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COVID-19 , Tromboembolia , Humanos , Parestesia/etiología , Isquemia , Extremidad Superior , SíncopeAsunto(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
INTRODUCTION AND IMPORTANCE: Carcinoid tumors are rare malignancies of neuroendocrine origin that can manifest with a constellation of systemic symptoms including right-sided cardiac involvement. Many patients with carcinoid heart disease require valve replacement, but intraoperative management of carcinoid syndrome varies within the literature. CASE PRESENTATION: A 72-year-old man with carcinoid syndrome underwent tricuspid and pulmonic valve replacement with multiple episodes of carcinoid crisis intraoperatively as well as right ventricular dysfunction after cardiopulmonary bypass. CLINICAL DISCUSSION: Octreotide is the mainstay in prevention and treatment of intraoperative carcinoid crisis, but reported dosages and timing varies significantly. The use of exogenous catecholamines is also controversial as they are thought to paradoxically worsen carcinoid symptoms. Our patient was managed successfully with both an octreotide infusion and intermittent boluses, as well as exogenous catecholamines for right ventricular support during and after cardiopulmonary bypass. CONCLUSION: The management of carcinoid syndrome in patients undergoing valve surgery for carcinoid heart disease is dependent on timely prevention and treatment of carcinoid crisis and effective mitigation of right ventricular dysfunction.
RESUMEN
Venovenous extracorporeal membrane oxygenation is increasingly used as a bridging strategy in decompensating patients awaiting lung transplantation. Various approaches for continuing support intraoperatively have been previously described. A two-circuit strategy that uses the in situ venovenous extracorporeal membrane oxygenation circuit supplemented with peripheral cardiopulmonary bypass allows for diversion of native cardiac output away from the transplanted lung as well as seamless continuation of venovenous extracorporeal membrane oxygenation postoperatively.
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Fibrilación Atrial , Neoplasias Cardíacas , Mixoma , Humanos , Mixoma/complicaciones , Mixoma/diagnóstico por imagen , Mixoma/cirugía , Atrios Cardíacos/diagnóstico por imagen , Neoplasias Cardíacas/complicaciones , Neoplasias Cardíacas/diagnóstico por imagen , Neoplasias Cardíacas/cirugíaAsunto(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)
Cardiomiopatía Hipertrófica , Insuficiencia de la Válvula Mitral , Obstrucción del Flujo Ventricular Externo , Cardiomiopatía Hipertrófica/complicaciones , Cardiomiopatía Hipertrófica/diagnóstico por imagen , Humanos , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/etiología , Insuficiencia de la Válvula Mitral/cirugía , Sístole , Obstrucción del Flujo Ventricular Externo/diagnóstico por imagen , Obstrucción del Flujo Ventricular Externo/etiologíaAsunto(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 imagenAsunto(s)
Ablación por Catéter , Ablación por Radiofrecuencia , Taquicardia Ventricular , Complejos Prematuros Ventriculares , Ablación por Catéter/efectos adversos , Disnea/diagnóstico , Disnea/etiología , Electrocardiografía , Humanos , Taquicardia Ventricular/cirugía , Resultado del Tratamiento , Complejos Prematuros Ventriculares/diagnóstico , Complejos Prematuros Ventriculares/cirugíaRESUMEN
BACKGROUND: Use of recombinant activated factor VII (rFVIIa) to achieve hemostasis during cardiac surgery continues to be debated, as support for its efficacy and safety has not been consistent. We examined our experience with rFVIIa for achieving hemostasis in high-risk patients undergoing complex ascending aortic surgery. METHODS: We reviewed patients who underwent complex ascending aortic surgery performed by a single surgeon (C. K. R.) from August 2014 to February 2019. Outcomes of patients who received rFVIIa were compared with those who did not. RESULTS: Of 59 consecutive patients, 20 patients (33.9%) received rFVIIa, whereas 39 (66.1%) did not. Median dose was 45.4 mcg/kg. rFVIIa was administered intraoperatively to 95% of patients who received it. Most patients underwent combined aortic valve, ascending aorta, and aortic arch surgery (80.0% vs. 64.1%, p = .52). Patients receiving rFVIIa had longer mean cross clamp times (212 vs. 173 min, p = .03) and received a greater median number of intraoperative blood products (18.5 vs. 12.0, p < .001). The number of patients who needed postoperative products (75.0% vs. 60.5%, p = .39), the median number of blood products transfused postoperatively (2 vs. 2, p = .40), and chest tube output (1138 vs. 805 ml, p = .17) were similar between groups. In-hospital mortality was similar between groups (10.0% vs. 10.3%, p = 1.00). Incidences of postoperative stroke (10.0% vs. 13.5%, p = 1.00) and thromboembolic events (10.0% vs. 13.5%, p = 1.00) were similar. CONCLUSIONS: Administration of rFVIIa intraoperatively for refractory bleeding during complex ascending aortic surgery provided hemostasis without greater in-hospital mortality or a higher risk of stroke and thromboembolic events.
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Factor VIIa , Cirujanos , Hemostasis , Humanos , Hemorragia Posoperatoria/epidemiología , Proteínas Recombinantes , Estudios RetrospectivosRESUMEN
Transversus abdominis plane (TAP) blocks are increasingly used for perioperative analgesia in patients undergoing abdominal surgeries. TAP blocks are easy to perform, reliably effective, and have an excellent safety profile. Nevertheless, we report a patient who underwent an open cholecystectomy and right hemicolectomy where a subcostal TAP block possibly contributed to an unusual abdominal wall abscess that lead to a prolonged and complicated postoperative course.
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Pared Abdominal , Músculos Abdominales/diagnóstico por imagen , Pared Abdominal/cirugía , Analgésicos Opioides , Humanos , Dolor Postoperatorio , Estudios ProspectivosRESUMEN
Olanzapine is increasingly used as a sleep aid in hospitalized patients. Although thought to have less extrapyramidal effects, known side effects include oversedation, arrythmias, and hypotension. We present the unusual case of hyperventilation with respiratory alkalosis after the administration of olanzapine for insomnia in an elderly postoperative patient. This led to a second admission to the intensive care unit with invasive interventions including mechanical ventilation and vasopressor support. Caution must be exercised in prescribing antipsychotics for off-label use, especially in a population whose baseline characteristics can affect the pharmacokinetics of second-generation antipsychotics.
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Alcalosis Respiratoria , Antipsicóticos , Hiperventilación , Olanzapina , Trastornos del Inicio y del Mantenimiento del Sueño , Anciano , Alcalosis Respiratoria/inducido químicamente , Antipsicóticos/efectos adversos , Humanos , Hiperventilación/inducido químicamente , Olanzapina/efectos adversos , Trastornos del Inicio y del Mantenimiento del Sueño/tratamiento farmacológicoRESUMEN
Mucopolysaccharidosis type I is a genetic disorder with impaired glycosaminoglycan degradation. Cardiac pathologic involvement in this subset of patients is predominantly valvular heart disease. Valvular heart disease seen in these patients will most likely require surgical intervention in their lifetime. Only a limited amount of reports are dedicated to the cardiac surgical management of mucopolysaccharidoses. We present the case of a 32-year-old female with Hurler-Scheie syndrome who required multiple valve replacements due to progression of valvular dysfunction and decline in the quality of life. Multidisciplinary evaluation and discussion early are crucial for quality of life optimization in this cohort of patients.