Document Detail

New technique of right heart bypass in congenital heart surgery with autologous lung as oxygenator.
MedLine Citation:
PMID:  14992913     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Modifications have been made in cardiopulmonary circuit to reduce the inflammatory deleterious effects and cost. We present our experience of one such right heart bypass (RHB) circuit utilizing autologus lung as oxygenator. METHODS: From September 2001 to December 2002, 15 patients underwent congenital heart surgery with this technique. Bypass circuit consisted of a reservoir and a roller pump along with a cardiotomy sucker. The left pulmonary artery and main pulmonary artery were used for arterial return, and venous drainage was achieved with innominate vein cannulation. Inferior vena cava cannulation was performed when needed. Thirteen patients underwent bidirectional Glenn shunt surgery (12 to 24 months, 6 to 10 kg). One patient (26 years old) underwent central shunt with enlargement of confluence and left pulmonary artery. Another patient (18 months old) underwent 1.5 ventricle repair. RESULTS: There were no hospital deaths. Mean flow achieved on RHB was 0.57 +/- 0.3 L/min/m(2), central venous pressure was 3.3 +/- 1.8 mm Hg (0 to 7 mm Hg), and mean arterial pressure could be maintained satisfactorily in all patients (54 +/- 14 mm Hg). Mean RHB time was 54 +/- 14 min. Mean central venous pressure was 10.1 +/- 2.4 mm Hg after procedure and saturation was similar to that on (RHB 88% +/- 8%). The mean amount of drainage was 9.1 +/- 4.2 mL/kg per 24 hours. Avoiding an oxygenator and reducing the number of tubings achieved a combined cost savings of 40% for all procedures. CONCLUSIONS: Right heart bypass is a simple, safer, and less expensive alternative to conventional cardiopulmonary bypass. This technique allows effective decompression of superior vena cava, adequate oxygenation, and predicts saturation after Glenn shunt. It can also be applied for central shunts and pulmonary artery reconstructions with cost containment.
Krishnanaik Shivaprakasha; Isaac Rameshkumar; Raman Krishna Kumar; Suresh Gangadharan Nair; Sajan Koshy; Gopalraj Sumangala Sunil; Suresh Gururaja Rao
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The Annals of thoracic surgery     Volume:  77     ISSN:  0003-4975     ISO Abbreviation:  Ann. Thorac. Surg.     Publication Date:  2004 Mar 
Date Detail:
Created Date:  2004-03-02     Completed Date:  2004-04-08     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  15030100R     Medline TA:  Ann Thorac Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  988-93     Citation Subset:  AIM; IM    
Department of Pediatric Cardiac Sciences, Kerala, India.
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MeSH Terms
Blood Pressure / physiology
Central Venous Pressure / physiology
Heart Bypass, Right / economics,  instrumentation,  methods*
Heart Defects, Congenital / surgery*
Lung / physiology*
Pulmonary Artery / surgery

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