Intracaval Leiomyoma with Intracardiac Extension

AbstractThe objective of this study was to explain step by step how to achieve a complete resection of an intravascular leiomyoma. A 48-year-old woman was referred to our institution with progressive dyspnea on exertion, lightheadedness, and previous history of total abdominal hysterectomy and bilateral salpingo-oophorectomy for a uterine leiomyoma echocardiography, computed tomography, and magnetic resonance imaging of the heart and abdomen/pelvis were performed and an intracaval mass with extension into the right heart and pulmonary artery was identified. After multidisciplinary review, a single-stage sternotomy–laparotomy procedure on cardiopulmonary bypass (with beating heart, mild hypothermia, and no deep hypothermic circulatory arrest) ensured complete resection of a giant intravenous leiomyoma (IVL). Multidisciplinary approach, multimodality imaging, and single-stage sternotomy–laparotomy procedure on cardiopulmonary bypass (with heart beating and mild hypothermia) ensure complete resection of IVL.

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Myocardial performance and hemodynamics after cardiopulmonary bypass and deep hypothermic circulatory arrest in neonatal piglets

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0029-1191530 ◽

2009 ◽

Vol 56 (S 01) ◽

Author(s):

T Tirilomis ◽

L Nolte ◽

OJ Liakopoulos ◽

K Steinke ◽

M Bensch ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Circulatory Arrest ◽

Deep Hypothermic Circulatory Arrest ◽

Hypothermic Circulatory Arrest ◽

Myocardial Performance ◽

Neonatal Piglets

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A cardiopulmonary bypass strategy to support a patient with vein of Galen malformation

Perfusion ◽

10.1177/02676591211001534 ◽

2021 ◽

pp. 026765912110015

Author(s):

Alex Robertson ◽

Nagarajan Muthialu ◽

Mike Broadhead

Keyword(s):

Cardiopulmonary Bypass ◽

Surgical Repair ◽

Circulatory Arrest ◽

Ductus Arteriosus ◽

Venous Drainage ◽

Deep Hypothermic Circulatory Arrest ◽

Vein Of Galen ◽

Vein Of Galen Malformation ◽

Neurological Sequelae ◽

Ph Stat

We present a dissection of the patent ductus arteriosus and pulmonary artery for surgical repair utilising cardiopulmonary bypass in the setting of vein of Galen malformation. Several strategies were employed to attenuate the cerebral shunt including pH-stat, high cardiac index, restrictive venous drainage, continuous ventilation and deep hypothermic circulatory arrest. The patient recovered from surgery with no apparent neurological sequelae.

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Results of using cardiopulmonary bypass for spinal cord protection during surgical repair of complex aortic coarctation

Cardiology in the Young ◽

10.1017/s1047951113000115 ◽

2013 ◽

Vol 24 (1) ◽

pp. 113-119 ◽

Cited By ~ 4

Author(s):

Stany Sandrio ◽

Matthias Karck ◽

Matthias Gorenflo ◽

Tsvetomir Loukanov

Keyword(s):

Spinal Cord ◽

Cardiopulmonary Bypass ◽

Aortic Arch ◽

Aortic Coarctation ◽

Mild Hypothermia ◽

Circulatory Arrest ◽

Main Pulmonary Artery ◽

Neurologic Complication ◽

Spinal Cord Protection ◽

Age Range

AbstractBackgroundThe aim of this study was to evaluate the surgical treatment of complex aortic coarctation using partial cardiopulmonary bypass to increase the spinal cord protection.MethodsA total of 15 patients (age range from 7 to 48 years) underwent coarctation repair through a left posterolateral thoracotomy with cardiopulmonary bypass. Cannulation was performed via the descending aorta and the main pulmonary artery. In all, six surgeries were performed under hypothermic circulatory arrest and nine repairs were performed under mild hypothermia. The clinical outcome regarding the development of restenosis, as well as major neurologic complication, was studied.ResultsThere was no mortality. None of the patients developed paraplegia. Of the 15 patients, two developed a recurrent stenosis at the proximal anastomosis between the aortic arch and the aortic prothesis at a mean follow-up of 5.5 years. In the remaining 13 patients, echocardiography and magnetic resonance imaging showed no evidence of a significant gradient.ConclusionComplex aortic coarctation without hypoplasia of the proximal aortic arch and intra-cardiac anomalies can be repaired with low mortality and neurologic morbidity via a left thoracotomy using cardiopulmonary bypass. The use of cardiopulmonary bypass goes along with a low risk of spinal cord and lower body ischaemia and provides a sufficient amount of time for the anastomoses.

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Acid-base Management in Cardiopulmonary Bypass

JAI (Jurnal Anestesiologi Indonesia) ◽

10.14710/jai.v0i0.32404 ◽

2021 ◽

Vol 13 (2) ◽

pp. 134-143

Author(s):

Sonny Lesmana Surya ◽

Yudi Hadinata

Keyword(s):

Cardiopulmonary Bypass ◽

Cerebral Perfusion ◽

Circulatory Arrest ◽

Deep Hypothermic Circulatory Arrest ◽

Selective Cerebral Perfusion ◽

Acid Base ◽

Cerebral Dysfunction ◽

Base Management ◽

Ph Stat

Cardiopulmonary bypass (CPB) merupakan alat penunjang fungsi sirkulasi dan pernapasan pasien yang biasa digunakan ketika menjalani pembedahan jantung atau pembuluh darah besar. Selama prosedur CPB, kondisi hipotermia dipertahankan untuk menurunkan kebutuhan oksigen dan laju metabolisme. Kondisi hipotermia akan mempengaruhi keseimbangan asam-basa pada tubuh. Manajemen asam-basa selama prosedur CPB dicapai dengan menggunakan metode a-stat atau pH-stat. Pada metode a-stat, manajemen asam-basa dilakukan dengan menjaga pHa 7.4 dan PaCO2 40 mmHg pada suhu 37oC tanpa penambahan CO2 oksigen untuk menjaga total CO2 tetap konstan. Sedangkan, pada metode pH-stat, diberikan CO2 oksigen untuk menjaga PaCO2 40 mmHg dan pHa 7.4 secara in vivo. Masih banyak perdebatan terkait waktu penerapan masing-masing metode. Pada level mikrosirkulasi, manajemen a-stat terbukti memberikan keuntungan pada otak dan mengurangi insidensi postoperative cerebral dysfunction. Sedangkan, metode pH-stat dilaporkan meningkatkan risiko emboli otak, sehingga tidak disarankan untuk pasien yang memiliki risiko tinggi gangguan aliran darah otak. Namun, terdapat pula laporan yang menyatakan pH-stat bermanfaat pada operasi bedah jantung anak. Berdasarkan hal itu, usia pasien dapat menentukan waktu penggunaan metode a-stat dan pH-stat. Satu indikasi primer penggunaan pH-stat adalah selama proses pendinginan saat deep hypothermic circulatory arrest (DHCA), sedangkan metode a-stat lebih baik digunakan selama selective cerebral perfusion (SCP) dan rewarming.

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Successful outcome of placenta previa percreta with bladder invasion

Bangabandhu Sheikh Mujib Medical University Journal ◽

10.3329/bsmmuj.v10i2.31923 ◽

2017 ◽

Vol 10 (2) ◽

pp. 93

Author(s):

Syeda Sayeeda ◽

Nahreen Akhter ◽

Firoza Begum ◽

Sajid Hasan

Keyword(s):

Coming Out ◽

Placenta Previa ◽

Blood Clot ◽

Previous History ◽

Total Abdominal Hysterectomy ◽

Abdominal Hysterectomy ◽

Watery Diarrhoea ◽

Successful Outcome ◽

Low Grade ◽

Bladder Irrigation

<p>A 41 year old multiparous lady, with previous history of one cesarean section presented at her 24 weeks of gestation with frank hematuria. The case was diagnosed as placenta previa percreta with the bladder involvement by ultrasound doppler and confirmed by MR urogram. So, peripartum hysterectomy was planned. On opening of the abdomen, a hugely distended bladder was found, which when retracted engorged blood vessels were found over the lower segment of uterus. Baby was delivered by giving a transverse incision in the upper segment. By keeping placenta in situ, total abdominal hysterectomy was done with quick successive clamping. Severe per-operative bleeding was occurred. Bladder irrigation started following total abdominal hysterectomy. Continuous small clots were coming out through catheter. A large old blood clot was removed by cystostomy done by an urologist. A sprouting vessel and a linear injury were noticed at the base of the bladder. The vessel was ligated and the injury was repaired. After proper hemostasis, the abdomen was closed in layers. The patient was shifted to ICU. Patient developed complications like MI, watery diarrhoea, low grade fever which was managed accordingly. She was discharged healthy on her 19th post-operative day.</p>

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Results with continuous cardiopulmonary bypass for the bidirectional cavopulmonary anastomosis

Cardiology in the Young ◽

10.1017/s104795110800200x ◽

2008 ◽

Vol 18 (2) ◽

pp. 147-152 ◽

Cited By ~ 5

Author(s):

Robroy H. MacIver ◽

Robert D. Stewart ◽

Carl L. Backer ◽

Constantine Mavroudis

Keyword(s):

Cardiopulmonary Bypass ◽

Circulatory Arrest ◽

Deep Hypothermic Circulatory Arrest ◽

Moderate Hypothermia ◽

Absorbable Sutures ◽

Cavopulmonary Anastomosis ◽

Postoperative Length ◽

The Mean ◽

Bidirectional Cavopulmonary Anastomosis ◽

Cardiac Operations

AbstractObjectiveSome centres have proposed creating the bidirectional cavopulmonary anastomosis without cardiopulmonary bypass, while others continue to use deep hypothermic circulatory arrest. The purpose of this review is to evaluate the results of using continuous cardiopulmonary bypass with moderate hypothermia, perhaps the most commonly used of the three techniques for this procedure.MethodsBetween 1990 and 2005, 114 patients, having a mean age of 1.58 years, with a median age of 8 months, and ranging from 3 months to 16 years, underwent creation of either a unilateral cavopulmonary anastomosis, in 94 cases, or bilateral anastomoses in 20 cases. All had continuous cardiopulmonary bypass with moderate hypothermia at 32 degrees Celsius, with 24 also having aortic cross-clamping with cardioplegia for simultaneous intracardiac procedures. Interrupted absorbable sutures were used to create the anastomosis in 105 patients.ResultsPerioperative mortality was 5%, with 6 of the patients dying. The mean period of cardiopulmonary bypass for an isolated anastomosis was 91 minutes, with a range from 44 to 160 minutes. In 10 patients (8.8%), it was necessary to place a graft to augment the anastomosis. The average postoperative length of stay was 7.9 days for those undergoing an isolated unilateral anastomosis, and 16.4 days for patients undergoing combined cardiac operations. We have now created the Fontan circulation in 79 of the patients, at an average interval from the bidirectional cavopulmonary anastomosis of 2.1 plus or minus 1.14 years. In 76 patients, we performed postoperative angiograms, and none revealed any stenoses.ConclusionsThe bidirectional cavopulmonary anastomosis can be performed successfully with continuous cardiopulmonary bypass and moderate hypothermia with a beating heart, avoiding circulatory arrest. The use of interrupted and absorbable sutures was not associated with any late anastomotic stenosis.

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