Inotropic support after cardiac surgery is sometimes employed for a long period without any definite criteria to wean patients from it. There are few reports describing factors influencing the inotropic support period. This study was undertaken to clarify the proper inotropic support period, especially to judge which patients can be weaned from it within 24 h. From January 2000 to December 2001, 151 patients, 88 (58.2%) with ischemic heart disease, 51 (33.8%) with valvular disease, 7 (4.6%) with congenital heart disease, and 5 (3.4%) with other heart disease, underwent cardiac surgery. The mean age was 66.2 +/- 10.1 years (range 30-95); 98 patients (65%) were male. The data were analyzed retrospectively. Eighty patients (53%) were weaned from inotropic support within 24 h after cardiac surgery. Univariate analysis showed that intra-aortic balloon pumping, blood transfusion, operation time, cardiopulmonary bypass time, and aortic cross-clamping time significantly influenced the inotropic support period. Multivariate analysis indicated that intra-aortic balloon pumping, blood transfusion, and cardiopulmonary bypass time significantly influenced the inotropic support period. Intra-aortic balloon pumping, blood transfusion, and cardiopulmonary bypass time might determine the inotropic support period. Appropriate surgical procedure and methods both reducing cardiopulmonary bypass time (<75 min) and minimizing blood loss are the keys to weaning patients from inotropic support within 24 h.

No abstract

No abstract

A 9-year-old boy with multisaccular thoracic aortic aneurysm associated with coarctation of the aorta underwent definitive repair under partial cardiopulmonary bypass. The operation consisted of resection of the aneurysm and reconstruction of the descending aorta. Aortic reconstruction was done without an artificial graft, and extended end-to-end anastomosis was performed successfully. He has been doing well and there was no significant restenosis at the repair site 5 years after the operation. Some authors reported that untreated coarctation of the aorta frequently developed aneerysm, which usually has multisaccular lesions. Surgical strategy of aortic reconstruction for coarctation of the aorta in boyhood should be decided prudently to avoid postoperative complications.

A 52-year-old female, who had no history of mitral valve surgery, presented with idiopathic left atrial dissection (LAD). She underwent resection of the intra-atrial mass (Figs. 1 and 2) that was proved to be a thrombus in the left atrial wall. Preoperative diagnosis was difficult because echocardiography (movie) showed atypical findings of LAD. Appendix A. Supplementary data European Journal of Cardio-thoracic Surgery 38 (2010) 505 Fig. 2. Magnetic resonance imaging. Both T1-weight (A) and T2-weight (B) imaging exhibited a solid legion with iso-high intensity.Fig. 1. Computed tomography, plane (A) and enhanced.Computed tomography revealed a relatively heterogenous mass with a well defined margin, and the mass was not enhance with contrast material. Intra-operative exploration was the undefined bulge of the intact intima, like a subintimal tumor, and we found a block of red thrombus within the left atrial wall. Histological examination confirmed no malignant cells in it.