Intestinaler ”low flow state” unter Monitoring von Mukosa- und Serosa-Kalium-Aktivität, Elektromyographie und Schockmediatorprofilen

1994 ◽  
pp. 271-275 ◽  
Author(s):  
H. W. Ch. Töns ◽  
M. Polivoda ◽  
M. Anurov ◽  
Ch. Klein ◽  
A. Öttinger ◽  
...  
Keyword(s):  
Low Flow ◽  
Flow State

High Prevalence of Severe Aortic Stenosis in Low-Flow State Associated With Atrial Fibrillation

2021 ◽  
Author(s):  
Said Alsidawi ◽  
Sana Khan ◽  
Sorin V. Pislaru ◽  
Jeremy J. Thaden ◽  
Edward A. El-Am ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Left Ventricular ◽  
Hazard Ratio ◽  
Low Flow ◽  
Left Ventricular Ejection ◽  
Aortic Valve Area ◽  
Flow State ◽  
Ventricular Ejection Fraction

Background: Atrial fibrillation (AF) is a low-flow state and may underestimate aortic stenosis (AS) severity. Single-high Doppler signals (HS) consistent with severe AS (peak velocity ≥4 m/s or mean gradient ≥40 mm Hg) are averaged down in current practice. The objective for the study was to determine the significance of HS in AF low-gradient AS (LGAS). Methods: One thousand five hundred forty-one patients with aortic valve area ≤1 cm 2 and left ventricular ejection fraction ≥50% were identified and classified as high-gradient AS (HGAS) (≥40 mm Hg) and LGAS (<40 mm Hg), and AF versus sinus rhythm (SR). Available computed tomography aortic valve calcium scores (AVCS) were retrieved from the medical record. Outcomes were assessed. Results: Mean age was 76±11 years, female 47%. Mean gradient was 51±12 in SR-HGAS, 48±10 in AF-HGAS, 31±5 in SR-LGAS, and 29±7 mm Hg in AF-LGAS, all P ≤0.001 versus SR-HGAS; HS were present in 33% of AF-LGAS. AVCS were available in 34%. Compared with SR-HGAS (2409 arbitrary units; interquartile range, 1581–3462) AVCS were higher in AF-HGAS (2991 arbitrary units; IQR1978–4229, P =0.001), not different in AF-LGAS (2399 arbitrary units; IQR1817–2810, P =0.47), and lower in SR-LGAS (1593 arbitrary units; IQR945–1832, P <0.001); AVCS in AF-LGAS were higher when HS were present ( P =0.048). Compared with SR-HGAS, the age-, sex-, comorbidity index-, and time-dependent aortic valve replacement-adjusted mortality risk was higher in AF-HGAS (hazard ratio=1.82 [1.40–2.36], P <0.001) and AF-LGAS with HS (hazard ratio=1.54 [1.04–2.26], P =0.03) but not different in AF-LGAS without HS or SR-LGAS (both P =not significant). Conclusions: Severe AS was common in AF-LGAS. AVCS in AF-LGAS were not different from SR-HGAS. AVCS were higher and mortality worse in AF-LGAS when HS were present.

P6486Flow state, gradients and anatomopathological valvular calcification: influence in aortic stenosis surgical outcomes

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
J T Museli ◽  
L Zambruno ◽  
N Coria ◽  
G Giunta ◽  
J F Salmo ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Ejection Fraction ◽  
Low Flow ◽  
P Value ◽  
Flow State ◽  
Normal Flow ◽  
Perioperative Mortality ◽  
High Gradient ◽  
The Relationship

Abstract Introduction Aortic stenosis (AS) patients are heterogeneous. The relationship between stenosis severity, transvalvular flow state and gradients is conflictive and non-linear. Objective To evaluate the relationship between transvalvular flow state and gradients with the anatomopathological aortic valve characteristics and perioperative morbimortality among patients (pt) submitted to aortic valve replacement (AVR). Methods We analyzed 516 pt with symptomatic severe AS (effective valve area <1 cm2) with preserved left ventricular ejection fraction (>50%) submitted to AVR. Perioperative mortality and a combined endpoint (death, low cardiac output syndrome and acute renal injury) were analyzed dividing the population by transvalvular flow (35 ml/m2) and mean gradient (40 mmHg), both measured by echocardiography. A morphologic evaluation of 383 operatively excised native cardiac valves was performed. Valvular thickening and calcification were categorized in mild, moderate and severe. Results Male subjects represented 52.9% (283 pt). Mean age were 69±11.5 years. Pt showed a mean ejection fraction of 61±4.8%, the peak gradient was 86.2±24 mmHg, and mean gradient was 53±18 mmHg. Cardiac low output syndrome (normal flow (NF) – 14%, low flow (LF) – 23%; p<0,02), IABP (NF 1,8%, LF 6%, p<0,02) and perioperative mortality (NF 2,7%, LF 7%, p<0,02) were more frequent in low flow pt (185 – 35%). Bicuspid valves represented 24.5% of the whole population. Bicuspid patients were younger 64±9 vs 73±12 years (p<0.05) and had more moderate–severe calcification (MSC) 93.4% vs 75.6% (p<0.05). No difference was found in moderate -severe thickening (MSTh) and MSC when analyzing the population by flow (35 ml/m2). On the contrary, low gradient pt (<40mmHg) had lower MSC and MSTh. (Table) Finally, 4 groups were considered: normal flow–high gradient NFHG (52.2%), normal flow–low gradient NFLG (12%), low flow–high gradient LFHG (25.5%) and low flow–low gradient LFLG (10.1%). A trend toward more perioperative events was seen in the LF-LG group despite less calcified and thickened valves. (Figure) Table 1 Normal Flow Low Flow P value Normal gradient Low gradient P value M-S thickening 143 (58.1%) 80 (58.3%) NS 186 (62.4%) 37 (43.5%) 0.0018 M-S calcification 195 (79.2%) 119 (86.8%) NS 263 (88.2%) 51 (60%) <0.05 Bicuspid valve 62 (25%) 32 (23%) NS 62 (25.2%) 32 (23.3%) NS M-S: Moderate-Severe. Figure 1 Conclusions In our population of severe symptomatic AS with preserved ejection fraction submitted to AVR, low gradient pts had less calcified and thickened valves. LFLG pts presented a trend towards more perioperative events despite having less valvular calcification.

Hemodynamic functions and blood viscosity in surface hypothermia

1978 ◽  
Vol 235 (2) ◽  
pp. H136-H143 ◽  
Author(s):  
R. Y. Chen ◽  
S. Chien
Keyword(s):  
Body Temperature ◽  
Blood Viscosity ◽  
Flow Resistance ◽  
Plasma Viscosity ◽  
Low Flow ◽  
Flow State ◽  
Surface Cooling ◽  
Plasma Loss ◽  
Pulmonary Flow ◽  
Anesthetized Dogs

Hemodynamic functions and blood viscosity changes in hypothermia (core approximately 25 degrees C) were studied in 14 pentobarbital-anesthetized dogs subjected to surface cooling. The viscosity of blood (eta B) increased progressively to 173% of that at 37 degrees C when body temperature was lowered to 25 degrees C. The increase in blood viscosity was caused by: a) the direct effect of low temperature on plasma viscosity, b) hemoconcentration as a result of plasma loss, and c) the low-flow (low-shear) state induced by hypothermia. A larger portion of the increased viscosity was caused by the low-flow state in hypothermia. The systemic flow resistance (SFR) increased to 271% of control, and this was attributable about equally to the increases in blood viscosity and systemic vascular hindrance (SFR/eta B). Similarly, the viscosity of blood contributed significantly to raising the pulmonary flow resistance. The relative constancy of mixed venous O2 saturation suggests that the cardiac output at low body temperature is generally adequate to meet the metabolic needs

scholarly journals Acute Esophageal Necrosis and Low-Flow State

2007 ◽  
Vol 21 (4) ◽  
pp. 245-247 ◽  
Author(s):  
Ahmad Burtally ◽  
Philippe Gregoire
Keyword(s):  
Gastroesophageal Junction ◽  
Low Flow ◽  
Quebec City ◽  
Flow State ◽  
Present Case Report ◽  
Acute Esophageal Necrosis ◽  
Esophageal Necrosis ◽  
Black Esophagus ◽  
Proximal Extension ◽  
Clinical Conditions

Acute esophageal necrosis (AEN), also called black esophagus, is quite exceptional. Endoscopic findings show circumferential black discolouration of the esophagus with or without exudates. The etiology of AEN is presently unknown and is assumed to be multifactorial. Distal esophageal involvement with proximal extension ending sharply at the gastroesophageal junction is the most common presentation. The present case report describes the clinical and endoscopic evolution of black esophagus observed in a patient with significant peripheral vascular disease, who was presented to the intensive care unit at the Hopital Saint-Francois d’Assise (Quebec City, Quebec). Through an extensive review of the literature, common underlying clinical conditions of patients diagnosed with AEN have been identified.

The Effect of Altered Cerebral Blood Flow on the Cerebral Kinetics of Thiopental and Propofol in Sheep

2000 ◽  
Vol 93 (4) ◽  
pp. 1085-1094 ◽  
Author(s):  
Richard N. Upton ◽  
Guy L. Ludbrook ◽  
Cliff Grant ◽  
David J. Doolette
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Random Order ◽  
High Flow ◽  
Low Flow ◽  
Flow State ◽  
Concentration Difference ◽  
Blood Flows ◽  
Kinetics Of ◽  
The Brain

Background Thiopental and propofol are highly lipid-soluble, and their entry into the brain often is assumed to be limited by cerebral blood flow rather than by a diffusion barrier. However, there is little direct experimental evidence for this assumption. Methods The cerebral kinetics of thiopental and propofol were examined over a range of cerebral blood flows using five and six chronically instrumented sheep, respectively. Using anesthesia (2.0% halothane), three steady state levels of cerebral blood flow (low, medium, and high) were achieved in random order by altering arterial carbon dioxide tension. For each flow state, 250 mg thiopental or 100 mg propofol was infused intravenously over 2 min. To quantify cerebral kinetics, arterial and sagittal sinus blood was sampled rapidly for 20 min from the start of the infusion, and 1.5 h was allowed between consecutive infusions. Various models of cerebral kinetics were examined for their ability to account for the data. Results The mean baseline cerebral blood flows for the "high" flow state were over threefold greater than those for the low. For the high-flow state the normalized arteriovenous concentration difference across the brain was smaller than for the low-flow state, for both drugs. The data were better described by a model with partial membrane limitation than those with only flow limitation or dispersion. Conclusions The cerebral kinetics of thiopental and propofol after bolus injection were dependent on cerebral blood flow, despite partial diffusion limitation. Higher flows produce higher peak cerebral concentrations.

scholarly journals Enhanced constriction of the peripheral large artery in response to acute induction of a low-flow state in human hypercholesterolemia.

1991 ◽  
Vol 11 (1) ◽  
pp. 161-166 ◽  
Author(s):  
V Filitti ◽  
P Giral ◽  
A Simon ◽  
I Merli ◽  
M Del Pino ◽  
...  
Keyword(s):  
Low Flow ◽  
Large Artery ◽  
Flow State

scholarly journals Double Interatrial Septum appearing as an Atrial Myxoma: A Case Report and Review of the Literature

2017 ◽  
Vol 5 (1) ◽  
pp. 16-20
Author(s):  
Julie Wyrobek ◽  
IV Chales H Brown ◽  
Megan P Kostibas ◽  
Susan A Mayer ◽  
Duke E Cameron ◽  
...  
Keyword(s):  
Case Report ◽  
Thrombus Formation ◽  
Interatrial Septum ◽  
Vital Role ◽  
Atrial Myxoma ◽  
Accurate Diagnosis ◽  
Low Flow ◽  
Flow State ◽  
Review Of The Literature ◽  
Echocardiographic Evaluation

ABSTRACT A double interatrial septum (DIS) is a rare finding during echocardiographic evaluation and can often be mistaken for other more common atrial anomalies. The interatrial cavity created by the septum creates a low-flow state that increases risk of thrombus formation and thromboembolic events. Transesophageal echocardiography (TEE) plays a vital role in accurate diagnosis as a DIS is often not seen during transthoracic echocardiography (TTE). In this case, we report a patient who presented for surgery with a preoperative diagnosis of an atrial myxoma, was instead discovered to have a DIS, and then subsequently underwent DIS resection without complication. We discuss the differential of a DIS, including an atrial septal pouch, cor triatriatum, atrial myxoma, and aneurysmal interatrial septum and the classic features of each anomaly for appropriate diagnosis and management. How to cite this article Wyrobek J, Brown CH IV, Kostibas MP, Mayer SA, Cameron DE, Hayanga HK. Double Interatrial Septum appearing as an Atrial Myxoma: A Case Report and Review of the Literature. J Perioper Echocardiogr 2017;5(1):16-20.

scholarly journals Pharmacological management of low blood flow state in less than 28weeks neonate.

2021 ◽  
Author(s):  
Femi Adeniyi ◽  
Kunle Oyedokun ◽  
Adeniyi Ajiboye ◽  
Sanjeev Rath
Keyword(s):  
Blood Pressure ◽  
Blood Flow ◽  
Pharmacological Treatment ◽  
Superior Vena ◽  
Ductus Arteriosus ◽  
Vena Cava ◽  
Low Flow ◽  
Systemic Resistance ◽  
Preterm Neonates ◽  
Flow State

low blood flow state is defined as insufficient cardiac output to maintain adequate cellular metabolism at the organ level. A low blood flow state can be measured by reduced organ perfusion, such as reduced superior vena cava flow[1,2] or high resistance flow in superior mesenteric doppler scan [3]. The combination of capillary refill time of greater than 4 seconds and serum lactate greater than 4 mmol/litre has 97% sensitivity of identifying low blood flow state [4]. In the presence of the above markers of a low blood flow state, the blood pressure may be normal or high in the first 48hours of life due to high systemic resistance [5]. Therefore, high, or normal blood pressure should be interpreted with great caution. CONCLUSIONThe pharmacological treatment of a low blood flow state should be guided by thorough clinical assessment. The prophylaxis or stress dose hydrocortisone treatment of low flow state is gaining grounds mainly when there is evidence of adrenal insufficiency. The choice and titration of pharmacological treatment should be guided by functional echocardiography. The use of Dobutamine as first-line treatment is advised when myocardia dysfunction on echocardiography is noted.Milrinone use is reserved for extreme preterm neonates with myocardia dysfunction before patent ductus arteriosus ligation. Dopamine and noradrenaline remain the commonly used first and second-line vasopressors, respectively, to manage low blood flow states secondary to poor vasomotor resistance.

scholarly journals Acute Esophageal Necrosis Early after Renal Transplantation

2021 ◽  
Vol 2021 ◽  
pp. 1-4
Author(s):  
Ahmad Makeen ◽  
Faisal Al-Husayni ◽  
Turki Banamah
Keyword(s):  
Blood Pressure ◽  
Kidney Transplantation ◽  
Renal Transplantation ◽  
Graft Loss ◽  
Low Flow ◽  
Esophageal Mucosa ◽  
Flow State ◽  
Acute Esophageal Necrosis ◽  
Esophageal Necrosis ◽  
Black Discoloration

Background. Acute esophageal necrosis (AEN) is defined as a diffused black discoloration of the esophageal mucosa involving mainly the distal part of the esophagus. It is considered a rare clinical entity with a high mortality rate. The etiology of AEN is unknown, but it has been correlated to many causes such as malignancies, infections, and hemodynamics instability. Here, we report a case of a patient developing AEN a few days after kidney transplantation. Case Presentation. A 57-year-old male was admitted electively for kidney transplantation that he received from his son. The surgery was complicated with a significant drop in blood pressure but otherwise was uneventful. The patient was showing good signs of recovery but then suffered from significant hematemesis. An urgent upper esophagogastroduodenoscopy revealed black discoloration of the esophageal mucosa in keeping with AEN. The patient was treated with proton pump inhibitors infusion and started empirically on antivirals and antifungals. The patient’s condition improved in regards to the AEN; nonetheless, the complications resulted in graft loss, and the patient returned to hemodialysis. Conclusion. AEN is a critical condition that mandates early intervention. Identifying high-risk populations may aid in early anticipation and diagnosis. Patients with chronic kidney disease are at risk of atherosclerosis leading to a low flow state which is exacerbated during renal transplantation surgery, especially if the procedure was complicated with a drop in blood pressure.

scholarly journals 229 Long-term clinical and echocardiographic outcome following TAVR in patients with severe aortic stenosis and different transvalvular flow state

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Laura Fusini ◽  
Manuela Muratori ◽  
Gloria Tamborini ◽  
Sarah Ghulam Ali ◽  
Paola Gripari ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Low Flow ◽  
Volume Index ◽  
Aortic Valve Area ◽  
Flow State ◽  
Flow Gradient

Abstract Aims Haemodynamic classifications of severe aortic stenosis (AS) have important prognostic implications, with low flow state (defined on the basis of a stroke volume index, SVi&lt;35 mL/m2) known to be a predictor of worse prognosis. As transcatheter aortic valve replacement (TAVR) has become widely used for patients with severe AS, issues were raised concerning its efficacy in patients with different haemodynamic classifications combining transvalvular flow state and pressure gradients. In fact, data on TAVR outcomes in patients with low gradient (LG) AS are limited and in some cases controversial. The aim of this study was to evaluate the efficacy and long-term clinical and echocardiographic outcome of TAVR in patients with different transvalvular flow-gradient patterns. Methods In this single centre study, 1078 patients (mean age 81±7 years) with severe symptomatic AS (AVA&lt;1 cm2) undergoing TAVR were categorized according to flow-gradient patterns as follow: 867 patients (80%) with normal flow-high gradient (NF-HG: mean transaortic gradient DP mean&gt;40 mmHg), 94 (9%) with paradoxical low flow LG (pLF-LG: DP mean&lt;40 mmHg, ejection fraction EF &gt; 50%, and SVi&lt;35 mL/m2), and 117 (11%) classical LF-LG (DP mean&lt;40 mmHg, EF &lt; 50%, SVi&lt;35 mL/m2). Results TAVR was feasible in all AS subtypes with similar rate of unsuccessful procedure (1.3% NF-HG, 1.1% pLF-LG, 0% LF-LG P=470). Valvular function after TAVR was excellent over time with respect to aortic pressure gradient (mean and peak) and aortic valve area regardless of flow state group (Figure A). Overall, intraoperative (P=957) and 30-day mortality (P=817) did not differ significantly among the 3 groups. Longer follow-up showed that, compared to NF-HG patients, pLF-LG had similar all-cause mortality rate [HR 1.35(0.95–1.90), P=0.094] up to 5 years and LF-LG had a significant higher mortality rate [HR 1.89(1.43–2.49), P&lt;0.001],(Figure B). Moreover, LF-LG patients had higher rehospitalization for heart failure (NF-HG: 3%, pLF-LG: 6%, LF-LG 10%, P=0.001). Conclusions We provided evidence that TAVR is an effective procedure in all patients with severe AS regardless of transvalvular flow-gradient patterns. A careful haemodynamic classifications of severe AS is of utmost importance for identifying patients who benefits the most from TAVR procedure.

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