Doppler ultrasound estimation of microbubbles in the arterial line during extracorporeal circulation

Perfusion ◽  
1990 ◽  
Vol 5 (1) ◽  
pp. 23-32 ◽  
Author(s):  
M. Sellman ◽  
T. Ivert ◽  
P. Stensved ◽  
M. Högberg ◽  
Bkh Semb
Keyword(s):  
Doppler Ultrasound ◽  
Extracorporeal Circulation ◽  
Artery Bypass ◽  
Arterial Line ◽  
Membrane Oxygenator ◽  
Filter Group ◽  
S 100 ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

A pulsed Doppler ultrasound system was used to analyse microbubble intensity and size in the arterial line during extracorporeal circulation (ECC). Thirty male patients, younger than 70 (range 28-69) years, underwent isolated coronary artery bypass grafting with either a bubble oxygenator (Shiley S-100) without (group 1, n = 10) or with (group 2, n = 10) a depth adsorption arterial line filter (Swank High Flow 6000); or with a membrane oxygenator (Shiley M-2000) without a filter (group 3, n = 10). Mean ECC and aortic crossclamp times were similar in the three groups. Measurements were performed during the initial five minutes of cooling, after 30-40 minutes of ECC and after 10 minutes of rewarming. Microbubble intensity and size did not differ significantly in the three groups at the different intervals. Significantly more and larger bubbles were detected in group 1 (15-150μm) compared to group 2 (< 35μm) (p< 0.001). In group 3 only a minimal number of small bubbles (< 65μm) were observed. An arterial line filter significantly reduced the number and size of microbubbles detected in the arterial line during ECC. A membrane oxygenator was associated with a further reduction of microbubble intensity.

Comparison of Antihypertensives after Coronary Artery Surgery

2005 ◽  
Vol 13 (4) ◽  
pp. 302-306 ◽  
Author(s):  
Fevzi Toraman ◽  
Hasan Karabulut ◽  
Onur Goksel ◽  
Serdar Evrenkaya ◽  
Sumer Tarcan ◽  
...  
Keyword(s):  
Coronary Artery ◽  
Sodium Nitroprusside ◽  
Artery Bypass ◽  
Effective Control ◽  
Hemodynamic Effects ◽  
Double Product ◽  
Myocardial Infraction ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Hypertension following coronary artery bypass grafting is a common problem that may result in postoperative myocardial infraction or bleeding, Hemodynamic effects were compared in 45 hypertensive coronary bypass patients randomized to receive either diltiazem, nitroglycerin, or sodium nitroprusside. Diltiazem was administered as an intravenous bolus of 0.3 mg·kg−1 within 5 min, followed by infusion of 0.1–0.8 mg·kg−1·h−1 in group 1. Nitroglycerin was infused at a rate of 1–3 μg·kg·h−1 in group 2, and sodium nitroprusside was given at a rate of 1–3 μg·kg−1·min−1 in group 3. Hemodynamic measurements were carried out before infusion (T1) and at 30 min (T2), 2 h (T3), and 12 h (T4) after initiation of treatment in the intensive care unit. Mean arterial pressure decreased significantly in all groups. There were no differences among groups at T1 and T2. At T3, heart rate in group 2 was significantly higher than group 1. At T3 and T4, the double product was highest in group 3 (group 1 vs. 3, p < 0.001). These results suggest that the hemodynamic effects of the 3 drugs are similar within the first 30 min. However, after 30 min, diltiazem affords better myocardial performance and more effective control of hypertension.

Influence of aspirin or heparin on platelet function and postoperative blood loss after coronary artery bypass surgery

Perfusion ◽  
2006 ◽  
Vol 21 (1) ◽  
pp. 61-66 ◽  
Author(s):  
Edmundas Sirvinskas ◽  
Audrone Veikutiene ◽  
Pranas Grybauskas ◽  
Jurate Cimbolaityte ◽  
Ausra Mongirdiene ◽  
...  
Keyword(s):  
Platelet Count ◽  
Coronary Artery ◽  
Platelet Aggregation ◽  
Blood Loss ◽  
Platelet Function ◽  
Artery Bypass ◽  
Postoperative Blood Loss ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

The aim of the study was to assess the effect of aspirin or heparin pretreatment on platelet function and bleeding in the early postoperative period after coronary artery bypass grafting (CABG) surgery. Seventy-five male patients with coronary artery disease who underwent CABG with cardiopulmonary bypass (CPB) were studied. The patients were divided into three groups: Group 1 ( n = 25) included patients receiving aspirin pretreatment, Group 2 ( n = 22) received heparin pretreatment, and Group 3 ( n = 28) included patients who received no antiplatelet or anticoagulant pretreatment. Twenty-four hours after surgery, all patients were administered aspirin therapy that was continued throughout their hospitalization period. We assessed the following preoperative blood coagulation indices: activated partial thromboplastin time (aPTT), international normalized ratio (INR), and fibrinogen. We compared platelet count and platelet aggregation induced by adenosinediphosphate (ADP) before surgery, 1 h after surgery, 20 h after surgery and on the seventh postoperative day. We assessed drained blood loss within 20 postoperative hours. Preoperative blood coagulation indices did not differ among the groups. Platelet count was also similar. One hour after surgery, platelet count significantly decreased in all groups ( p <0.001), after 20 postoperative hours it did not undergo any marked changes, and on the seventh postoperative day, it significantly increased in all groups ( p <0.001). Before surgery, the lowest index of ADP-induced platelet aggregation was found in Group 1 ( p <0.05). One hour after surgery, platelet aggregation significantly decreased in all groups, most markedly in Group 3 ( p <0.001), yet after 20 h, its restitution tendency and a significant increase in all groups was noted. On the seventh day, a further increase in the statistical mean platelet aggregation value was noted in Groups 2 and 3. Comparison of platelet aggregation after 20 postoperative hours and on the seventh day after surgery revealed a significantly higher than 10% increase of the index in 32% of patients in Group 1 ( p <0.05), 27.3% of patients in Group 2 ( p <0.05) and in 35.7% of patients in Group 3 ( p <0.001). The lowest statistically significant value of postoperative blood loss was noted in Group 2 ( p <0.01). Our study has shown that aspirin or heparin pretreatment had no impact on the dynamics of platelet function in the early postoperative period after CABG. The lowest postoperative blood loss was noted in patients pretreated with heparin.

Cardiac Tamponade After Removal of Temporary Pacer Wires

2012 ◽  
Vol 21 (6) ◽  
pp. 432-440 ◽  
Author(s):  
Linda Mahon ◽  
James F. Bena ◽  
Shannon M. Morrison ◽  
Nancy M. Albert
Keyword(s):  
Cardiac Tamponade ◽  
Artery Bypass ◽  
Bypass Graft ◽  
Vital Signs ◽  
Smoking History ◽  
Initial Surgery ◽  
Temporary Pacemaker ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background After removal of temporary pacemaker wires, nurses measure vital signs frequently to assess for cardiac tamponade; however, evidence for this procedure is limited. Objectives To determine risk factors for cardiac tamponade after temporary pacemaker wire removal. Methods Retrospective review of data for coronary artery bypass graft and valve surgery (N = 23 717) performed from January 1999 to December 2008. Patients were categorized by reason for reoperation: bleeding less than 3 days after initial surgery (n = 812, group 1), bleeding 3 days or more after index surgery but not for cardiac tamponade (n = 171, group 2), bleeding 3 days or more after index surgery for cardiac tamponade after temporary pacemaker wire removal (n = 23, group 3), and no reoperation (n = 22 711, group 4). Results Less than 1% (9.7 cases/10 000) of patients required reoperation for cardiac tamponade after removal of temporary pacer wires. Of patient-related factors studied, only smoking history differed for group 3 vs group 1 (P = .03) and group 2 (P = .01). Of vital sign changes, 1 patient (4%) had tachycardia and 3 patients had cardiac arrest, but only 1 of the 3 had hypotension before the arrest. In total, 12 patients (52%) had hypotension; however, it was mild or intermittent in 5 cases, and did not occur within the 4 hours after wire removal in 3 cases. After removal of temporary pacing wires, common early signs/symptoms were bleeding (26%) and dyspnea (26%). Other documented changes were pressure in the chest, diaphoresis, cold and clammy skin, dizziness, and mental status changes. Conclusions Tamponade related to pacer wire removal was rare and not consistently associated with changes in vital signs. Dyspnea, bleeding, and other factors may indicate early onset of cardiac tamponade after removal of temporary pacer wires.

Diagnostic performance of sensitive measurements of serum thyrotropin during severe nonthyroidal illness: their role in the diagnosis of hyperthyroidism.

1987 ◽  
Vol 33 (12) ◽  
pp. 2178-2184 ◽  
Author(s):  
M F Bayer ◽  
J A Macoviak ◽  
I R McDougall
Keyword(s):  
Thyroid Disease ◽  
Artery Bypass ◽  
Hospital Setting ◽  
Transplant Recipients ◽  
Group 4 ◽  
Group 3 ◽  
Group 5 ◽  
Group 2 ◽  
Serial Measurements ◽  
Group 1

Abstract Serum thyrotropin (TSH) concentrations were measured serially in 14 heart-transplant recipients (group 1) and 21 patients undergoing coronary artery bypass surgery (group 2), all without thyroid disease, and randomly in 158 patients hospitalized for various other nonthyroidal illnesses, including 144 judged euthyroid (group 3), six with increased FT4 and (or) T3 (group 4), and eight classified hypothyroid by conventional tests. The serial measurements indicated profound fluctuations. In group 1, TSH was subnormal in 21% of studies and increased in 10%. In group 2, corresponding abnormalities were found in 7% and 13%, respectively. Transiently low or high TSH tended to be associated with normal free thyroxin (FT4), prolonged subnormal TSH (greater than 1 week) with subnormal FT4. By contrast, subnormal TSH plus elevated FT4, or high TSH plus low FT4, were not encountered, making it unlikely that they occur by chance in severely ill patients who are not also hyper- or hypothyroid. In group 3, a suppressed TSH (plus borderline high FT4, T3/FT3) identified four cases of subclinical hyperthyroidism; however, another 11% of patients had subnormal and 10% had above-normal TSH, paired with normal FT4 and no evidence of thyroid disease. In group 4, suppressed TSH confirmed hyperthyroidism in five of six patients, and all in group 5 had increased TSH. We conclude that, in the hospital setting, sensitive TSH measurement can help to detect or confirm mild hyperthyroidism, but the positive predictive value of TSH alone may be as low as 35%.

scholarly journals Electrical impedancemetry a new method for evaluating myocardial protection in operations with heart extracorporeal circulation

2011 ◽  
Vol 3 (1) ◽  
pp. 23-33
Author(s):  
Gevorg A. Bledzhyants ◽  
Vadim A. Bubnov ◽  
Dmitry V. Puzenko ◽  
Vladimir A. Cherepenin
Keyword(s):  
Emergency Department ◽  
Information Content ◽  
Extracorporeal Circulation ◽  
Myocardial Protection ◽  
Medical Center ◽  
Bioelectrical Impedance ◽  
New Method ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Objective: to determine the information content of electrical impedancemetry as a method of assessing myocardial protection during cardioplegic different versions. The study included 54 patients operated on in the emergency department of valvular defects surgery at Bakulev's Medical Center. Depending on the method of myocardial protection patients were divided into 3 groups: Group 1 - patients whom Buckberg cardioplegia was used (n = 31), group 2 - patients underwent cardioplegia solution with Custodiol (n = 9), group 3 - patients who have a perioperative myocardial protection used hyperkalium solution (n = 14). All patients were studied bioelectrical impedance of the myocardium. The results showed that the electrical impedancemetry can well assess the state of the myocardium during surgery.

Intravenous Diltiazem for Treatment of Supraventricular Tachycardia after Coronary Artery Bypass Surgery

1998 ◽  
Vol 6 (3) ◽  
pp. 203-207
Author(s):  
C Levent Birincioğlu ◽  
A Tulga Ulus ◽  
Birol Yamak ◽  
S Fehmi Katircioğlu ◽  
Binali Mavitaş ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Coronary Artery ◽  
Sinus Rhythm ◽  
Coronary Artery Bypass ◽  
Supraventricular Tachycardia ◽  
Artery Bypass ◽  
Inotropic Support ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Between 1995 and 1997, 180 patients who had undergone coronary artery bypass grafting were given intravenous diltiazem for conversion of supraventricular tachycardia to sinus rhythm or control of ventricular rhythm in atrial fibrillation. The patients were divided into three groups of 60 each: group 1 required no inotropic support; group 2 had mild inotropic support with dopamine; group 3 had high-dose inotropic support with adrenalin and dopamine. Thirty-eight patients in group 1 (63%), 40 in group 2 (67%), and 32 in group 3 (53%) responded to one or two doses of diltiazem. There was no difference between the groups in terms of the success rate of the treatment (p > 0.05). Additional procedures were needed in 70 patients including cardioversion in 20 (12 in group 1, 8 in group 2). Mean cardiac index was significantly increased and mean pulmonary artery pressure was significantly decreased in all three groups after diltiazem treatment. After the first dose of diltiazem (0.25 mg·kg−1), the mean heart rate decreased from 141.5mg·kg−1 ± 3.8, 136.9 ± 8.5, and 140.2 ± 4.7 to 118.2 ± 5.1, 101.2 ± 6.7, and 105.6 ± 16.8 in groups 1, 2, and 3, respectively. The maximum decrease was seen after 5 minutes. After the second dose of diltiazem (0.35 mg·kg−1), although mean heart rates were not significantly decreased, 45% of group 1, 44% of group 2, and 46% of group 3 patients who did not respond to the first dose of diltiazem, converted to sinus rhythm. In the early postoperative period after coronary artery bypass graft surgery, diltiazem was of benefit in the treatment of supraventricular tachycardia and atrial fibrillation or flutter. This treatment may be especially useful in patients who are in poor hemodynamic condition.

Clinical outcomes of single-dose cardioplegia in high-risk coronary bypass

2020 ◽  
pp. 021849232096643
Author(s):  
Serdar Gunaydin ◽  
Orhan Eren Gunertem ◽  
Seyhan Babaroglu ◽  
Atike Tekeli Kunt ◽  
Kevin McCusker ◽  
...  
Keyword(s):  
Single Dose ◽  
Coronary Artery ◽  
High Risk ◽  
Myocardial Protection ◽  
Artery Bypass ◽  
Bypass Grafting ◽  
Risk Patients ◽  
Group 3 ◽  
Group 2 ◽  
Group 1

Background Despite the increasing popularity of single-dose cardioplegia techniques in coronary artery bypass grafting, the time window for successful reperfusion remains unclear. This study aimed to compare different cardioplegic techniques based on early and 30-day clinical outcomes via thorough monitoring. Methods This prospective cohort study included high-risk patients undergoing coronary artery bypass grafting and receiving 3 different types of cardioplegia between January 2017 and June 2019. Group 1 ( n = 101) had a single dose of del Nido cardioplegia, group 2 ( n = 92) had a single dose of histidine-tryptophane-ketoglutarate, and group 3 ( n = 119) had cold blood cardioplegia. Patients were examined perioperatively by memory loop recording and auto-triggered memory loop recording for 30 days, with documentation of predefined events. Results Interleukin-6 and cardiac troponin levels in group 1 were significantly higher than those in groups 2 and 3. The incidence of predefined events as markers of inadequate myocardial protection was significantly higher group 1, with more frequent atrial fibrillation attacks and more hospital readmissions. The readmission rate was 17.6% in group 1, 9% in group 2, and 8% in group 3. Conclusions Our data demonstrate the long-term efficacy of cardioplegic techniques, which may become more crucial in high-risk patients who genuinely have a chance to benefit from adjunct myocardial protection. Patients given del Nido cardioplegia had a significantly more prominent inflammatory response and higher troponin levels after cardiopulmonary bypass. This group had issues in the longer term with significantly more cardiac events and a higher rehospitalization rate.

scholarly journals Posthypoxic encephalopathy in patients undergoing coronary artery bypass surgery: clinical, neuropsychological, and neuroimaging aspects

2019 ◽  
Vol 11 (3) ◽  
pp. 35-42
Author(s):  
O. A. Portik ◽  
Yu. N. Tsarevskaya ◽  
A. Yu. Efimtsev ◽  
T. M. Alekseeva ◽  
G. E. Trufanov
Keyword(s):  
Coronary Artery ◽  
Coronary Artery Bypass ◽  
Extracorporeal Circulation ◽  
Coronary Artery Bypass Surgery ◽  
Bypass Surgery ◽  
Artery Bypass ◽  
Cognitive Status ◽  
Beating Heart ◽  
Group 2 ◽  
Group 1

Posthypoxic encephalopathy is a frequent complication after coronary artery bypass surgery (CABG), which includes stroke, early postoperative delirium, and postoperative cognitive dysfunction (PCD). The more pronounced prevalence and severity of the latter during surgery using extracorporeal circulation are currently being discussed.Objective: to analyze various types of cerebral dysfunction in patients undergoing CABG and to determine the role of perioperative factors in its development.Patients and methods. The investigation enrolled 53 patients who had undergone elective CABG for coronary heart disease. Group 1 included 20 patients who had undergone beating-heart surgery; Group 2 comprised 33 patients, in whom CABG had been performed using extracorporeal circulation (ECC). Neuropsychological testing and brain magnetic resonance imaging (MRI) (structural and functional techniques) were carried out.Results and discussion. Posthypoxic encephalopathy was diagnosed in 10 and 67% of patients in Group 1 and 2, respectively (p=0.05); these were precisely all the three types of brain dysfunction which were observed in Group 2 patients. Factors, such as over 70 years of age; median level of education; smoking; body mass index >30 kg/m2 ; ejection fraction <50%; class III effort angina; >210-min surgery duration; >55-min aortic ligation; and >115-min ECC, showed a statistically significant association with the onset of PCD (p<0.05). In Group 2, MRI revealed a weaker positive functional relationship of the medial prefrontal cortex with the posterior cingulate gyrus (<0.005); 18% of patients were found to have acute ischemic zones.Conclusion. Surgical myocardial revascularization using ECC is associated with a greater likelihood of PCD than beating-heart CABG. The factors that favored the development of PCD, such as increased age, low preoperative cognitive status, smoking, and long-term use of ECC, were identified when applying ECC. 

scholarly journals Prediction of the First Variceal Haemorrhage

HPB Surgery ◽  
1997 ◽  
Vol 10 (4) ◽  
pp. 255-258
Author(s):  
K-J Paquet
Keyword(s):  
Portal Vein ◽  
Doppler Ultrasound ◽  
Variceal Bleeding ◽  
Variceal Hemorrhage ◽  
Cox Regression Analysis ◽  
Prognostic Group ◽  
Group 3 ◽  
Group 2 ◽  
Ultrasound Parameters ◽  
Group 1

We followed 87 cirrhotic patients with esophageal varices and without previous hemorrhage for a mean period of 24 mo to prospectively evaluate the occurance of variceal bleeding within (early) or after (late) 6 mo from entry and the contribution of portal Doppler ultrasound parameters to the prediction of early and late hemorrhage. Clinical, biochemical, endoscopic and portal Doppler ultrasound parameters were recorded at entry. Variceal bleeding occurred in 22 patients (25.3%). Nine (40.9%) bled within the first 6 mo. Cox regression analysis identified variceal size, cherry-red spots, serum bilirubin and congestion index of the portal vein (the ratio of portal vein [cross-sectional area] and portal blood flow velocity) as the only independent predictors of first variceal hemorrhage. Discriminant analysis was used to find the prognostic index cut off points to identify patients who bled within 6 mo (prognostic group 1) or after 6 mo (prognostic group 2) or remained free of bleeding (prognostic group 3). The cumulative proportion of patients correctly classified was 73% in prognostic group 1, 47% in prognostic group 2 and more than 80% in prognostic group 3. The addition of Doppler ultrasound flowmetry to clinical, biochemical and endoscopic parameter only improved the classification of patients with early bleeding.

Adjusting Oxygen Fraction to Avoid Hyperoxemia during Cardiopulmonary Bypass

2007 ◽  
Vol 15 (4) ◽  
pp. 303-306 ◽  
Author(s):  
Fevzi Toraman ◽  
Serdar Evrenkaya ◽  
Sahin Senay ◽  
Hasan Karabulut ◽  
Cem Alhan
Keyword(s):  
Cardiopulmonary Bypass ◽  
Artery Bypass ◽  
Blood Gas Analysis ◽  
Gas Analysis ◽  
Oxygen Fraction ◽  
Wide Range ◽  
Group 3 ◽  
Group 2 ◽  
Inspired Oxygen ◽  
Group 1

Although an adverse influence of hyperoxemia during cardiopulmonary bypass is well documented, there is a wide range of oxygen settings during cardiopulmonary bypass, based mostly on trial and error. The aim of this study was to determine the optimal inspired oxygen fraction during cardiopulmonary bypass. Ninety patients undergoing isolated coronary artery bypass operations were randomly allocated to one of 3 groups of 30 each. In group 1, cardiopulmonary bypass was started with an inspired oxygen fraction of 0.40, increased to 0.60 during rewarming. These settings were 0.40 and 0.50 in group 2, and 0.35 and 0.45 in group 3. Samples for blood gas analysis were collected at defined time periods during the operation. PaO2 was significantly higher in groups 1 and 2 compared to group 3. All patients in group 1 and 88% of patients in group 2 suffered at least one episode of hyperoxemia during cardiopulmonary bypass, compared to 30% of patients in group 3. The differences were significant, and we concluded that to avoid hyperoxemia, inspired oxygen fraction should be kept at 0.35 during cardiopulmonary bypass and increased to 0.45 during rewarming.

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