect of N-acetyl-L-cysteine on lung ischaemia reperfusion injury in a porcine experimental model.

BACKGROUND: The purpose of the present study was to investigate the effect of N-acetyl-L-cysteine on lung ischaemia reperfusion injury. METHODS: Nineteen pigs were used. Group I (n = 5) underwent sham operation, group II (n = 7) 90-min left-lung ischaemia followed by 180-min reperfusion. In group III (n = 7) N-acetyl-l-cysteine was given (160 mg/kg) during ischaemia into the pulmonary artery. Lung-functional and haemodynamic parameters were measured; serum and lung tissue samples were obtained and analysed for interleukin-10 and tumour necrosis factor-alpha. At the end of the reperfusion bronchoalveolar lavage was carried out from the ipsilateral lung and analysis for total protein, phospholipase-A(2) and platelet-activating factor acetylhydrolase was carried out. Histological specimens were graded (0-3) for alveolar oedema, interstitial thickening and leucocyte infiltration. Statistical analysis was by means of one-way analysis of variance and Kruskal-Wallis test. RESULTS: There were no differences in haemodynamic parameters, serum and tissue interleukin-10 and tumour necrosis factor-alpha. Pulmonary compliance was decreased in groups II and III (P = 0.002 and P = 0.001, respectively) during ischaemia and reperfusion. Pulmonary vascular resistance was increased in group II (P = 0.051) during reperfusion. In group III total protein and platelet-activating factor acetylhydrolase were increased (P = 0.004 and P = 0.006, respectively) and phospholipase-A(2) was reduced (P = 0.002), indicating an indirect surfactant-protective effect. Interstitial thickening was excessive in group II (P = 0.001); however, alveolar oedema was reduced (P = 0.002) when compared with group III. CONCLUSION: N-acetyl-L-cysteine when administered directly in the pulmonary artery showed no significant change in haemodynamic and functional lung parameters during ischaemia reperfusion; it does, however, have an indirect surfactant-protective effect.

Heparin induced thrombocytopenia diagnosis in cardiac surgery: is there a role for thromboelastography?

The aim of the present protocol is to investigate the potency of thromboelastography (TEG) to screen postcardiac heparin induced thrombocytopenia (HIT) patients suspicious for HIT type II, and to differentiate which of them are subject to suffer thrombotic complications from those who will suffer hemorrhagic complications.