Assuntos
Cordas Tendinosas , Dispneia , Implante de Prótese de Valva Cardíaca/métodos , Estenose da Valva Mitral , Valva Mitral , Cordas Tendinosas/anormalidades , Cordas Tendinosas/diagnóstico por imagem , Cordas Tendinosas/cirurgia , Dispneia/diagnóstico , Dispneia/etiologia , Ecocardiografia Transesofagiana/métodos , Feminino , Próteses Valvulares Cardíacas , Humanos , Pessoa de Meia-Idade , Valva Mitral/anormalidades , Valva Mitral/diagnóstico por imagem , Valva Mitral/cirurgia , Estenose da Valva Mitral/congênito , Estenose da Valva Mitral/diagnóstico , Estenose da Valva Mitral/fisiopatologia , Estenose da Valva Mitral/cirurgia , Índice de Gravidade de Doença , Resultado do TratamentoRESUMO
Hepatic venous blood flow can be easily obtained using bedside ultrasound with either transthoracic or transesophageal echocardiography. Six critically ill patients with shock associated with absent or significantly reduced hepatic venous blood flow in the presence of normal or increased pulmonary venous flow are presented. In all these patients, the etiology of shock was secondary to increased resistance to venous return from either an intraabdominal process or through extrinsic or intrinsic occlusion of the proximal inferior vena cava or right atrium. These shock situations are secondary to increased resistance to venous return. Their treatment is highly specific and typically involves a surgical intervention.
Assuntos
Veias Hepáticas/diagnóstico por imagem , Fígado/irrigação sanguínea , Choque/diagnóstico por imagem , Adulto , Idoso , Estado Terminal , Ecocardiografia Transesofagiana , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Choque/etiologia , Ultrassonografia DopplerRESUMO
The congenitally bicuspid aortic valve with anomalous chordal attachment of the fused cusp to the aortic wall is a rare and unappreciated cause of aortic insufficiency. We report the case of a 43-year-old male patient who presented with severe aortic insufficiency caused by this anomaly and in whom surgical aortic valve repair was successfully performed. To our knowledge, this is the first report to describe the successful surgical repair of this rare variant of bicuspid aortic valve.
Assuntos
Insuficiência da Valva Aórtica/cirurgia , Valva Aórtica/anormalidades , Doenças das Valvas Cardíacas/cirurgia , Adulto , Valva Aórtica/cirurgia , Doença da Válvula Aórtica Bicúspide , Humanos , MasculinoRESUMO
Extracorporeal life support may be used in patients with refractory cardiogenic shock. The femoral venoarterial route can be used for implanting cannulae in patients who are hemodynamically unstable. Here we describe the use of an ultrasound-guided transversus abdominis plane block supplemented with the femoral component of the genitofemoral nerve as the anesthesia technique for peripheral cannulation of the femoral vessels in a patient with severe acute heart failure after myocardial infarction with ST-segment elevation. The procedure was performed using 40 mL of a 50:50 mixture of 0.5% levobupivacaine and 2% lidocaine (30 mL for transversus abdominis plane and 10 mL for genitofemoral block) associated with low-dose remifentanil infusion during spontaneous breathing. A left ventricular assist device was successfully implanted 4 days later.