The Obstetric Patient for Cardiac Surgery

2019 ◽  
pp. 335-340
Author(s):  
Lauren Powlovich ◽  
Amanda M. Kleiman
Keyword(s):  
Heart Failure ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Cardiac Disease ◽  
Medical Management ◽  
Heart Defects ◽  
Pregnant Patient ◽  
Developed Countries ◽  
Peripartum Hemorrhage ◽  
In Pregnancy

Cardiac disease is the second leading cause of morbidity and mortality in pregnancy behind peripartum hemorrhage. In developed countries, a majority of cardiac disease in pregnancy is secondary to congenital heart defects, whereas in developing countries, mitral stenosis secondary to rheumatic fever prevails as the leading cause of cardiac disease during pregnancy. There is added workload on the heart during pregnancy due to the increased blood volume and cardiac output of the parturient. In patients with preexisting cardiac disease, this added workload may lead to decompensated congestive heart failure. Alternatively, such physiologic changes may unmask an unknown cardiac lesion in an unsuspecting patient. Medical management is always the first-line treatment of the pregnant patient with decompensated heart failure. However, if medical management has failed, cardiac surgery with cardiopulmonary bypass may be necessary. Due to the unique maternal physiology and the presence of not only one but also two patients, anesthesia, cardiac surgery, and cardiopulmonary bypass come with specific challenges, hemodynamic goals, and ethical dilemmas.

scholarly journals Vasoresponsiveness in patients with heart failure (VASOR): protocol for a prospective observational study

2019 ◽  
Vol 14 (1) ◽  
Author(s):  
Marieke E. van Vessem ◽  
Saskia L. M. A. Beeres ◽  
Rob B. P. de Wilde ◽  
René de Vries ◽  
Remco R. Berendsen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Observational Study ◽  
Vascular Reactivity ◽  
Prospective Observational Study ◽  
Ex Vivo ◽  
Phase 1 ◽  
Resistance Arteries ◽  
Patients With Heart Failure

Abstract Background Vasoplegia is a severe complication which may occur after cardiac surgery, particularly in patients with heart failure. It is a result of activation of vasodilator pathways, inactivation of vasoconstrictor pathways and the resistance to vasopressors. However, the precise etiology remains unclear. The aim of the Vasoresponsiveness in patients with heart failure (VASOR) study is to objectify and characterize the altered vasoresponsiveness in patients with heart failure, before, during and after heart failure surgery and to identify the etiological factors involved. Methods This is a prospective, observational study conducted at Leiden University Medical Center. Patients with and patients without heart failure undergoing cardiac surgery on cardiopulmonary bypass are enrolled. The study is divided in two inclusion phases. During phase 1, 18 patients with and 18 patients without heart failure are enrolled. The vascular reactivity in response to a vasoconstrictor (phenylephrine) and a vasodilator (nitroglycerin) is assessed in vivo on different timepoints. The response to phenylephrine is assessed on t1 (before induction), t2 (before induction, after start of cardiotropic drugs and/or vasopressors), t3 (after induction), t4 (15 min after cessation of cardiopulmonary bypass) and t5 (1 day post-operatively). The response to nitroglycerin is assessed on t1 and t5. Furthermore, a sample of pre-pericardial fat tissue, containing resistance arteries, is collected intraoperatively. The ex vivo vascular reactivity is assessed by constructing concentrations response curves to various vasoactive substances using isolated resistance arteries. Next, expression of signaling proteins and receptors is assessed using immunohistochemistry and mRNA analysis. Furthermore, the groups are compared with respect to levels of organic compounds that can influence the cardiovascular system (e.g. copeptin, (nor)epinephrine, ANP, BNP, NTproBNP, angiotensin II, cortisol, aldosterone, renin and VMA levels). During inclusion phase 2, only the ex vivo vascular reactivity test is performed in patients with (N = 12) and without heart failure (N = 12). Discussion Understanding the difference in vascular responsiveness between patients with and without heart failure in detail, might yield therapeutic options or development of preventive strategies for vasoplegia, leading to safer surgical interventions and improvement in outcome. Trial registration The Netherlands Trial Register (NTR), NTR5647. Registered 26 January 2016.

Optimizing response of the neonate and infant to cardiopulmonary bypass

2005 ◽  
Vol 15 (S1) ◽  
pp. 142-148 ◽  
Author(s):  
Ross M. Ungerleider
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Heart Defects ◽  
Normal Anatomy ◽  
Complete Repair ◽  
Innovative Techniques

The evolution of cardiac surgery has led to increasing emphasis on complete repair of congenital heart defects early in life, nowadays increasingly performed in neonates or small infants. Good results have been achieved because of innovative techniques permitting reconstruction of normal anatomy, and restoration of normal physiology, before either the heart or the patient undergo deleterious adaptation to the congenitally abnormal physiology. Despite the ability surgically to correct complex defects in such small patients, limitations in outcome are sometimes encountered related to the systems necessary for repair. In particular, exposure to cardiopulmonary bypass may present the greatest challenge for these tiny patients.

Acute Kidney Injury in Children Undergoing Correction of Congenital Heart Disease

2011 ◽  
Vol 140 ◽  
pp. 84-90
Author(s):  
Yu Qing Jiao ◽  
Geng Xu Zhou ◽  
Jian Ping Huang ◽  
Xiao Yang Hong ◽  
Xue Yong Yang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Acute Kidney Injury ◽  
Regression Analysis ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Blood Cell ◽  
Cardiac Disease ◽  
Kidney Injury ◽  
Red Blood Cell Transfusion ◽  
Congenital Cardiac Disease

Objective To assess risk factors of acute kidney injury in congenital cardiac disease following cardiac surgery with cardiopulmonary bypass in children. Methods A 50% postoperative creatinine increase was regarded as the criterion of acute kidney injury. 124 children aged 3 years or little undergoing cardiac surgery were divided into three groups: (1) negative AKI (-); (2) AKI (+) with an increase in postoperative creatinine from 150% to 200%; and (3) AKI (++) with an increase in postoperative creatinine by more than 200%. Demographics, and preoperative, intraoperative, and postoperative variables were evaluated for associations with AKI using univariate and multiple logistic regression analysis. Results Several variables, including mortality, preoperative albumin and creatinine levels, cardiopulmonary bypass duration, and postoperative creatinine levels, were significant differences among the three groups (P < 0.05). Multiple regression analysis demonstrated that three risk factors, age (OR, 0.962; 95% CI, 0.925 to 1.000; P = 0.046), intraoperative red blood cell transfusion (OR, 1.003; 95% CI, 1.001 to 1.005; P = 0.030), and cardiopulmonary bypass duration (OR, 1.024; 95% CI, 1.016 to 1.032; P = 0.000) were independently associated with AKI after cardiac surgery. Conclusions This study showed that younger age, incremental intraoperative red blood cell transfusion, and prolonged cardiopulmonary bypass duration were independently associated with acute kidney injury after cardiac surgery. The type of congenital cardiac disease should be included in the analysis of acute kidney injury.

scholarly journals The level of Brain natriuretic Peptide as a Predictor of the Postoperative Period at Operations with Artificial Blood circulation

2019 ◽  
Vol 3 (6) ◽  
pp. 114-120
Author(s):  
Yu. A. Bakhareva ◽  
Z. Z. Nadiradze ◽  
A. V. Muravskaya
Keyword(s):  
Heart Failure ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Natriuretic Peptide ◽  
Postoperative Period ◽  
Perioperative Period ◽  
Early Postoperative Period ◽  
Results Of Treatment ◽  
Rate Of Increase ◽  
High Level

The level of natriuretic peptide is regarded as a prognostic predictor of postoperative heart failure in modern cardiac surgery, and moreover, this hormone is included in the standards of its early diagnosis around the world. This study was conducted at the Irkutsk Cardiac Surgery Center. The results of treatment of 78 patients were analyzed in order to determine the relationship between the dynamics of brain natriuretic peptides and the course of the early postoperative period in operations with artificial cardiopulmonary bypass. Patients were divided into three groups according to the level of natriuretic peptide elevation in the postoperative period. The study proved the dependence of the postoperative period on the multiplicity of the increase in the level of natriuretic peptide B-type.It was found that the higher the rate of increase in the hormone, the lower the numbers of the cardiac index in the postoperative period, longer duration of inotropic support (p > 0.05) and higher doses of adrenomimetics (p > 0.05). The duration of mechanical ventilation was also longer in the groups where a high level of natriuretic peptide was recorded (p > 0.05). Thus, the multiplicity of natriuretic peptide elevation can be a prognostic criterion for the postoperative period in cardiac patients. It is important to note that a single determination of the level of natriuretic peptide should not be used as a marker of postoperative heart failure and this study confirmed the necessity to monitor the dynamics of brain natriuretic peptide’s level in the perioperative period in patients operated with extracorporeal cardiopulmonary bypass.

Cardiovascular Disease in Pregnancy

2019 ◽  
Author(s):  
Lindsay E Emerick ◽  
Michael R Foley
Keyword(s):  
Cardiovascular Disease ◽  
Cardiovascular System ◽  
Cardiac Disease ◽  
Congenital Heart ◽  
Heart Diseases ◽  
Tertiary Care ◽  
Developed Countries ◽  
The United States ◽  
Team Approach ◽  
In Pregnancy

Cardiovascular disease in pregnancy is present in 0.1 to 4.0% of those in developed countries and 0.6% in developing countries. It accounts for 18% of ICU admissions in the United States. The incidence is increasing due to increases in obesity, hypertensive diseases, advanced maternal age, and repair of complex congenital heart diseases. The physiologic changes to the cardiovascular system lead to a state of high flow and low resistance in pregnancy. This causes physical exam findings that mimic cardiac disease in pregnancy, making the diagnosis, treatment, and management of cardiac disease even more difficult for clinicians. Each cardiac disease poses unique risks and potential complications during pregnancy, labor, delivery, and postpartum. Preconception counseling, complete understanding of physiologic changes to the cardiovascular system during pregnancy, multidisciplinary team approach, and delivery in a tertiary care center are the keys to the successful management of patients with cardiac disease in pregnancy. This review contains 4 figures, 6 tables, and 45 references.  Key Words: aortic stenosis, cardiac disease, cardiac risk assessment, congenital heart disease, endocarditis prophylaxis, Marfan syndrome, mechanical valve, mitral stenosis, pregnancy, pulmonary arterial hypertension

scholarly journals Influence of the type of congenital heart defects on epithelial lining fluid composition in infants undergoing cardiac surgery with cardiopulmonary bypass

2018 ◽  
Vol 83 (4) ◽  
pp. 791-797 ◽  
Author(s):  
Manuela Simonato ◽  
Aldo Baritussio ◽  
Virgilio P Carnielli ◽  
Luca Vedovelli ◽  
Gianclaudio Falasco ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Congenital Heart Defects ◽  
Congenital Heart ◽  
Heart Defects ◽  
Fluid Composition ◽  
Epithelial Lining ◽  
Epithelial Lining Fluid

scholarly journals Anticoagulation with Argatroban in a Patient with Heparin-Induced Thrombocytopenia and Renal Insufficiency Undergoing Orthotopic Heart Transplantation

2021 ◽  
Vol 2021 ◽  
pp. 1-3
Author(s):  
Michael Stuart Green ◽  
Johann Mathew ◽  
Christopher Ryan Hoffman ◽  
Henry Liu
Keyword(s):  
Heart Failure ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Heart Transplantation ◽  
Decompensated Heart Failure ◽  
Orthotopic Heart Transplantation ◽  
Clinical Use ◽  
Heparin Induced Thrombocytopenia ◽  
Advantages And Disadvantages ◽  
Immune Mediated

Unfractionated heparin is the anticoagulant of choice for cardiac surgery that requires cardiopulmonary bypass. However, it can cause serious side effects like heparin-induced thrombocytopenia (HIT), an immune-mediated process where antibodies are directed against heparin and platelet 4 complexes. In such cases, alternative pharmacologic strategies are implemented to facilitate safe bypass conditions. A woman with severe decompensated heart failure was heparinized for intra-aortic balloon pump and subsequent LVAD placement. On day 6, a fall in platelets from 113,000 to 26,000 was noted. She was diagnosed with HIT. Heparin was discontinued and replaced with an argatroban infusion for the duration of her care until heart transplantation was completed. We review the mechanism, diagnosis, and complications of HIT. We discuss cardiopulmonary bypass and its relation to heparin, HIT, and heparin alternatives. We discuss argatroban’s relevant pharmacology, clinical use, advantages, and disadvantages.

Abstract 15823: Diminished Vasoresponsiveness in Patients With Heart Failure

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Olga Papazisi ◽  
Marieke E van Vessem ◽  
Saskia L Beeres ◽  
Rob B de Wilde ◽  
Remco R Berendsen ◽  
...  
Keyword(s):  
Heart Failure ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Clinical Outcome ◽  
Prospective Observational Study ◽  
Independent Predictor ◽  
Medical Center ◽  
Vascular Response ◽  
Patients With Heart Failure ◽  
Vascular Responsiveness

Introduction: Vasoplegia is a severe complication after cardiac surgery and is associated with impaired clinical outcome. Pre-operative heart failure (HF) is considered an independent predictor of post-operative vasoplegia. We hypothesize that HF patients are more susceptible to vasoplegia due to altered vascular responsiveness. In this study, vasoresponsiveness in patients undergoing cardiac surgery for HF is investigated. Methods: A prospective, observational study was conducted at Leiden University Medical Center. We included patients with HF (N=18) and without HF (N=18) who underwent cardiac surgery on cardiopulmonary bypass. Vasoresponsiveness was assessed at 4 different timepoints: 1) before induction, 2) after induction, 3) after cessation of cardiopulmonary bypass and 4) on the first postoperative day. The vascular response was recorded as change in systemic vascular resistance (SVR) after the administration of phenylephrine (bolus 2 μg/kg). Results: Thirty-six patients were included [67 (61-71) years, 78% male]. Vascular responsiveness was significantly attenuated in patients with HF compared to controls. The response to phenylephrine was already diminished at baseline in HF patients and was almost abolished after cessation of cardiopulmonary bypass (Figure). Roughly the same pattern of vasoresponsiveness was found when excluding patients that received norepinephrine. Moreover, HF patients required a significantly higher amount of noradrenaline [169.80 (IQR 14.77-318.97) ug/kg] compared to controls [3.61 (IQR 0-41.60) ug/kg] to maintain similar SVR during the first 24h postoperatively. Conclusions: The vascular responsiveness is altered in patients with HF and this might explain the higher prevalence of vasoplegia in this patient population.

scholarly journals Cardiac Drugs in Pregnancy

2018 ◽  
Vol 03 (02/03) ◽  
pp. 155-160
Author(s):  
Donepudi Aruna ◽  
Mekala Padmaja
Keyword(s):  
Heart Failure ◽  
Heart Disease ◽  
Cardiac Disease ◽  
Signs And Symptoms ◽  
Cardiac Lesions ◽  
Changes In Pregnancy ◽  
Pedal Edema ◽  
Physiologic Changes Of Pregnancy ◽  
Rheumatic Heart ◽  
In Pregnancy

AbstractHeart disease complicating pregnancy is an indirect cause of maternal mortality and its incidence in India is 1 to 4%. Cardiac disease in pregnant women is most commonly due to rheumatic heart disease (RHD), congestive heart failure, and less commonly due to ischemic heart disease or cardiomyopathy. Though the frequency of RHD has decreased worldwide, it is still predominant in developing countries such as India. Around 15 to 52% of cardiac abnormalities first diagnosed during routine antenatal checkups or due to the signs and symptoms caused by physiologic changes of pregnancy. The most common clinical features of cardiac lesions such as breathlessness, pedal edema, and murmurs that mimic normal physiologic changes in pregnancy pose a diagnostic difficulty for obstetricians.

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