Balloon atrial septostomy: a weapon to challenge right heart failure after cardiac surgery.

Right heart failure is a common complication after cardiac surgery, and its mortality remains high. The medical management and veno-arterial extracorporeal membrane oxygenation has shown significant improvement in the majority of cases. However, a minority of patients may still require long-term mechanical circulatory support or heart transplantation. Balloon atrial septostomy is a new method for the prevention and treatment of right heart failure, which may avoid the patient's dependence on mechanical circulatory support. We used this method to try to treat patients with right heart failure after cardiac surgery, and all received good benefits. Therefore, we selected several representative cases to report, in order to guide other qualified cardiac surgeons to carry out relevant clinical practice.

Direct Apical Cannulation With Protek Duo Rapid Deployment Cannula via Mini Thoracotomy for Ambulatory Venoarterial-Extracorporeal Membrane Oxygenation.

National trends show rapid increases in the use of mechanical circulatory support devices (MCSD) over the last 20 years. While current literature has not proven a mortality benefit in cardiogenic shock as a complication of acute myocardial infarction (AMI-CS) with percutaneous MCSD, these devices are vital to maximizing cardiopulmonary parameters for definitive therapy. To minimize complications, many different techniques have been described including a novel off-pump direct apical cannulation for venoarterial-extracorporeal membrane oxygenation (VA-ECMO). This technique allows early ambulation and avoids peripheral artery access complications but has only been described in small case series. Our case series represents the largest summary of patients (50) using this technique and contains the only comparison data to date. Fifty-four percentage of our patients were Society for Cardiovascular Angiography and Interventions (SCAI) stage D and 22% were arrested before cannulation. We achieved flows on average >5 L/min and most patients required biventricular drainage (86%) and an oxygenator (92%). Thirty day survival was 56% and most survivors were bridged to heart transplant (30%). Our most common complication was bleeding (16%). This technique showed significant improvement in ejection fraction (EF), cardiac output/index (CO/CI), and pulmonary artery pressures. This case series demonstrates the safety and efficacy of this novel technique for central cannulation in cardiogenic shock at large scale within a single institution.

Impact of Epidural Catheter-Incision Congruency on Postoperative Analgesia after Major Abdominal Surgery: An Observational Study in a Teaching Hospital.

OBJECTIVE: To determine the frequency of appropriate epidural catheter-incision congruency in adult patients undergoing major abdominal surgeries, as well as the frequency of ineffective postoperative analgesia with continuous epidural infusion, side effects, and complications of epidural insertion and epidural catheter infusion. STUDY DESIGN: Observational study. Place and Duration of the Study: Department of Anaesthesiology, The Aga Khan University Hospital, Karachi, Pakistan, from September to November 2022. METHODOLOGY: All adult patients who underwent elective major abdominal surgery under general anaesthesia with epidural analgesia were included in this study. Data were collected by chart review of the patients enrolled in Acute Pain Service for the study period. Intraoperative anaesthesia form, epidural infusion form and all records of acute pain service for the postoperative period were reviewed and recorded. RESULTS: One hundred and eighty-two patients were included in this study. The epidural catheter was inserted congruent to the surgical incision i.e. T10-T11 level or above in 43 (23.6%) patients only. In the postoperative period, overall effective epidural analgesia was observed in 79 (43.4%) of the patients. Motor block in lower limbs was observed in 66 (36.26%) of patients in the immediate postoperative period. CONCLUSION: The present study shows appropriate epidural catheter-incision congruency in only 23.6% of the patients. This could be one of the common reasons for ineffective postoperative pain relief via epidural analgesia in 56.6% of patients. KEY WORDS: Epidural catheter insertion site, Major abdominal surgeries, Postoperative analgesia.

[Endoscopic-percutaneous rendezvous procedure for the management of difficult biliary tract: experience in an endoscopic center in Lima-Peru]. / Procedimiento endoscópico-percutáneo de rendezvous para el manejo de vía biliar difícil: experiencia en un centro endoscópico de Lima-Perú.

OBJECTIVES: Biliary access refractory to conventional cannulation techniques is a challenging clinical scenario for most endoscopists. The endoscopic-percutaneous rendezvous technique is an optimal alternative with high success rates and low complication rates in expert hands, however its routine use in the West, mainly in Latin America, is still limited. The aim of our study was to evaluate the feasibility, efficacy and safety of endoscopic-percutaneous rendezvous in the management of difficult biliary tract in an endoscopic center in Peru. MATERIALS AND METHODS: Descriptive study - case series type that included 21 patients, with diagnosis of difficult bile duct, all treated by endoscopic-percutaneous rendezvous between July 2017 to July 2020. We evaluated: age, gender, number of previous failed endoscopic retrograde cholangiopancreatography, associated endoscopic findings, rate of successful cannulation, rate of successful resolution of difficult choledocholithiasis, adverse events and procedure-related mortality. RESULTS: The rate of successful cannulation was 100% (21/21). There were 12 cases (57.1%) of difficult choledocholithiasis of which there was a successful resolution rate of 91.6% (11/12). The overall adverse event rate was 4.7% (1/21), which was one case of post-sphincteroplasty gastrointestinal bleeding that was successfully resolved endoscopically only. CONCLUSIONS: Endoscopic-percutaneous rendezvous performed by expert hands is feasible, safe and clinically effective for the management of the difficult bile duct in Latin America.

Papaverine prior to catheter balloon insertion for labor induction: a randomized controlled trial.

BACKGROUND: Catheter balloon insertion is a common method for cervical ripening and labor induction. Papaverine and its derivatives are musculotropic antispasmodic drugs that directly induce smooth muscle relaxation. Used during childbirth, these drugs have been suggested to shorten the duration of labor. OBJECTIVE: This study aimed to evaluate the effect of administering papaverine before catheter balloon insertion on changes in Bishop scores and on the labor induction-to-delivery interval. STUDY DESIGN: This randomized, double-blinded, placebo-controlled trial was conducted in a single tertiary university-affiliated hospital. Participants were admitted at term for labor induction with an initial Bishop score of ≤6. Participants were randomized to receive 80 mg intravenous papaverine or 0.9% normal saline solution within 30 minutes of Foley catheter balloon insertion. The co-primary outcomes were the difference in Bishop score from before catheter balloon insertion to after removal and the labor induction-to-delivery interval. The secondary outcomes included maternal pain and satisfaction scores, delivery within 24 hours, and neonatal outcomes. Both intention-to-treat and per-protocol analyses were performed. RESULTS: Overall, 110 women were enrolled. In the intention-to-treat analysis, the median difference in Bishop score was greater in the papaverine group than in the placebo group (5 [interquartile range, 1-11] vs 4 [interquartile range, 0-7], respectively; P=.025), and the median catheter balloon insertion-to-delivery interval was shorter in the papaverine group than in the placebo group (21 hours [interquartile range, 6-95] vs 26 hours [interquartile range, 3-108], respectively; P=.031). A higher proportion of women delivered within 24-hours in the papaverine group than in the placebo group (65.5% vs 41.8%, respectively; P=.012). Pain and satisfaction scores, delivery, and neonatal outcomes were similar between the groups. Similar results were found in the per-protocol analysis. CONCLUSION: Papaverine administration before Foley catheter balloon insertion for cervical ripening resulted in improved Bishop scores and shorter catheter balloon insertion-to-delivery intervals.

Nurse-assisted arterio-venous fistula cannulation during home hemodialysis: first results of the DIADIDEAL study / La ponction de fistule assistée par infirmier libéral en hémodialyse à domicile : premiers résultats de l'étude DIADIDEAL.

Introduction: We have launched a pilot study, called DIADIDEAL, to propose nurse-assistance at home for arterio-venous fistula (AVF) cannulation in home hemodialysis (HHD) patients. The aim of the present study was to describe enrollment of the patients and their nurses. Materials: All prevalent HD patients on 30th November 2018 with no medical contraindication to HDD treatment and all incident patients on dialysis from the 30th November 2018 to the 21st April 2023 were eligible. Results: Among 155 prevalent HD patients, 4 patients were included. Among the 276 incident patients on dialysis during the study period, 6 were included. We have phoned 23 nurse centers during the recruitment period. Eight of them agreed to learn in our unit how to cannulate AVF; 27 private nurses were enrolled. Discussion: The results of the DIADIDEAL study will be available in 2024; we hope it will lead to a reimbursement of nurse-AVF cannulation at home in HDD.

Introduction: L'étude DIADIDEAL est une étude pilote sur la ponction de fistule artério-veineuse (FAV) assistée par infirmier libéral en hémodialyse à domicile (HDD). L'objectif de l'étude actuelle est de rapporter le recrutement des patients et de leurs infirmiers diplômés d'État libéraux (IDEL). Matériels et méthodes: Tous les patients prévalents en HD au 30 novembre 2018 n'ayant pas de contre-indication médicale à un traitement par HDD ainsi que tous les patients incidents en dialyse du 30 novembre 2018 au 21 avril 2023 étaient éligibles. Résultats: Parmi les 155 patients prévalents en hémodialyse, 4 ont été inclus. Parmi les 276 patients incidents en dialyse sur la période, 6 ont été inclus dans l'étude. Parmi les 23 cabinets IDEL contactés pour l'étude, 8 ont accepté et 27 IDEL ont été formés à la ponction de FAV. Discussion: Les résultats de l'étude DIADIDEAL seront disponibles en 2024 et viseront à obtenir une nomenclature pour l'acte de ponction de FAV par les IDEL.

Balloon dacryoplasty: A boon for dacryologists in managing persistent congenital nasolacrimal duct obstructions.

PURPOSE: To study the outcomes of balloon dacryoplasty (BD) or (BDCP) in children with persistent congenital nasolacrimal duct obstruction (pCNLDO) by using new and reused balloon catheters. METHODS: Our retrospective analysis focused on managing pCNLDO by using the BD or BDCP technique. The study included children aged >1 year to <12 years who underwent single or multiple probings before. Our specific lacrimal workup included a detailed history and examination, as published earlier. We used conventional, straight, 2 mm × 13 mm/3 mm × 15 mm lacrimal balloons (FCI, Ophthacath). We have described a technique to use the same catheter for three BD procedures (1 new + 2 reuse). The outcomes were categorized as complete success, partial success, and failure. The minimum follow-up of each child was 6 months. RESULTS: We analyzed 64 children (89 eyes) with a mean age of 58 months (15-132 months). All children (100%) had epiphora with discharge and positive FDDT. All children underwent BD under general anesthesia - new balloons in 59 eyes and reused balloons in 30 eyes. The balloons were plasma sterilized akin to vitrectomy cutters and tubings of phaco machines. We noted three leaks from reused balloons (2 from the balloon tip and 1 from the plastic hub). At a mean follow-up of 14.5 months, complete success was noted in 77 eyes (86.5%) (52 new and 25 reuse), while 8 eyes had partial success (8.9%) (4 new and 4 reuse). Failure of BD was noted in four eyes (4.5%) (3 new and 1 reuse). None had significant complications with new or reused balloons. CONCLUSION: BD or BDCP is a quick, safe, easy, and effective procedure that resolves pCNLDO symptoms satisfactorily. Carefully reusing a conventional balloon catheter is possible with comparable efficacy and no additional complications in pCNLDO.

Dual lumen venopulmonary extracorporeal membrane oxygenation cannulation technique using the ProtekDuo.

In this video tutorial, we present the cannulation technique for venopulmonary extracorporeal membrane oxygenation using the ProtekDuo dual-lumen cannula in a patient with acute respiratory distress syndrome.

Effect of cervical Bishop score on induction of labor at term in primiparas using Foley catheter balloon: a retrospective study.

BACKGROUND: Previous studies had found that the mechanical methods were as effective as pharmacological methods in achieving vaginal delivery. However, whether balloon catheter induction is suitable for women with severe cervical immaturity and whether it will increase the related risks still need to be further explored. RESEARCH AIM: To evaluate the efficacy and safety of Foley catheter balloon for labor induction at term in primiparas with different cervical scores. METHODS: A total of 688 primiparas who received cervical ripening with a Foley catheter balloon were recruited in this study. They were divided into 2 groups: Group 1 (Bishop score ≤ 3) and Group 2 (3 < Bishop score < 7). Detailed medical data before and after using of balloon were faithfully recorded. RESULTS: The cervical Bishop scores of the two groups after catheter placement were all significantly higher than those before (Group 1: 5.49 ± 1.31 VS 2.83 ± 0.39, P<0.05; Group 2: 6.09 ± 1.00 VS 4.45 ± 0.59, P<0.05). The success rate of labor induction in group 2 was higher than that in group 1 (P<0.05). The incidence of intrauterine infection in Group 1 was higher than that in Group 2 (18.3% VS 11.3%, P<0.05). CONCLUSION: The success rates of induction of labor by Foley catheter balloon were different in primiparas with different cervical conditions, the failure rate of induction of labor and the incidence of intrauterine infection were higher in primiparas with severe cervical immaturity.

Continuous Catheter Techniques.

Continuous peripheral nerve block catheters are simple in concept: percutaneously inserting a catheter adjacent to a peripheral nerve. This procedure is followed by local anesthetic infusion via the catheter that can be titrated to effect for extended anesthesia or analgesia in the perioperative period. The reported benefits of peripheral nerve catheters used in the surgical population include improved pain scores, decreased narcotic use, decreased nausea/vomiting, decreased pruritus, decreased sedation, improved sleep, and improved patient satisfaction.

Effect of veno-arterial extracorporeal membrane oxygenation lower-extremity cannulation on intra-arterial flow characteristics, oxygen content, and thrombosis risk.

PURPOSE: This study aimed to investigate the effects of lower-extremity cannulation on the intra-arterial hemodynamic environment, oxygen content, blood damage, and thrombosis risk under different levels of veno-arterial (V-A) ECMO support. METHODS: Computational fluid dynamics methods were used to investigate the effects of different levels of ECMO support (ECMO flow ratios supplying oxygen-rich blood 100-40 %). Flow rates and oxygen content in each arterial branch were used to determine organ perfusion. A new thrombosis model considering platelet activation and deposition was proposed to determine the platelet activation and thrombosis risk at different levels of ECMO support. A red blood cell damage model was used to explore the risk of hemolysis. RESULTS: Our study found that partial recovery of cardiac function improved the intra-arterial hemodynamic environment, with reduced impingement of the intra-arterial flow field by high-velocity blood flow from the cannula, a flow rate per unit time into each arterial branch closer to physiological levels, and improved perfusion in the lower extremities. Partial recovery of cardiac function helps reduce intra-arterial high shear stress and residence time, thereby reducing blood damage. The overall level of hemolysis and platelet activation in the aorta decreased with the gradual recovery of cardiac contraction function. The areas at high risk of thrombosis under V-A ECMO femoral cannulation support were the aortic root and the area distal to the cannula, which moved to the descending aorta when cardiac function recovered to 40-60 %. However, with the recovery of cardiac contraction function, hypoxic blood pumped by the heart is insufficient in supplying oxygen to the front of the aortic arch, which may result in upper extremity hypoxia. CONCLUSION: We developed a thrombosis risk prediction model applicable to ECMO cannulation and validated the model accuracy using clinical data. Partial recovery of cardiac function contributed to an improvement in the aortic hemodynamic environment and a reduction in the risk of blood damage; however, there is a potential risk of insufficient perfusion of oxygen-rich blood to organs.