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

Perfusion ◽  
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.

Acid-base Management in Cardiopulmonary Bypass

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.

A novel augmented venous-drainage model of cardiopulmonary bypass for deep hypothermic circulatory arrest without blood priming

Perfusion ◽  
2017 ◽  
Vol 33 (4) ◽  
pp. 297-302 ◽  
Author(s):  
Xuan Jiang ◽  
Tianxiang Gu ◽  
Yu Liu ◽  
Chun Wang ◽  
Enyi Shi ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Femoral Artery ◽  
Jugular Vein ◽  
Circulatory Arrest ◽  
Venous Drainage ◽  
Deep Hypothermic Circulatory Arrest ◽  
Hypothermic Circulatory Arrest ◽  
Blood Gas ◽  
Left Femoral Artery ◽  
The Right

Objective: Cardiopulmonary bypass (CPB) and deep hypothermic circulatory arrest (DHCA) are commonly used in cardiac surgery. However, the mortality and morbidity are still high in practice. Developing novel protective stategies and elucidating the underlying mechanisms for the pathophysiological consequences of DHCA have been hampered because of the absence of a satisfactory recovery animal model. The aim of this study was to establish a novel and safe DHCA model without blood priming in rats to study the pathophysiology of potential complications. Methods: Ten adult male Sprague-Dawley rats (age, 14-16 weeks; weight, 200-300g) were used. The entire CPB circuit consisted of a modified reservoir, a custom-designed small-volume membrane oxygenator, a roller pump and a home-made heat exchanger, all of which were connected via silicon tubing. The volume of the priming solution was less than 10 ml. The right jugular vein, right carotid artery and left femoral artery were cannulated. The blood was drained from the right atrium through the right jugular vein and fed back to the rat via the left femoral artery. CPB was commenced at a full flow rate. The animals were cooled to a pericranial temperature of 18°C and then subjected to 45 minutes of DHCA with global ischemia. Circulatory arrest was followed by rewarming and over 60 minutes of reperfusion. CPB was terminated carefully. Blood in the circuit was centrifuged and slowly transfused to achieve optimal hematocrit. Blood gas and hemodynamic parameters were recorded at each time point before CPB, during CPB and after CPB. Results: All CPB and DHCA processes were achieved successfully. No rat died in our research. Blood gas analyses at different times were normal. Cardiac function and blood pressure were stable after the operation. The vital signs of all the rats were stable. Conclusion: The novel augmented venous-drainage CPB and DHCA model in rats could be established successfully without blood priming.

Results with continuous cardiopulmonary bypass for the bidirectional cavopulmonary anastomosis

2008 ◽  
Vol 18 (2) ◽  
pp. 147-152 ◽  
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.

scholarly journals Transpulmonary Closure of Giant Persistent Ductus Arteriosus under Cardiopulmonary Bypass and Normothermic Cardioplegia

2019 ◽  
Vol 03 (01) ◽  
pp. 36-38
Author(s):  
Ujjwal K. Chowdhury ◽  
Sukhjeet Singh ◽  
Niwin George ◽  
Lakshmi Kumari Sankhyan ◽  
Poonam Malhotra Kapoor
Keyword(s):  
Cardiopulmonary Bypass ◽  
Female Patient ◽  
Circulatory Arrest ◽  
Ductus Arteriosus ◽  
Foley Catheter ◽  
Persistent Ductus Arteriosus ◽  
Temporary Occlusion

AbstractA 25-year-old female patient with a giant, short, calcified, hypertensive, window ductus arteriosus underwent successful closure via transpulmonary approach under normothermic cardiopulmonary bypass without circulatory arrest using a Foley catheter for temporary occlusion.

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