- Email: [email protected]
12.11 Is thoracostomy necessary in closed heart surgery?
CardiothoracidMediastinum pressure (RVDP) was determined with a working IVS at 0 and
12.11
2 Vmin Left ventricular (LV) output, at a constant mean arterial pressure of 80mm Hg. Thereafter, the IVS was thermally inactivated and measurements, using the same protocol were repeated. Results: At constant arterial pressure and identical LV output, thermal inactivation of the IVS led to a significant decrease in maximal RVDP (inactivated versus working IVS: 35.9 1 10.1 versus 62.3 -t 15.7mm Hg, respectively, P -C O.OOl), and maximal positive RV dP/dt (inactivated versus working IVS: 695 t 210 versus 1270 t 260mm Hg/sec, respectively, P < 0.001). Maximal RVDP did not differ between left heart outputs of 0 and 2l/min (working IVS: 0 versus 2l/min: 62.3 -t 15.6 versus 62.4 + 16.4mm Hg, respectively, P = ns; inactivated IVS: 0 versus 2I/min: 35.5 10.5 versus 36.4 + 10.1 mm Hg, respectively, P = ns). Conclusions: These results suggest, that the functional status of the JVS is a major determinant of maximal RV function. At constant LV conditions, an inactivated IVS leads to a significant decrease in maximal RVDP and RV dP/dt. While the IVS contributes to RV function, ventricular interaction via altered LV volume load is not a major determinant of maximal RV function.
Is Thoracostomy
CARDIOVASCULAR SURGERY
SEPTEMBER 1997
Necessary in Ciosed Heart Surgery?
A.A. BOLOURIAN,
Mashad, Iran
Insertion of one or two chest tubes in closed cardiac procedures has been routinely achieved by most cardiothoracic surgeons. Between June 1990 and July 1996, 173 patients aged 1 month to 29 years (average 5.6 year) underwent the Patent Ductus Arteriosus Division and Ligation (PDA D&L). During the last year (July 1995 to 1996) 30 cases were operated without thoracostomy, while in 143 cases a ehest tube was inserted for 18-24 hours postoperatively. There was neither hospital nor late mortality in all cases. The need for narcotics, hospital stay, satisfaction of the team, have been operation time, fevere and other complications compared in two groups, with and without thoracostomy. Some statistically important differences were observed. Simultaneously, other closed cardiac operatluns, such as repair of coarctation of the aorta and modified Blalock-Taussig shunts have been camed out without thoracostomy with the same results. The advantages of this technique are discussed and the results are presented.
65
12.11
2 Vmin Left ventricular (LV) output, at a constant mean arterial pressure of 80mm Hg. Thereafter, the IVS was thermally inactivated and measurements, using the same protocol were repeated. Results: At constant arterial pressure and identical LV output, thermal inactivation of the IVS led to a significant decrease in maximal RVDP (inactivated versus working IVS: 35.9 1 10.1 versus 62.3 -t 15.7mm Hg, respectively, P -C O.OOl), and maximal positive RV dP/dt (inactivated versus working IVS: 695 t 210 versus 1270 t 260mm Hg/sec, respectively, P < 0.001). Maximal RVDP did not differ between left heart outputs of 0 and 2l/min (working IVS: 0 versus 2l/min: 62.3 -t 15.6 versus 62.4 + 16.4mm Hg, respectively, P = ns; inactivated IVS: 0 versus 2I/min: 35.5 10.5 versus 36.4 + 10.1 mm Hg, respectively, P = ns). Conclusions: These results suggest, that the functional status of the JVS is a major determinant of maximal RV function. At constant LV conditions, an inactivated IVS leads to a significant decrease in maximal RVDP and RV dP/dt. While the IVS contributes to RV function, ventricular interaction via altered LV volume load is not a major determinant of maximal RV function.
Is Thoracostomy
CARDIOVASCULAR SURGERY
SEPTEMBER 1997
Necessary in Ciosed Heart Surgery?
A.A. BOLOURIAN,
Mashad, Iran
Insertion of one or two chest tubes in closed cardiac procedures has been routinely achieved by most cardiothoracic surgeons. Between June 1990 and July 1996, 173 patients aged 1 month to 29 years (average 5.6 year) underwent the Patent Ductus Arteriosus Division and Ligation (PDA D&L). During the last year (July 1995 to 1996) 30 cases were operated without thoracostomy, while in 143 cases a ehest tube was inserted for 18-24 hours postoperatively. There was neither hospital nor late mortality in all cases. The need for narcotics, hospital stay, satisfaction of the team, have been operation time, fevere and other complications compared in two groups, with and without thoracostomy. Some statistically important differences were observed. Simultaneously, other closed cardiac operatluns, such as repair of coarctation of the aorta and modified Blalock-Taussig shunts have been camed out without thoracostomy with the same results. The advantages of this technique are discussed and the results are presented.
65