scholarly journals Visit-to-Visit Blood PressureVariations and Hemodynamic Deterioration in Atherosclerotic Major Cerebral ArteryDisease

2022 ◽  
Vol 31 (1) ◽  
pp. 106206
Author(s):  
Hiroshi Yamauchi ◽  
Shinya Kagawa ◽  
Kuninori Kusano ◽  
Miki Ito ◽  
Chio Okuyama
Keyword(s):  
Hemodynamic Deterioration

Usefulness of Transesophageal Echocardiography in Patients With Hemodynamic Deterioration Late After Cardiac Surgery

CHEST Journal ◽  
1993 ◽  
Vol 104 (5) ◽  
pp. 1631-1632 ◽  
Author(s):  
Benny Schoebrechts ◽  
Maire-Christine Herregods ◽  
Frans Van de Werf ◽  
Hilaire De Geest
Keyword(s):  
Cardiac Surgery ◽  
Transesophageal Echocardiography ◽  
Hemodynamic Deterioration

Outcomes after Off-Pump Reoperative Coronary Artery Bypass Grafting

2007 ◽  
Vol 2 (1) ◽  
pp. 29-32 ◽  
Author(s):  
Cullen D. Morris ◽  
John D. Puskas ◽  
Sorin V. Pusca ◽  
Omar M. Lattouf ◽  
William A. Cooper ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Propensity Scores ◽  
Left Internal Mammary Artery ◽  
Artery Bypass ◽  
Retrospective Chart Review ◽  
Technical Difficulty ◽  
Off Pump ◽  
Intention To Treat ◽  
Hemodynamic Deterioration

Objective Application of off-pump techniques to reoperative coronary artery bypass (redo CABG) has been limited by technical difficulty and potential for embolism of atheromatous debris from diseased grafts, resulting in myocardial infarction and rapid hemodynamic deterioration. We compared outcomes after off-pump (OPCAB) and on-pump (ONCAB) in redo CABG. Methods A retrospective chart review was performed for patients who underwent redo CABG at a single academic institution between January 1997 and December 2004. Outcomes were compared between groups based on intention to treat. Propensity scores were calculated for each patient using 23 preoperative risk factors. Logistic regression was applied for each end point as a function of group and propensity score. Results A total of 771 consecutive patients had redo CABG (639 ONCAB and 132 OPCAB); 22 patients (16.7%) were converted from OPCAB to ONCAB for hemodynamic in stability, severe adhesions, or graft injury; 7 patients (1.1%) were converted from ONCAB to OPCAB for severe aortic calcification. Propensity-matched comparison of outcomes after OPCAB versus ONCAB for redo CABG showed that OPCAB was associated with a reduction in postoperative complications, transfusion, atrial fibrillation, and length of stay. OPCAB patients received fewer grafts with similar use of left internal mammary artery conduit; conversion from OPCAB to ONCAB did not reduce the benefit of OPCAB. Conclusions OPCAB can be safely and effectively applied to reoperative CABG in selected cases.

scholarly journals Surgical Repair of Post Infarction Ventricular Septal Rupture: An 18 Years’ Retrospective Multicenter Study

2021 ◽  
Author(s):  
Zohre Mohammadi ◽  
Masoud Majidi ◽  
Saman Rostambeigi ◽  
Parham Sadeghipour ◽  
Anahita Tatavoosi ◽  
...  
Keyword(s):  
Multicenter Study ◽  
Surgical Repair ◽  
Pressure Overload ◽  
Coronary Bypass ◽  
Annual Number ◽  
Consecutive Series ◽  
Ventricular Septal Rupture ◽  
Low Cardiac Output ◽  
Hemodynamic Deterioration ◽  
Acute Mi

Background: Ventricular Septal Rupture (VSR) is a rare but challenging complication after myocardial infarction (MI). In the presence of acute MI, volume and pressure overload lead to acute heart decompensation. The present study was designed to evaluate the early surgical outcome of VSR for over 18 years. Method: This multicenter study was done during 2000-2018, in which 99 patients with post-MI VSR were included. Results: The patients (n=11) presenting hemodynamic deterioration at the time of hospital admission, died before any attempt for surgery. A consecutive series of 88 patients with surgical repair of VSR was evaluated. The mean interval from MI to VSR diagnosis was 7.5±7.2 days and from admission to the operation was 5±5 days. VSR location did not influence the outcome (p=0.1). The concomitant coronary bypass was done for all patients; two-vessel disease was more prevalent (39%). Only 25 patients survived and left the hospital (13 patients died in the operating room due to the failure of pump weaning and 50 patients in the ICU due to low cardiac output). Predictors of poor prognosis included low ejection fraction (p=0.01), prolonged pump time (p=0.01), and operation in the second half of this period (p=002). Conclusion: Despite the improvement in perioperative management and cardiac surgery techniques, the perioperative mortality rate of VSR has remained high where the assist device is not accessible. We suggest VSR repair limited to certain centers with adequate experiences because of the low average annual number.

Anesthesia

2019 ◽  
pp. 175-187
Author(s):  
Christopher J. Plambeck ◽  
Michael K. Loushin ◽  
Michael F. Sweeney
Keyword(s):  
Anesthetic Management ◽  
Preoperative Evaluation ◽  
Management Plan ◽  
Left Ventricular ◽  
Care Providers ◽  
Anesthetic Care ◽  
Ventricular Assist ◽  
Hemodynamic Deterioration ◽  
Left Ventricular Assist ◽  
Post Cardiopulmonary Bypass

The anesthetic care of the left ventricular assist device (LVAD) recipient presents to the anesthesiologist a unique set of challenges which must be skillfully managed for the successful completion of this complex surgical procedure. The anesthesiologist must perform a thorough preoperative evaluation and carefully assess the patient’s cardiovascular, pulmonary, renal, and hepatic systems. Special consideration to the risk of post-implantation right ventricular (RV) dysfunction is critical. In patients with advanced heart failure, a well-formulated anesthetic management plan must be developed to provide adequate anesthesia while at the same time preventing hemodynamic deterioration. The performance of a comprehensive transesophageal echocardiogram study is essential for identifying potential issues that may need to be addressed during the surgery. The post-cardiopulmonary bypass period is fraught with several challenges which the anesthesiologist must address, such as RV dysfunction or failure, vasoplegia, and coagulopathy. The transition of care to the ICU is facilitated by the application of a standardized checklist to ensure that all critical information is conveyed to the critical care providers. The anesthesiologist also frequently provides care for the LVAD patient undergoing a non-cardiac surgery or procedure. A careful preoperative evaluation and a thorough understanding of the technology and physiology of the LVAD patient is essential to the development of a safe and sensible anesthetic management plan.

Heart failure: update on treatment and prognosis

2001 ◽  
Vol 10 (4) ◽  
pp. 285-293 ◽  
Author(s):  
LG Futterman ◽  
L Lemberg
Keyword(s):  
Beta Blockers ◽  
Left Ventricular ◽  
The Body ◽  
Fine Tuning ◽  
Significant Advance ◽  
Aldosterone Antagonists ◽  
Exercise Regimen ◽  
Hemodynamic Deterioration ◽  
Common Diagnosis ◽  
End Stage

HF is a prevalent and debilitating disease, affecting nearly 5 million patients and perhaps an equal number with asymptomatic left ventricular dysfunction who are at high risk of atrial fibrillation developing. An estimated 550,000 new cases occur every year. HF is the most common diagnosis in hospitalized patients aged 65 and over and is a major cause of death. The median survival after onset is 1.7 years in men and 3.2 years in women. The majority of cardiac deaths in patients with HF are sudden and arrhythmogenic: the rest are due to progressive hemodynamic deterioration. A significant advance in the past decade has been the recognition of the importance of inhibiting the neurohormonal action in HF with the use of beta-blockers, angiotensin receptor, and aldosterone antagonists. In addition, a new concept in HF therapy has evolved. The view that chronic HF is an irreversible, end-stage process is being supplanted by the fact that it is possible to effect biological improvement in the intrinsic defects of function and structure in hearts afflicted with chronic HF. Reversibility of HF has been reported by (1) unloading the failing heart using an LVAD, (2) the sophisticated use of diuretic combinations and neurohormonal blocking drugs, or (3) employing continuous arteriovenous hemofiltration. Thus it is now possible to reverse a process that has long been considered irreversible. Exercise programs designed for patients with HF that have been advocated recently can be difficult to apply. Fine tuning of an exercise regimen is required because a reduction in cardiac work is mandatory when treating HF, where the concern is that the heart may not be capable of supplying the metabolic needs of the body, even in resting states. Finally, although not emphasized in the recent literature on HF, the use of diuretics and sodium restriction continue to be the mainstays of therapy without which compensation of HF is not possible.

scholarly journals Cardiac Catheterization versus Echocardiography for Monitoring Pulmonary Pressure: A Prospective Study in Patients with Connective Tissue Disease-Associated Pulmonary Arterial Hypertension

Diagnostics ◽  
2020 ◽  
Vol 10 (1) ◽  
pp. 49
Author(s):  
Vasiliki Kalliopi Bournia ◽  
Iraklis Tsangaris ◽  
Loukianos Rallidis ◽  
Dimitrios Konstantonis ◽  
Frantzeska Frantzeskaki ◽  
...  
Keyword(s):  
Pulmonary Arterial Hypertension ◽  
Connective Tissue ◽  
Arterial Hypertension ◽  
Negative Predictive Value ◽  
Connective Tissue Disease ◽  
Cardiac Catheterization ◽  
Predictive Value ◽  
Hemodynamic Deterioration ◽  
Pulmonary Arterial

Standard echocardiography is important for pulmonary arterial hypertension (PAH) screening in patients with connective tissue disease (CTD), but PAH diagnosis and monitoring require cardiac catheterization. Herein, using cardiac catheterization as reference, we tested the hypothesis that follow-up echocardiography is adequate for clinical decision-making in these patients. We prospectively studied 69 consecutive patients with CTD-associated PAH. Invasive baseline pulmonary artery systolic pressure (PASP) was 60.19 ± 16.33 mmHg (mean ± SD) and pulmonary vascular resistance (PVR) was 6.44 ± 2.95WU. All patients underwent hemodynamic and echocardiographic follow-up after 9.47 ± 7.29 months; 27 patients had a third follow-up after 17.2 ± 7.4 months from baseline. We examined whether clinically meaningful hemodynamic deterioration of follow-up catheterization-derived PASP (i.e., > 10% increase) could be predicted by simultaneous echocardiography. Echocardiography predicted hemodynamic PASP deterioration with 59% sensitivity, 85% specificity, and 63/83% positive/negative predictive value, respectively. In multivariate analysis, successful echocardiographic prediction correlated only with higher PVR in previous catheterization (p = 0.05, OR = 1.235). Notably, in patients having baseline PVR > 5.45 WU, echocardiography had both sensitivity and positive predictive values of 73%, and both specificity and negative predictive value of 91% for detecting hemodynamic PASP deterioration. In selected patients with CTD-PAH echocardiography can predict PASP deterioration with high specificity and negative predictive value. Additional prospective studies are needed to confirm that better patient selection can increase the ability of standard echocardiography to replace repeat catheterization.

Grafts for Left Main Trunk Lesion Using “MIDCAB Doughnut” on Beating Heart

2000 ◽  
Vol 8 (2) ◽  
pp. 114-117 ◽  
Author(s):  
Masao Takahashi ◽  
Go Watanabe ◽  
Hidetoshi Furuta ◽  
Toshio Doi ◽  
Nobuyuki Tanaka ◽  
...  
Keyword(s):  
Blood Flow ◽  
Internal Thoracic Artery ◽  
Axillary Artery ◽  
Beating Heart ◽  
Left Main ◽  
Main Trunk ◽  
Left Main Trunk ◽  
Hemodynamic Deterioration ◽  
Obtuse Marginal Branch ◽  
Obtuse Marginal

Successful beating heart multiple bypass grafting to the left anterior descending and circumflex artery for a left main trunk lesion was performed in 5 patients through a left thoracotomy using the “MIDCAB doughnut” for immobilization and hemostasis. After completion of left internal thoracic artery-to-left anterior descending artery grafting, a radial artery or saphenous vein graft was anastomosed safely to the obtuse marginal branch, without hemodynamic deterioration. Extending the left anterior small thoracotomy 3 or 4 cm laterally, the obtuse marginal branch could be approached easily without rotating the beating heart. The device achieved a still and stable operative field even for circumflex grafting. An inflow of the graft to the circumflex was placed at the left axillary artery to prevent blood flow shortage to the left coronary system. Mean perioperative blood flow was 29.5 ± 7.1 mL·min−1 in the internal thoracic artery grafts and 43 ± 8 mL·min−1 in the circumflex grafts. Postoperative angiography revealed patency of all grafts. The technique may extend the surgical indications for beating heart bypass surgery without cardiopulmonary bypass.

scholarly journals Circuit Determinants of Ventricular Tachycardia Cycle Length: Characterization of Fast and Unstable Human VT

Circulation ◽  
2020 ◽  
Author(s):  
Takuro Nishimura ◽  
Gaurav A. Upadhyay ◽  
Zaid A. Aziz ◽  
Andrew D. Beaser ◽  
Dalise Y. Shatz ◽  
...  
Keyword(s):  
High Resolution ◽  
Cycle Length ◽  
Wide Spectrum ◽  
Common Pathway ◽  
Outer Loop ◽  
Hemodynamic Deterioration ◽  
Wide Range ◽  
Pathway Length ◽  
Intrinsic Mean ◽  
Complete Circuit

Background: Fast ventricular tachycardias (VTs) have been historically attributed to shorter path lengths with smaller reentrant circuit dimensions in animal models. The relationship between the dimensions of the reentrant VT circuit and tachycardia cycle length (TCL) has not been examined in humans. This study aimed to analyze the determinants of the rate of human VT with comparison of circuit dimensions and conduction velocity (CV) across a wide range of both stable and unstable VTs delineated by high-resolution mapping. Methods: 54 VTs with complete circuit delineation (>90% TCL) by high-resolution multielectrode mapping were analyzed in 49 patients (male 88%, 65 years [58-71], nonischemic 47%). Fast VT was defined as TCL <333 ms (rate >180 bpm). Unstable VT was defined by hemodynamic deterioration with an intrinsic mean arterial pressure <60 mmHg during a sustained episode. Results: The median TCL of VT was 365 ms (306-443 ms) and 24 fast VTs with TCL<333ms (180 bpm) were characterized. A wide range of CV was observed within the entrance (0.03-0.55 m/s), common pathway (0.03-0.77 m/s), exit (0.03-0.53m/s), and outer loop (0.17-1.13 m/s). There were no significant differences in the median dimensions of the isthmus and path length between fast versus slow VTs and unstable versus stable VTs. The outer loop CV was the only circuit component that correlated with TCL both in ischemic cardiomyopathy (r=-0.5, p=0.006) and nonischemic cardiomyopathy(r=-0.45, p=0.028). The duration of the longest diastolic electrogram was inversely correlated with the dimensions of common pathway (length: r=-0.46, p=0.001, width: r=-0.3, p=0.047) and predictive of VT termination by a single radiofrequency application (r=-0.41, p=0.023). Conclusions: Due to a wide spectrum of CV observed within the reentrant path during human VT, the dimensions of the circuit were not predictive of VT cycle length. For the first time, we demonstrate that the CV of the outer loop, rather than isthmus, is the principal determinant of the rate of VT. The size of the circuit was similar between fast versus slow VTs and unstable versus stable VTs. Long, continuous electrograms were indicative of spatially confined isthmus dimensions, confirmed by rapid termination of VT during radiofrequency delivery.

Sign in / Sign up

Export Citation Format

Share Document