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1.
Artigo em Inglês | MEDLINE | ID: mdl-35044113

RESUMO

Spinal cord injury secondary to coarctation repair in children is a serious, though relatively uncommon, complication. Several measures have been proposed to minimize this risk, which seems to affect more older children than neonates and those with inadequate collateral circulation. Left heart bypass has been proposed as a protective strategy.


Assuntos
Coartação Aórtica , Adolescente , Coartação Aórtica/cirurgia , Criança , Derivação Cardíaca Esquerda , Humanos , Recém-Nascido , Recidiva Local de Neoplasia , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares
2.
J Extra Corpor Technol ; 53(3): 186-192, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34658410

RESUMO

A 1-year old male patient with Williams syndrome and multiple prior interventions presented for surgical repair of his descending aorta (DA) through a left thoracotomy. Concerns for significant bleeding and spinal cord protection led the care team to consider a left heart bypass (LHB) circuit with options for pump sucker use, heat exchange capacity, and the possibility of converting to traditional cardiopulmonary bypass (CPB). A traditional CPB circuit with a roller-head arterial pump was assembled with a bypass line around the cardiotomy venous reservoir (CVR). Excluding the CVR with this line allowed for a closed LHB circuit. A second pump head was integrated to both recirculate the CVR volume and to serve as a means for controlled volume administration to the closed LHB circuit. Pump sucker return directed to the CVR could easily be transfused back to the patient. The patient was placed on the hybrid LHB circuit and cooled to 32°C. DA clamps were placed. Upper body dynamic blood pressure was managed for a target mean of 50 mmHg, the left atrial pressure (LAP) was maintained in the 5-7 mmHg range, and the nonpulsatile lower body blood pressure was targeted at 40-50 mmHg. Cerebral near-infrared spectroscopy (NIRS) helped guide volume and pressure management. The surgeons placed two long-segment patches on the DA, moving clamps as needed. The patient was rewarmed and separated from the hybrid LHB circuit after 82 minutes. Closed circuit LHB can be provided with a roller-head hybrid circuit incorporating an oxygenator for gas exchange, central cooling and warming, and arterial line filtration along with a CVR for pump sucker use and controlled transfusion to the patient.


Assuntos
Derivação Cardíaca Esquerda , Síndrome de Williams , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Ponte Cardiopulmonar , Humanos , Lactente , Masculino , Oxigenadores
3.
Zhong Nan Da Xue Xue Bao Yi Xue Ban ; 46(4): 400-403, 2021 Apr 28.
Artigo em Inglês, Chinês | MEDLINE | ID: mdl-33967087

RESUMO

OBJECTIVES: Thoracoabdominal aortic aneurysm (TAAA) prosthetic vessel replacement is one of the most complex operations in the field of cardiovascular surgery. The key to success of this operation is to prevent and avoid ischemia of important organs while repairing TAAA. This study aims to summarize and analyze the effect of prosthetic vessel replacement under left heart bypass in the treatment of TAAA. METHODS: Data of 15 patients with TAAA who underwent prosthetic vessel replacement under left heart bypass in Xiangya Hospital of Central South University were retrospectively analyzed. According to Crawford classification, there were 2 cases of type I, 8 cases of type II, 3 cases of type III, and 2 cases of type V. There were 14 cases of selective operation and 1 case of emergency operation. All operations were performed under left heart bypass, and cerebrospinal fluid drainage was performed before operation. Left heart bypass was established by intubation of left inferior pulmonary vein and distal abdominal aorta or left femoral artery. The thoracoabdominal aorta was replaced segment by segment. After aortic dissection, the kidneys were perfused with cold crystalloid renal protective solution, and the celiac trunk and superior mesenteric artery were perfused with warm blood. RESULTS: One patient with TAAA after aortic dissection of type A died. During the operation, straight blood vessels were used to repair TAAA, and the celiac artery branches were trimmed into island shape and anastomosed with prosthetic vessels. After the operation, massive bleeding occurred at the anastomotic stoma, then anaphylactic reaction occurred during massive blood transfusion, resulting in death. One patient suffered from paraplegia due to ischemic injury of spinal cord. The other patients recovered well and were discharged. The postoperative ventilation time was (16.5±13.8) h and the postoperative hospital stay was (10±4) d. The amount of red blood cell transfusion was (13±9) U. The patients were followed up for 2 months to 2 years, and the recovery was satisfactory. CONCLUSIONS: The effect of prosthetic vessel replacement under left heart bypass in the treatment of TAAA is good, which is worthy of clinical promotion.


Assuntos
Aneurisma da Aorta Torácica , Dissecção Aórtica , Implante de Prótese Vascular , Dissecção Aórtica/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Derivação Cardíaca Esquerda , Humanos , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento
4.
ANZ J Surg ; 90(12): 2434-2440, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32935430

RESUMO

BACKGROUND: Most large-volume centres use left heart bypass (LHB) as their preferred organ protection strategy during repair of descending thoracic aortic (DTA) and thoracoabdominal aortic (TAA) pathologies. We investigate the use of hypothermic circulatory arrest (HCA) for similar pathologies and compare the outcomes of both. METHODS: A PubMed, Embase and Scopus search for studies in English on LHB versus HCA for repair of DTA and TAA pathologies published from inception till February 2020 was performed. Our analysis excluded studies without direct comparison of the two organ protection strategies. Clinical endpoints that were studied were 30-day mortality, post-operative stroke, spinal cord deficit, renal failure and respiratory failure. Random effects meta-analyses of the effect of the two strategies across all clinical endpoints were conducted. RESULTS: HCA is non-inferior to LHB across all clinical endpoints. In terms of 30-day mortality (odds ratio (OR) 1.19, 95% confidence interval (CI) 0.31-4.59, P = 0.14, I2 = 49%), stroke (OR 0.41, 95% CI 0.12-1.39, P = 0.97, I2 = 0%), spinal cord deficit (OR 0.56, 95% CI 0.22-1.45, P = 0.78, I2 = 0%), renal failure (OR 1.33, 95% CI 0.37-4.76, P = 0.98, I2 = 0%) and respiratory failure (OR 0.86, 95% CI 0.37-1.97, P = 0.16, I2 = 46%), there was no statistically significant difference between the two cohorts. CONCLUSION: Evidence is limited, but suggests that HCA alone provides adequate organ protection during repair of DTA and TAA pathologies, and has equivalent outcomes when compared to LHB.


Assuntos
Aneurisma da Aorta Torácica , Derivação Cardíaca Esquerda , Aorta , Aneurisma da Aorta Torácica/cirurgia , Parada Cardíaca Induzida , Humanos , Complicações Pós-Operatórias , Estudos Retrospectivos , Resultado do Tratamento
5.
Cardiol Young ; 28(12): 1436-1443, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30198456

RESUMO

BackgroundsThe aim of this study was to assess the impact of age at bidirectional cavopulmonary anastomosis on haemodynamics after total cavopulmonary connection. METHODS: We conducted a retrospective analysis of 100 consecutive patients who underwent total cavopulmonary connection from 2010 to 2014. All patients had previously undergone bidirectional cavopulmonary anastomosis. These patients were classified into two groups according to age at bidirectional cavopulmonary anastomosis: younger group, 6 months (n=67). RESULTS: The proportion of hypoplastic left heart syndrome was higher in the younger group (48 versus 4%). After total cavopulmonary connection, the chest tube period was longer in the younger group (10.1±6.6 versus 6.7±4.5 days; p=0.009). Catheterisation 6 months after total cavopulmonary connection revealed that pulmonary artery pressure was higher (11.5±1.9 versus 10.4±2.1 mmHg; p=0.017) and Nakata index was lower (219±79 versus 256±70 mm2/m2; p=0.024) in the younger group. In patients with a non-hypoplastic left heart syndrome, there was no difference in post-operative haemodynamics between two groups, but the total amount of chest drainage after total cavopulmonary connection was larger in the younger group (109±95 versus 55±40 ml/kg; p=0.044). CONCLUSIONS: Early bidirectional cavopulmonary anastomosis did not affect the outcome of total cavopulmonary connection. Longer chest tube period, smaller pulmonary artery, and higher pulmonary artery pressure after total cavopulmonary connection were recognised in early bidirectional cavopulmonary anastomosis patients, especially in hypoplastic left heart syndrome.


Assuntos
Derivação Cardíaca Direita/métodos , Síndrome do Coração Esquerdo Hipoplásico/cirurgia , Artéria Pulmonar/fisiopatologia , Fatores Etários , Feminino , Técnica de Fontan , Derivação Cardíaca Esquerda , Hemodinâmica , Hospitais Pediátricos , Humanos , Lactente , Japão , Masculino , Análise de Regressão , Estudos Retrospectivos , Resultado do Tratamento
6.
Med Hypotheses ; 114: 35-39, 2018 May.
Artigo em Inglês | MEDLINE | ID: mdl-29602461

RESUMO

Left ventricular hypertrophy (LVH) is a well established cardiovascular risk factor, accounting for an increase in cardiovascular morbid-mortality, although how much the magnitude and the kind of LVH could affect cardiovascular outcomes is in large part unknown. We speculate that mild LVH in absence of left ventricular (LV) chamber dilation, could play a protective role towards functional capacity, clinical outcome, cardiovascular and total morbi-mortality in conditions in which LV systolic function is generally reduced. Accordingly to many epidemiological observations, the availability of extra-quote of systolic function could lead to a significative improvement in the final outcome of some kinds of heart patients, as those undergoing bypass-grafting, where the stress for heart and cardiovascular system is always high. We suppose that the functional reserve available for patients with LVH could make the difference with respect to other patients undergoing myocardial revascularization. Similarly, the availability of a contractile reserve warranted by LVH could ensure a little gain in the outcome for patients after other major cardiovascular events (such as myocardial infarction or other heart surgery as surgical valve replacement). However, our hypothesis only involves mild LVH without LV chamber dilation, that is the initial stage of "non-dilated concentric" LVH and "non-dilated eccentric" LVH according to the new four-tiered classification of LVH based on relative wall thickness and LV dilation. Support for our hypothesis derives from the well-known protective role of systolic function that is a major factor in almost all cardiovascular diseases, where LV ejection fraction (LVEF) has shown to significantly improve quality of life, as well as morbidity and mortality. The knowledge that mild LVH in absence of LV chamber dilation is not as harmful in such conditions as believed at present could make avoidable some drugs prescription in some stages of the disease. Furthermore, it may allow a better evaluation of the risk profile of patients with LVH undergoing some cardiovascular major events like bypass grafting, myocardial infarction or surgical heart valve replacement.


Assuntos
Doenças Cardiovasculares/diagnóstico por imagem , Derivação Cardíaca Esquerda , Hipertrofia Ventricular Esquerda/diagnóstico por imagem , Valvas Cardíacas/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Humanos , Modelos Teóricos , Contração Miocárdica , Qualidade de Vida , Fatores de Risco , Sístole , Função Ventricular Esquerda
7.
Eur J Vasc Endovasc Surg ; 53(5): 672-678, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28372985

RESUMO

OBJECTIVES: To compare early (30 day mortality and major complications) and midterm (survival) outcomes in elective open surgical descending and thoraco-abdominal aortic repair using left heart bypass (LHB) versus hypothermic circulatory arrest (HCA) for organ protection, hypothesising non-inferiority of HCA management. METHOD: This was a retrospective clinical cohort study with cross sectional follow-up. All elective (n = 90) descending or thoraco-abdominal aortic repairs performed between 2004 and 2015 using either LHB (n = 57) or HCA (n = 33) were included. Pre- and intra-operative variables were evaluated by univariate statistical analysis. Thirty day and follow-up mortality were primary endpoints; major complications were secondary endpoints. Propensity score matching was employed to adjust for selection bias. Kaplan-Meier methods were used to estimate midterm survival. RESULTS: Overall 30 day mortality was 8/90 (8.9%): 6/57 (10.5%) using LHB vs. 2/33 (6.1%) using HCA, p = .47. Five patients (5.6%) suffered paraplegia: 3/57 (5.3%) using LHB vs. 2/33 (6.1%) using HCA, p = .87. Stroke occurred in 6/57 (11%) vs. 2/33 (6.1%), p = .76; renal failure in 27/57 (47%) vs. 19/33 (58%), p = .90; and respiratory failure in 17/57 (30%) vs. 11/33 (33%), p = .68. In 26 propensity score matched pairs, findings remained unaltered. Total follow-up was 443 patient years (median 4.9 years). Estimated survival was 78% at 1 year and 77% at 5 years in LHB vs. 72% and 67%, respectively, with HCA; there were no significant inter-group differences, before or after propensity score matching. CONCLUSIONS: In elective descending or thoraco-abdominal aortic repair, no statistically significant differences in 30 day mortality, major complications, or follow-up survival were found when LHB and HCA were compared. These findings remained after propensity score matching.


Assuntos
Aorta Abdominal/cirurgia , Aorta Torácica/cirurgia , Parada Cardíaca Induzida , Derivação Cardíaca Esquerda , Procedimentos Cirúrgicos Vasculares , Idoso , Aorta Abdominal/diagnóstico por imagem , Aorta Torácica/diagnóstico por imagem , Distribuição de Qui-Quadrado , Estudos Transversais , Procedimentos Cirúrgicos Eletivos , Feminino , Parada Cardíaca Induzida/efeitos adversos , Parada Cardíaca Induzida/mortalidade , Derivação Cardíaca Esquerda/efeitos adversos , Derivação Cardíaca Esquerda/mortalidade , Humanos , Estimativa de Kaplan-Meier , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Complicações Pós-Operatórias/etiologia , Pontuação de Propensão , Estudos Retrospectivos , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento , Procedimentos Cirúrgicos Vasculares/efeitos adversos , Procedimentos Cirúrgicos Vasculares/mortalidade
8.
J Cardiothorac Vasc Anesth ; 31(4): 1197-1202, 2017 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-27919719

RESUMO

OBJECTIVE: The aim of this study was to reveal the mechanism of improved arterial oxygenation by measuring the changes in oxygenation before and after initiation of left heart bypass (LHB) during one-lung ventilation (OLV) for thoracic aortic surgery. DESIGN: Prospective, observational study. SETTING: Single-institution, private hospital. PARTICIPANTS: The study comprised 50 patients who underwent aortic surgery via a left thoracotomy approach with LHB circulatory support. INTERVENTIONS: Patients were ventilated using pure oxygen during OLV, and the ventilator setting was left unchanged during the measurement period. MEASUREMENTS AND MAIN RESULTS: The measurement of partial pressure of arterial oxygen (PaO2) was made at the following 4 time points: 2 minutes after heparin infusion (point 1 [P1]), 2 minutes after inflow cannula insertion through the left pulmonary vein (P2), immediately before LHB initiation (P3), and 10 minutes after LHB initiation (P4). The mean±standard deviation (mmHg) of PaO2 measurements at the P1, P2, P3, and P4 time points were 244±121, 250±123, 419±122, and 430±109, respectively, with significant increases between P1 and P3, P1 and P4, P2 and P3, and P2 and P4 (p<0.0001, respectively). No significant increase in PaO2 was seen between P1 and P2 or between P3 and P4. CONCLUSIONS: The improved arterial oxygenation during OLV in patients who underwent thoracic aortic surgery using LHB can be attributed to the insertion of an inflow cannula via the left pulmonary vein into the left atrium before LHB.


Assuntos
Aorta Torácica/metabolismo , Cateterismo de Swan-Ganz/tendências , Derivação Cardíaca Esquerda/tendências , Ventilação Monopulmonar/tendências , Oxigênio/metabolismo , Toracotomia/tendências , Adulto , Idoso , Idoso de 80 Anos ou mais , Aorta Torácica/cirurgia , Cateterismo de Swan-Ganz/métodos , Feminino , Derivação Cardíaca Esquerda/métodos , Humanos , Masculino , Pessoa de Meia-Idade , Ventilação Monopulmonar/métodos , Oximetria/métodos , Oximetria/tendências , Estudos Prospectivos , Toracotomia/métodos
9.
Artigo em Inglês | MEDLINE | ID: mdl-26825797

RESUMO

There are different surgical techniques for providing circulatory support during the repair of thoracoabdominal aortic aneurysms. They all aim at reducing the afterload of the heart and the preservation of distal organ perfusion. Partial or total extracorporeal circulation with or without cooling and left heart bypass (LHB) are actually the most used surgical approaches. The objective of this study was to describe and comment on the technical aspects of the LHB. We briefly describe our results and put them into perspective based on the current literature.


Assuntos
Aneurisma da Aorta Abdominal/cirurgia , Aneurisma da Aorta Torácica/cirurgia , Derivação Cardíaca Esquerda/métodos , Cateterismo/métodos , Circulação Extracorpórea/métodos , Humanos , Complicações Pós-Operatórias
10.
BMJ Case Rep ; 20152015 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-26106169

RESUMO

Takayasu's arteritis (TA) is a large vessel vasculitis of unknown aetiology characterised by involvement of the aorta and its major branches. Tuberculous arteritis of the aorta is an uncommon condition usually secondary to the dissemination of Mycobacterium tuberculosis infection from the mediastinum and/or lung to the adjacent aorta; this may mimic TA. We report a case of a 23-year-old woman with cutaneous granulomatous vasculitis and saccular aneurysmal dilation of the aorta and large vessels, and highlight the findings shared by TA and tuberculous arteritis.


Assuntos
Aorta/patologia , Derivação Cardíaca Esquerda , Arterite de Takayasu/diagnóstico , Tuberculose Cardiovascular/diagnóstico , Adulto , Anti-Inflamatórios/administração & dosagem , Antígenos de Bactérias/sangue , Antituberculosos/administração & dosagem , Feminino , Derivação Cardíaca Esquerda/métodos , Humanos , Imunidade Celular , Leucócitos Mononucleares/imunologia , Prednisolona/administração & dosagem , Arterite de Takayasu/complicações , Arterite de Takayasu/microbiologia , Arterite de Takayasu/patologia , Arterite de Takayasu/terapia , Resultado do Tratamento , Tuberculose Cardiovascular/complicações , Tuberculose Cardiovascular/patologia , Tuberculose Cardiovascular/terapia
11.
Clin Res Cardiol ; 104(2): 95-111, 2015 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-25349064

RESUMO

Cardiogenic shock due to acute myocardial infarction, postcardiotomy syndrome following cardiac surgery, or manifestation of heart failure remains a clinical challenge with high mortality rates, despite ongoing advances in surgical techniques, widespread use of primary percutaneous interventions, and medical treatment. Clinicians have, therefore, turned to mechanical means of circulatory support. At present, a broad range of devices are available, which may be extracorporeal, implantable, or percutaneous; temporary or long term. Although counter pulsation provided by intra-aortic balloon pump (IABP) and comprehensive mechanical support for both the systemic and the pulmonary circulation through extracorporeal membrane oxygenation (ECMO) remain a major tool of acute care in patients with cardiogenic shock, both before and after surgical or percutaneous intervention, the development of devices such as the Impella or the Tandemheart allows less invasive forms of temporary support. On the other hand, concerning mid-, or long-term support, left ventricular assist devices have evolved from a last resort life-saving therapy to a well-established viable alternative for thousands of heart failure patients caused by the shortage of donor organs available for transplantation. The optimal selection of the assist device is based on the initial consideration according to hemodynamic situation, comorbidities, intended time of use and therapeutic options. The present article offers an update on currently available mechanical circulatory support systems (MCSS) for short and long-term use as well as an insight into future perspectives.


Assuntos
Oxigenação por Membrana Extracorpórea/instrumentação , Derivação Cardíaca Esquerda/instrumentação , Coração Auxiliar , Balão Intra-Aórtico/instrumentação , Choque Cardiogênico/terapia , Desenho de Equipamento/tendências , Medicina Baseada em Evidências , Oxigenação por Membrana Extracorpórea/tendências , Derivação Cardíaca Esquerda/tendências , Humanos , Balão Intra-Aórtico/tendências , Avaliação da Tecnologia Biomédica
14.
J Artif Organs ; 16(1): 34-41, 2013 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-23053045

RESUMO

The impact of continuous flow left ventricular assist device (LVAD) pumping on platelet aggregation was investigated in animal experiments utilizing six calves. A single-use MagLev centrifugal blood pump, MedTech MagLev, was used to bypass the calves' hearts from the left atrium to the descending aorta at a flow rate of 50 ml/kg/min. The LVAD's impact on blood coagulation activities was evaluated based on the platelet aggregability, which was measured with a turbidimetric assay method during the preoperative, operative, and postoperative periods. Heparin and warfarin were used for anticoagulation, while aspirin was used for the antiplatelet therapy. A decrease in platelet aggregation immediately after the pump started was observed in the cases of successful long-term pump operation, while the absence of such a decrease might have caused coagulation-related complications to terminate the experiments. Thus, the platelet aggregability was found to be significantly affected by the pump, and its initial trend may be related to the long-term outcome of the mechanical circulatory support.


Assuntos
Derivação Cardíaca Esquerda , Coração Auxiliar , Agregação Plaquetária/fisiologia , Animais , Anticoagulantes/farmacologia , Aspirina/farmacologia , Bovinos , Heparina/farmacologia , Masculino , Agregação Plaquetária/efeitos dos fármacos , Inibidores da Agregação Plaquetária/farmacologia , Varfarina/farmacologia
15.
Rev Bras Cir Cardiovasc ; 27(1): 97-102, 2012.
Artigo em Inglês, Português | MEDLINE | ID: mdl-22729306

RESUMO

OBJECTIVE: To describe our experience with repair of coarctation of the aorta in adults using left heart bypass. METHODS: From November 2007 to October 2009, eight adult patients with coarctation of the aorta underwent surgical repair under circulatory support using a left atrium to femoral artery bypass circuit, with graft interposition tube through left posterolateral thoracotomy. Five patients were female, with mean age of 31.5 ± 13.1 years. All patients had hypertension and others associated cardiovascular diseases. RESULTS: There were no deaths or neurological complications. The mean surgical time was 308 minutes with mean left heart bypass and distal aortic clamping time of 73 and 65 minutes respectively. Postoperative bleeding was 696 ml in average. Six patients developed severe hypertension postoperatively requiring intravenous vasodilators. The mean length of stay was 9 days. A significant reduction of gradient blood pressure occurred. Echocardiographic follow-up up to two months postoperatively showed mean aortic / graft gradient of 20.3 mmHg. CONCLUSION: In this series the use of left heart bypass showed to be a safe option in the surgical correction of coarctation of the aorta in adults, especially in patients with abnormal aortic wall. There was no spinal cord ischemia in the cases studied.


Assuntos
Coartação Aórtica/cirurgia , Derivação Cardíaca Esquerda/métodos , Paraplegia/prevenção & controle , Adulto , Pressão Sanguínea/fisiologia , Cateterismo/métodos , Feminino , Artéria Femoral , Seguimentos , Derivação Cardíaca Esquerda/efeitos adversos , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
16.
J Artif Organs ; 15(2): 207-10, 2012 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-22358461

RESUMO

Since left heart bypass or biventricular circulatory assist with an extracorporeal centrifugal pump as a bridge to decision or recovery sometimes requires long-time support, the long-term durability of extracorporeal centrifugal pumps is crucial. The Rotaflow Centrifugal Pump(®) (MAQUET Cardiopulmonary AG, Hirrlingen, Germany) is one of the centrifugal pumps available for long-term use in Japan. However, there have been few reports of left heart bypass or biventricular circulatory support over the mid-term. This is a case report of left heart bypass support with the Rotaflow Centrifugal Pump(®) as a bridge to decision and recovery for an adult patient who could not be weaned from cardiopulmonary bypass and percutaneous cardiopulmonary support after cardiac surgery. We could confirm that the patient's consciousness level was normal; however, the patient could not be weaned from the left heart bypass support lasting 1 month. Therefore, the circulatory assist device was switched to the extracorporeal Nipro ventricular assist device (VAD). This time, left heart bypass support could be maintained for 30 days using a single Rotaflow Centrifugal Pump(®). There were no signs of hemolysis during left heart bypass support. The Rotaflow Centrifugal Pump(®) itself may be used as a device for a bridge to decision or recovery before using a VAD in cardiogenic shock patients.


Assuntos
Estenose da Valva Aórtica/cirurgia , Derivação Cardíaca Esquerda , Coração Auxiliar , Oxigenação por Membrana Extracorpórea , Evolução Fatal , Feminino , Humanos , Pessoa de Meia-Idade , Complicações Pós-Operatórias
17.
J Card Surg ; 27(1): 119-21, 2012 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-22321117

RESUMO

BACKGROUND: Left heart mechanical circulatory support (MCS) through the left chest via the pulmonary vein and descending thoracic aorta is a good option for patients with an inaccessible anterior mediastinum and/or poor peripheral access. MATERIALS AND METHODS: We report the case of a 19-year-old small female with a newly discovered bulky primary mediastinal diffuse large B-cell lymphoma (PMBL) who developed refractory inverted Takotsubo cardiomyopathy (TC) with cardiogenic shock. RESULTS: Temporary MCS was implemented in order to stabilize the patient and proceed with a chemotherapy treatment. Given the patient's oncologic "frozen" mediastinum and the presence of poor peripheral arterial access, the left heart temporary MCS was successfully implanted through a left mini-thoracotomy via the left inferior pulmonary vein and descending thoracic aorta. CONCLUSIONS: This is the first report of temporary MCS to treat inverted TC and diffuse PMBL.


Assuntos
Derivação Cardíaca Esquerda , Linfoma Difuso de Grandes Células B/complicações , Neoplasias do Mediastino/complicações , Cardiomiopatia de Takotsubo/cirurgia , Feminino , Derivação Cardíaca Esquerda/métodos , Humanos , Cardiomiopatia de Takotsubo/etiologia , Toracotomia , Adulto Jovem
19.
Interact Cardiovasc Thorac Surg ; 12(5): 881-2, 2011 May.
Artigo em Inglês | MEDLINE | ID: mdl-21343157

RESUMO

Percutaneous cardiovascular device implantation plays an important and increasing role in the treatment of congenital heart disease. Device related complications of malposition and embolisation are uncommon and can usually be retrieved by catheter. We present two interesting cases in which migrated devices resulted in thoracic aortic obstruction; both were refractory to percutaneous retrieval. Device retrieval was achieved by thoracotomy and utilising partial left heart bypass because of specific concerns of distal perfusion. Our experience is presented.


Assuntos
Aorta Torácica/cirurgia , Cateterismo/efeitos adversos , Remoção de Dispositivo , Embolia/cirurgia , Migração de Corpo Estranho/cirurgia , Derivação Cardíaca Esquerda , Cardiopatias Congênitas/terapia , Dispositivo para Oclusão Septal/efeitos adversos , Stents/efeitos adversos , Toracotomia , Adulto , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/fisiopatologia , Aortografia/métodos , Cateterismo/instrumentação , Embolia/diagnóstico por imagem , Embolia/etiologia , Embolia/fisiopatologia , Feminino , Migração de Corpo Estranho/diagnóstico por imagem , Migração de Corpo Estranho/etiologia , Migração de Corpo Estranho/fisiopatologia , Cardiopatias Congênitas/fisiopatologia , Hemodinâmica , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Fluxo Sanguíneo Regional , Tomografia Computadorizada por Raios X , Resultado do Tratamento
20.
Artif Organs ; 34(9): 766-77, 2010 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-20883395

RESUMO

The ventricular performance is dependent on the drainage effect of rotary blood pumps (RBPs) and the performance of RBPs is affected by the ventricular pulsation. In this study, the interaction between the ventricle and RBPs was examined using the pressure-volume (P-V) diagram of the ventricle and dynamic head pressure-bypass flow (H-Q) curves (H, head pressure: arterial pressure minus ventricular pressure vs. Q, bypass flow) of the RBPs. We first investigated the relationships in a mock loop with a passive fill ventricle, followed by validation in ex vivo animal experiments. An apical drainage cannula with a micro-pressure sensor was especially fabricated to obtain ventricular pressure, while three pairs of ultrasonic crystals placed on the heart wall were used to derive ventricular volume. The mock loop-configured ventricular apical-descending aorta bypass revealed that the external work of the ventricle expressed by the area inside the P-V diagrams (EW(Heart) ) correlated strongly with the area inside dynamic H-Q curves (EW(VAD)), with the coefficients of correlation being R² = 0.869 ∼ 0.961. The results in the mock loop were verified in the ex vivo studies using three Shiba goats (10-25 kg in body weight), showing the correlation coefficients of R² = 0.802 ∼ 0.817. The linear regression analysis indicated that the increase in the bypass flow reduced pulsatility in the ventricle expressed in EW(Heart) as well as in EW(VAD) . Experimental results, both mock loop and animal studies, showed that the interaction between cardiac external work and H-Q performance of RBPs can be expressed by the relationships "EW(Heart) versus EW(VAD) ." The pulsatile nature of the native heart can be expressed in the area underneath the H-Q curves of RBPs EW(VAD) during left heart bypass indicating the status of the level of assistance by RBPs and the native heart function.


Assuntos
Derivação Cardíaca Esquerda/instrumentação , Coração Auxiliar , Contração Miocárdica , Volume Sistólico , Função Ventricular Esquerda , Pressão Ventricular , Animais , Pressão Sanguínea , Cabras , Modelos Lineares , Masculino , Miniaturização , Modelos Animais , Modelos Cardiovasculares , Desenho de Prótese , Fluxo Pulsátil , Reprodutibilidade dos Testes , Fatores de Tempo , Transdutores de Pressão
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