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Emergency Abdominal Aortic Aneurysm Repair in a Patient with Failing Heart: Axillofemoral Bypass Using a Centrifugal Pump Combined with Levosimendan for Inotropic Support
Pavel Michalek,Pavel Sebesta,Michael Stern
Case Reports in Vascular Medicine , 2011, DOI: 10.1155/2011/497940
Abstract: We describe the case of an 83-year-old patient requiring repair of a large symptomatic abdominal aortic aneurysm (AAA). The patient was known to have coronary artery disease (CAD) with symptoms and signs of significant myocardial dysfunction, left-heart failure, and severe aortic insufficiency. The procedure was performed with the help of both mechanical and pharmacological circulatory support. Distal perfusion was provided by an axillofemoral bypass with a centrifugal pump, with dobutamine and levosimendan administered as pharmacological inotropic support. The patient's hemodynamic status was monitored with continuous cardiac output monitoring and transesophageal echocardiography. No serious circulatory complications were recorded during the perioperative and postoperative periods. This paper suggests a potential novel approach to combined circulatory support in patients with heart failure, scheduled for open abdominal aortic aneurysm repair.
How should an infected perinephric haematoma be drained in a tetraplegic patient with baclofen pump implanted in the abdominal wall? – A case report
Subramanian Vaidyanathan, Bakul M Soni, Peter L Hughes, Gurpreet Singh, John WH Watt, Tun Oo, Pradipkumar Sett
BMC Urology , 2002, DOI: 10.1186/1471-2490-2-9
Abstract: A 56-year-old male with C-4 tetraplegia had undergone implantation of programmable pump in the anterior abdominal wall for intrathecal infusion of baclofen to control spasticity. He developed perinephric haematoma while he was taking warfarin as prophylactic for deep vein thrombosis. Perinephric haematoma became infected with a resistant strain of Pseudomonas aeruginosa, and required percutaneous drainage. Positioning this patient on his abdomen without anaesthesia, for insertion of a catheter from behind, was not a realistic option. Administration of general anaesthesia in this patient in the radiology department would have been hazardous.Percutaneous drainage was carried out by anterior approach under propofol sedation. The site of entry of percutaneous catheter was close to cephalic end of baclofen pump. By carrying out drainage from anterior approach, and by keeping this catheter for ten weeks, we took a risk of causing infection of the baclofen pump site, and baclofen pump with a resistant strain of Pseudomonas aeruginosa. The alternative method would have been to anaesthetise the patient and position him prone for percutaneous drainage of perinephric collection from behind. This would have ensured that the drainage track was far away from the baclofen pump with minimal risk of infection of baclofen pump, but at the cost of incurring respiratory complications in a tetraplegic subject.Spasticity is a common problem in the patients with tetraplegia due to cervical spinal cord injury. Spasticity may not be relieved by oral medications in a few patients, who may then be considered for implantation of a programmable pump for continuous intrathecal infusion of baclofen. Spinal cord injury patients who have undergone implantation of a baclofen pump require special care while performing procedures in the ipsilateral kidney. For example, while carrying out extracorporeal lithotripsy of renal calculus, which is on the same side as the baclofen pump, precautions need to b
Unexplained abdominal pain as a driver for inappropriate therapeutics: an audit on the use of intravenous proton pump inhibitors  [PDF]
Pauline Siew Mei Lai,Yin Yen Wong,Yong Chia Low,Hui Ling Lau,Kin-Fah Chin,Sanjiv Mahadeva
PeerJ , 2015, DOI: 10.7717/peerj.451
Abstract: Background. Proton pump inhibitors (PPIs) are currently the most effective agents for acid-related disorders. However, studies show that 25–75% of patients receiving intravenous PPIs had no appropriate justification, indicating high rates of inappropriate prescribing.
Outflow occlusion for circulatory arrest in dogs
Andrade, James N.B.M. de;Stopiglia, Angelo J.;Fantoni, Denise T.;Abduch, Maria C.;Kahvegian, Marcia;
Pesquisa Veterinária Brasileira , 2009, DOI: 10.1590/S0100-736X2009000200009
Abstract: the purpose of this study was to evaluate the possibility of producing circulatory arrest by occlusion of the pulmonary trunk as an alternative to the venous inflow occlusion through the left hemithorax. eight healthy mongrel dogs were divided in two groups. group i underwent 4 minutes of outflow occlusion and group ii was submitted to 8 minutes of circulatory arrest. outflow occlusion was performed through left thoracotomy and pericardiotomy by passing a rumel tourniquet around the pulmonary trunk. physical examination, electrocardiography, echocardiography, blood gas analyses, hemodynamic, and oxygen transport variables were obtained before and after the procedure. the dogs from group i did not have any clinical, electrocardiographic, echocardiographic, or hemo-dynamic abnormalities after anesthetic recover. in the group ii, only one dog survived, which had no clinical, electrocardiographic, or echocardiographic abnormalities. in this last dog, just after releasing the occlusion, it was detected increases in the following parameters: heart rate (hr), systolic, diastolic and mean arterial blood pressure (sap; dap; map), pulmonary artery pressure (pap), pulmonary wedge pressure (pwp), central venous pressure (cvp), cardiac output (co), systolic index (si), cardiac index (ci), left and right ventricular stroke work (lvsw; rvsw), oxygen delivery index (do2), oxygen consumption index (vo2), and oxygen extraction (o2 ext). moreover, the oxygen content of arterial and mixed venous blood (cao2; cvo2), and the arterial and mixed venous partial pressure of oxygen (pao2; pvo2) were decreased 5 minutes after circulatory arrest. outflow occlusion is a feasible surgical procedure for period of 4 minutes of circulatory arrest.
Instability conditions for circulatory and gyroscopic conservative systems  [PDF]
Petre Birtea,Ioan Casu,Dan Comanescu
Mathematics , 2011, DOI: 10.1016/j.physd.2012.07.002
Abstract: We give a method which generates sufficient conditions for instability of equilibria for circulatory and gyroscopic conservative systems. The method is based on the Gramians of a set of vectors whose coordinates are powers of the roots of the characteristic polynomial for the studied systems. New instability results are obtained for general circulatory and gyroscopic conservative systems. We also apply this method for studying the instability of motion for a charged particle in a stationary electromagnetic field.
Design Analysis and Performance Prediction of the Cardiac Axial Blood Pump
D.H. Hussein,H. Gitano-Briggs,M.Z. Addullah
Research Journal of Biological Sciences , 2012,
Abstract: Computational Fluid Dynamics (CFD) has been used for developing and evaluating the performance of a novel design of the Cardiac Axial Blood Pump (CABP). This device could be used as an implantable pump for boosting blood circulation in patients whose hearts are not providing sufficient output. Based on the Berlin Heart configuration the blood pump has been designed for a flow rate of 5 L min-1 and 100 mmHg of head pressure. Finite element analysis method has been performed to predict the shear stress, velocity and pressure drop applied on the fluid through the pump and the shear stress on the pump impeller. Furthermore, flow streamlines has been discussed to predict the flow streamlines behavior and the expected stagnation points. The aim of this research is to design an efficient blood pump to support the blood circulatory system and reduce the shear stress and blood hemolysis during transport through the pump. The design simulated at several rotational speeds (5000-7000 rpm) to investigate the relationship between the rotational speeds and shear stress. Results indicate that the rotational speed has a direct correlation with shear stress and pressure drop. On the same stream, we found that at 6500 rpm the pump gives its optimal pressure drop and shear stress.
Deep Hypothermic Circulatory Arrest: Current Concepts  [PDF]
Ajmer Singh
Indian Anaesthetists' Forum , 2011,
Abstract: The use of hypothermia for therapeutic purposes is an established technique in children with complex congenital cardiac lesions and in adults for aortic arch reconstruction. Deep hypothermia decreases brain metabolism and oxygen requirement, whereas circulatory arrest provide bloodless surgical field.
Factors influencing the outcome of paediatric cardiac surgical patients during extracorporeal circulatory support
Sendhil K Balasubramanian, Ravindranath Tiruvoipati, Mohammed Amin, Kanakkande K Aabideen, Giles J Peek, Andrew W Sosnowski, Richard K Firmin
Journal of Cardiothoracic Surgery , 2007, DOI: 10.1186/1749-8090-2-4
Abstract: From April 1990 to December 2003, 53 patients required ECMO following surgical correction of CCD. Retrospectively collected data was analyzed with univariate and multivariate logistic regression analysis.Median age and weight of the patients were 150 days and 5.4 kgs respectively. The indications for ECMO were low cardiac output in 16, failure to wean cardiopulmonary bypass in 13, cardiac arrest in 10 and cardio-respiratory failure in 14 patients. The mean duration of ECMO was 143 hours. Weaning off from ECMO was successful in 66% and of these 83% were survival to hospital-discharge. 37.7% of patients were alive for the mean follow-up period of 75 months. On univariate analysis, arrhythmias, ECMO duration >168 hours, bleeding complications, renal replacement therapy on ECMO, arrhythmias and cardiac arrest after ECMO were associated with hospital mortality.On multivariate analysis, abnormal neurology, bleeding complications and arrhythmias after ECMO were associated with hospital mortality. Extra and intra-thoracic cannulations were used in 79% and 21% of patients respectively and extra-thoracic cannulation had significantly less bleeding complications (p = 0.031).ECMO provides an effective circulatory support following surgical repair of CCD in children. Extra-thoracic cannulation is associated with less bleeding complications. Abnormal neurology, bleeding complications on ECMO and arrhythmias after ECMO are poor prognostic indicators for hospital survival.Mechanical circulatory support plays a critical role in the management of medically refractory post cardiotomy circulatory failure. Various circulatory assist devices like Intra aortic balloon pump (IABP), Ventricular assist devices (VAD) and Venoarterial Extracorporeal membrane oxygenation (VA-ECMO) have been successfully used in postcardiotomy cardiogenic shock [1-3]. VA-ECMO is the most commonly used therapy, especially in paediatric patients, following repair of congenital cardiac defects. This is due to the a
Postcardiotomy Mechanical Circulatory Support in Two Infants with Williams’ Syndrome  [PDF]
Constantinos A. Contrafouris,Andrew C. Chatzis,Meletios A. Kanakis,Prodromos A. Azariadis,Fotios A. Mitropoulos
Case Reports in Surgery , 2014, DOI: 10.1155/2014/795726
Abstract: Supravalvar aortic stenosis (SVAS) in patients with Williams’ syndrome is often accompanied by coronary, pulmonary, and even myocardial lesions and therefore associated with increased perioperative morbidity and mortality. Extracorporeal membrane oxygenation (ECMO) provides reliable short-term mechanical circulatory support to patients, especially young, in acute postoperative cardiac failure when conventional means are ineffective. The incorporation of centrifugal pumps in these systems has made their use more efficient and less traumatic. We describe our experience of using the Levitronix CentriMag pump in two patients with Williams' syndrome who underwent surgical correction of supravalvular aortic stenosis. 1. Introduction Supravalvar aortic stenosis (SVAS) is commonly found in patients with Williams’ syndrome. The association of SVAS and pulmonary artery stenosis with mental retardation and distinctive facial features is known as the Williams-Beuren syndrome [1, 2]. Prominent feature is the diseased media of the ascending aorta, which also may affect the coronary arteries as well as the pulmonary vasculature, causing stenoses. Although there is supporting evidence of a genetic defect in elastin, it is also true that the disease affects all layers of the major vessels along with other parts of the cardiovascular system, including the cardiac valves, the myocardium, and the peripheral vessels [3–5]. Although low cardiac output is not uncommon following surgery for congenital heart disease in the paediatric population, conventional methods of treatment prove that efficient and postcardiotomy mechanical support is, therefore, rarely required. Extracorporeal membrane oxygenation (ECMO) constitutes an effective and essentially the only available short-term circulatory support for acute postoperative severe cardiopulmonary failure in the paediatric population following cardiac surgery. Nonetheless, it has been associated with increased risk of complications including bleeding, thromboembolism, plasma leakage, and infection [6, 7]. 2. Case Report 2.1. Case I An 8-month-old boy with Williams’ syndrome and supravalvular aortic stenosis was admitted to our department for surgical treatment. Repair was achieved by extended aortoplasty with incision of noncoronary and right coronary sinuses and implantation of an inverted Y-shaped Dacron patch. Failure to wean from cardiopulmonary bypass (CPB) due to postcardiotomy cardiac failure resulted in the institution of extracorporeal membrane oxygenation (ECMO). Reexploration for bleeding was required the first day.
Organ donation after circulatory death: the forgotten donor?
Mohamed Y Rady, Joseph L Verheijde, Joan McGregor
Critical Care , 2006, DOI: 10.1186/cc5038
Abstract: A mandatory implementation of donation after circulatory death (DCD) from eligible patients facing imminent or cardiac death in hospitals across the USA was introduced at a national conference and is to be effective from January 2007 [1]. The DCD requirement is focused on patients who are neurologically intact or do not fulfill neurologic death criteria before withdrawal of ventilator support [2]. The mandatory requirement will be implemented through the collaboration of the Institute of Medicine, Joint Commission on Accreditation of Healthcare Organizations, Center for Medicare and Medicaid Services, and the Department of Health and Human Services (see the glossary of terms in Table 1) [3,4].The transplantation community has been reorganized into 58 donation service areas (DSAs) to cover the entire country [5]. Each DSA is centered on one organ procurement organization (OPO) that facilitates the recovery and flow of transplantable organs from donor hospital(s) to regional transplant center(s) within a defined geographic location. Each of the DSAs will have to meet a target goal of 75% or higher of cadaveric organ donation rate from its affiliated hospitals.The uniform determination of death relies on irreversible cessation of circulatory or neurologic function. The unitarian determination of death by either neurologic or circulatory criteria rather than fulfilling both criteria simultaneously is accepted as the standard for cadaveric organ procurement [2]. The DCD criteria relies on expert opinion, which permits the procurement process after 5 min of apnea, unresponsiveness, and pulselessness [6].The pivotal assumption that DCD will eliminate the possibility that the procurement process is the direct cause of death has been challenged. Spontaneous return of both circulatory and neurologic function (autoresuscitation or Lazarus phenomenon) has been reported after 10 min of electric asystole [7]. The notion of a specific time interval for determination of irreversibl
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