Asunto(s)
Insuficiencia Cardíaca , Defectos del Tabique Interatrial , Corazón Auxiliar , Dispositivo Oclusor Septal , Humanos , Defectos del Tabique Interatrial/cirugía , Defectos del Tabique Interatrial/diagnóstico por imagen , Insuficiencia Cardíaca/cirugía , Cateterismo Cardíaco/métodos , Cateterismo Cardíaco/instrumentación , Implantación de Prótesis/métodos , Implantación de Prótesis/instrumentaciónAsunto(s)
Endocarditis Bacteriana , Insuficiencia de la Válvula Tricúspide , Humanos , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/etiología , Insuficiencia de la Válvula Tricúspide/cirugía , Atrios Cardíacos/diagnóstico por imagen , Endocarditis Bacteriana/complicacionesRESUMEN
A left-sided inferior vena cava poses a unique challenge when cannulating for cardiopulmonary bypass during thoracoabdominal aortic aneurysm repair, and how to effectively and safely do so has not been previously described. A 51-year-old woman with a history of Loeys-Dietz syndrome and a left-sided inferior vena cava underwent open Crawford extent II thoracoabdominal aortic aneurysm repair. Cardiopulmonary bypass cannulation was performed using the right axillary artery, left common femoral artery, and right internal jugular vein. The patient's repair was successful, and she was ultimately discharged back to her home.
Asunto(s)
Apéndice Atrial , Fibrilación Atrial , Endocarditis , Apéndice Atrial/diagnóstico por imagen , Apéndice Atrial/cirugía , Fibrilación Atrial/complicaciones , Fibrilación Atrial/diagnóstico por imagen , Fibrilación Atrial/cirugía , Ecocardiografía Transesofágica , Endocarditis/complicaciones , Endocarditis/diagnóstico por imagen , Endocarditis/cirugía , HumanosAsunto(s)
Seno Coronario , Anomalías de los Vasos Coronarios , Vena Cava Superior Izquierda Persistente , Seno Coronario/diagnóstico por imagen , Seno Coronario/cirugía , Anomalías de los Vasos Coronarios/complicaciones , Anomalías de los Vasos Coronarios/diagnóstico por imagen , Anomalías de los Vasos Coronarios/cirugía , Humanos , Vena Cava Superior/diagnóstico por imagenRESUMEN
Intraaortic balloon pump (IABP) counterpulsation, introduced more than 50 years ago, remains the most commonly utilized mechanical circulatory support device for patients with cardiogenic shock and myocardial ischemia, despite lack of definitive proof regarding its outcome in these patients. Part I of this review focused on the history of counterpulsation, physiologic principles, technical considerations, and evidence for its use in cardiogenic shock; Part II will discuss periprocedural uses for IABP counterpulsation and review advances in technology, including the emergence of alternative mechanical circulatory support devices that have influenced IABP utilization.
Asunto(s)
Corazón Auxiliar/tendencias , Hemodinámica , Contrapulsador Intraaórtico/tendencias , Isquemia Miocárdica/terapia , Revascularización Miocárdica , Choque Cardiogénico/terapia , Difusión de Innovaciones , Humanos , Contrapulsador Intraaórtico/efectos adversos , Contrapulsador Intraaórtico/instrumentación , Contrapulsador Intraaórtico/mortalidad , Isquemia Miocárdica/mortalidad , Isquemia Miocárdica/fisiopatología , Revascularización Miocárdica/efectos adversos , Revascularización Miocárdica/mortalidad , Recuperación de la Función , Factores de Riesgo , Choque Cardiogénico/mortalidad , Choque Cardiogénico/fisiopatología , Resultado del Tratamiento , Función VentricularRESUMEN
Intraaortic balloon pump counterpulsation is the most common form of mechanical circulatory support used in patients with myocardial ischemia and cardiogenic shock. The physiologic principles of counterpulsation include diastolic augmentation of aortic pressure and systolic reduction of left ventricular afterload, resulting in hemodynamic benefits through increased coronary perfusion pressure and improved myocardial oxygen balance in patients with myocardial ischemia. Major trials have failed to conclusively demonstrate improvements in morbidity and mortality with counterpulsation therapy for patients with acute myocardial infarction (MI), cardiogenic shock, and/or severe coronary artery disease undergoing revascularization therapy, and the debate over its applications continues. Part I of this review focuses on the history of the development of counterpulsation, technical considerations, and complications associated with its use, its physiologic effects, and evidence for its use in myocardial ischemia and cardiogenic shock.
Asunto(s)
Enfermedad de la Arteria Coronaria/terapia , Contrapulsador Intraaórtico , Infarto del Miocardio/terapia , Revascularización Miocárdica , Choque Cardiogénico/terapia , Animales , Contraindicaciones de los Procedimientos , Enfermedad de la Arteria Coronaria/historia , Enfermedad de la Arteria Coronaria/mortalidad , Enfermedad de la Arteria Coronaria/fisiopatología , Hemodinámica , Historia del Siglo XX , Historia del Siglo XXI , Humanos , Contrapulsador Intraaórtico/efectos adversos , Contrapulsador Intraaórtico/historia , Contrapulsador Intraaórtico/mortalidad , Infarto del Miocardio/historia , Infarto del Miocardio/mortalidad , Infarto del Miocardio/fisiopatología , Revascularización Miocárdica/efectos adversos , Revascularización Miocárdica/mortalidad , Recuperación de la Función , Medición de Riesgo , Factores de Riesgo , Choque Cardiogénico/historia , Choque Cardiogénico/mortalidad , Choque Cardiogénico/fisiopatología , Resultado del Tratamiento , Función VentricularRESUMEN
The under-representation of women in academic leadership roles, including in anaesthesiology, is a well-documented phenomenon that has persisted for decades despite more women attending medical school, participating in anaesthesiology residencies, and joining academic faculties. The percentage of female anaesthesiologists who hold senior academic ranks or leadership roles, such as chair, lags behind the percentage of female anaesthesiologists overall. Trends towards increasing the numbers of women serving in educational leadership roles, specifically residency programme directors, suggest that there are areas in which academic anaesthesiology has been, and can continue, improving gender imbalance. Continued institutional efforts to recruit women into anaesthesiology, reduce gender bias, and promote interventions that foster gender equity in hiring and promotion will continue to benefit women, academic anaesthesiology departments, and the healthcare system overall.