Extracorporeal Cardiopulmonary Resuscitation During Cesarean Delivery in a Patient With D-Transposition of the Great Vessels, Years Following Mustard Operation.

Patients with surgically repaired complex congenital cardiac anomalies present unique characteristics that can make the implementation of extracorporeal membrane oxygenation (ECMO) support especially challenging. Very few series have reported the outcomes of ECMO support during pregnancy and peripartum. We report a case of successful extracorporeal cardiopulmonary resuscitation during cesarean delivery in a patient with surgically repaired d-transposition of the great arteries, and we discuss particular aspects that contributed to successful implementation of ECMO support and hospital discharge.

Presumed Malignant Hyperthermia Treated During Cardiopulmonary Bypass in a Pediatric Patient Undergoing Aortic Valve Replacement: A Case Report.

There are no case reports of malignant hyperthermia in pediatric patients treated on cardiopulmonary bypass (CPB). We report the case of a 10-year-old boy undergoing aortic valve replacement. The patient developed progressive tachycardia and hypercarbia. In addition, EtCO2 and PaCO2 were equal and myoglobinuria was suspected given darkened urine. Numerous dantrolene boluses were given on CPB, and a dantrolene infusion was started. The patient's base deficit and creatine phosphokinase normalized by postoperative day 2. This case demonstrates the importance of expeditious diagnosis of malignant hyperthermia, and the need for additional dantrolene when treating patients whose blood volume is diluted on CPB.

Significance of accidental extensions in the lower uterine segment during cesarean delivery.

OBJECTIVES: This study was undertaken to determine risk factors and perioperative complications associated with accidental extensions in the lower uterine segment during cesarean deliveries (CDs). STUDY DESIGN: This is a retrospective chart review of all CDs performed at Jackson Memorial Hospital/University of Miami between the years 1999 and 2002. Operative reports were reviewed to abstract data on the occurrence of extensions. Indication for CD, cervical status at the time of CD, birth weight, and fetal presentation and position were included in the analyses. Postoperative hematocrits, length of surgery, estimated blood loss, decline in hematocrit by 10%, need for transfusion, or hysterectomy were compared among CD with and without extensions. RESULTS: A total of 2,811 CDs were available for this study. Accidental extensions in the lower uterine segment occurred in 6.6% of the cases. Extensions were more commonly found in primary CD (8% vs 5%, P < .01. Extensions were more frequent if cervical dilatation was 8 cm or greater (18.3% vs 7%, P < .01), complete effacement (15% vs 8%, P < .01) station greater than +1 (16% vs 6.9%, P < .01), and if the fetal position was noted to be in the occiput posterior position (10% vs 5%, P < .01). When extensions were present, length of surgery was longer (56 vs 49 minutes, P < .01) and estimated blood loss was greater (994 +/- 675 mL vs 936 +/- 370 mL, P < .01). Arrest of descent as indication for CD was found to be an independent risk factor for the occurrence of extensions during CD (odds ratio 2.6, 95% CI 1.5-4.5, P = .001). CONCLUSION: Extensions in the lower uterine segment during CD do not increase maternal morbidity.

Alterations of the female reproductive system in recipients of islet grafts.

BACKGROUND: Transplantation of allogeneic tissues is becoming a wider practice for the replacement of organ function lost to congenital or acquired pathologies. Chronic immunosuppression remains a necessity to prevent organ rejection, despite increased risks of infection, organ toxicity, and malignancies. Abnormalities of female gonadal function in patients of reproductive age are recognized, however, pathological alterations of the reproductive system in patients treated with new generation immunosuppressive drugs are still poorly documented. METHODS: We report herein our observations of abnormalities of the reproductive system in 13 female recipients of allogeneic islets for type 1 diabetes, under immunosuppression therapy based on daclizumab induction and tacrolimus/sirolimus maintenance. RESULTS: Menstrual cycle alterations and clinically significant ovarian cysts were frequently observed in our patients, some requiring medical or surgical intervention. All ovarian cysts appeared of benign nature. CONCLUSIONS: Our findings suggest that pre- and posttransplant evaluation of female patients should include menstrual history, baseline pelvic ultrasound, and hormonal levels to assess the presence and monitor the progression of such alterations.