Cardiopulmonary bypass on a patient with malaria

Perfusion ◽  
1999 ◽  
Vol 14 (3) ◽  
pp. 219-221 ◽  
Author(s):  
Thomas J Coley ◽  
James C Hart
Keyword(s):  
Cardiopulmonary Bypass ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Blood Cells ◽  
Literature Search ◽  
Severe Aortic Stenosis ◽  
Extensive Literature ◽  
History Of ◽  
Extensive Literature Search ◽  
Primaquine Phosphate

There are special considerations when performing cardiopulmonary bypass (CPB) on a patient with malaria. A 70-year-old female with a recent history of severe aortic stenosis was scheduled to undergo elective aortic valve replacement. One week prior to surgery, the patient developed shaking chills and fever, with a positive malaria smear. An extensive literature search was undertaken to determine the effect of CPB on a patient with active malaria, but no prior reference was found. One major concern was the lysis of red blood cells while on bypass. The surgery was performed uneventfully, following 2 weeks of treatment with primaquine phosphate.

Abstract 13454: The Impact of Prior Stroke on the Outcome of Patients With Severe Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Romain Didier ◽  
Edward Koifman ◽  
Sarkis Kiramijyan ◽  
Smita Negi ◽  
Ricardo Escarcega ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Minor Stroke ◽  
Post Procedure ◽  
Cerebrovascular Events ◽  
History Of ◽  
The Impact ◽  
Prior Stroke

Introduction: Prior stroke has been identified as an independent correlate for post-procedure cerebrovascular events (CVE) in aortic stenosis (AS) patients undergoing surgical aortic valve replacement (SAVR). The present study aimed to evaluate the impact of prior cerebrovascular events on outcome in AS patients undergoing TAVR. Methods: Patients with severe AS undergoing TAVR between May 2007-March 2015 were included and categorized to patients with and without prior CVE defined as stroke and transit ischemic attack. Baseline, procedural characteristics, in-hospital outcomes, 1-month and 1-year mortality were compared, in accordance with the VARC-2 consensus. Results: A cohort of 662 consecutive patients with severe AS undergoing TAVR was included in the analysis. Of these, 120 patients had prior CVE, and 542 without. Balloon expandable valve was used in 70.7% and self-expandable valve in 29.3% of the patients. Trans-femoral access was used in 78% (571), and pre-TAVR balloon aortic valvuloplasty was performed in 87% (574). Patients with prior CVE had a higher mean STS score compared to those without prior CVE (10.1% versus 8.8%, respectively; p=0,006) and demonstrated higher rates of atherosclerotic disease involving the coronary, peripheral and carotid arteries. In-hospital minor stroke occurred more often in patients with prior CVE vs. those without CVE (3.3% vs. 0.7%; p=0.04). However, similar mortality rates were recorded at 1, 6, and 12 months (figure 1), and there were no significant differences in major stroke, bleeding, or post-procedure hospital stay between both groups. Conclusions: Prior history of CVE infers a higher risk for in-hospital minor stroke, yet no impact on other outcomes post TAVR. Patients with and without a history of prior CVE with severe aortic stenosis will similarly benefit from TAVR. Therefore, a history of CVE should not be considered an exclusion criterion.

scholarly journals Spontaneous regression of severe aortic stenosis after massive embolization in a patient with antiphospholipid syndrome

2019 ◽  
Vol 25 (1) ◽  
pp. 4-8
Author(s):  
Ali Youssef ◽  
Mustafa Alrefae ◽  
Sayed Abouelsoud
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Antiphospholipid Syndrome ◽  
Severe Aortic Stenosis ◽  
Valve Surgery ◽  
Lower Limbs ◽  
Acute Ischemia ◽  
Primary Antiphospholipid Syndrome ◽  
Aortic Valve Surgery ◽  
History Of

Summary We present a case of probably unreported aortic stenosis evolution in a patient with primary antiphospholipid syndrome (APS). A female patient, 54 years old, with a history of recurrent deep venous thrombosis, an episode of pulmonary embolism and was positive for APS antibodies. She was kept on warfarin and aspirin. The patient was admitted with acute pulmonary edema and severe aortic stenosis. While preparing for aortic valve surgery, the patient developed acute stroke, and a week later developed concurrent acute ischemia of both lower limbs. Emergency surgery salvaged the lower limbs and follow up transthoracic echocardiography showed marked regression of the thickening of the aortic valve leaflets, only mild aortic stenosis and moderate aortic regurgitation. Aortic valve surgery was cancelled, and the patient was kept on warfarin and aspirin. Conclusion Development of severe aortic stenosis is uncommon in primary APS, and this scenario of spontaneous improvement from a severe to a mild aortic stenosis, is probably unreported before.

scholarly journals Asymptomatic Patients with Severe Aortic Stenosis and the Impact of Intervention

2021 ◽  
Vol 8 (4) ◽  
pp. 35
Author(s):  
Mevlüt Çelik ◽  
Milan Milojevic ◽  
Andras P. Durko ◽  
Frans B. S. Oei ◽  
Edris A. F. Mahtab ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Severe Aortic Stenosis ◽  
Survival Rates ◽  
Aortic Valve Area ◽  
Term Survival ◽  
Asymptomatic Patients ◽  
History Of ◽  
The Impact

Objectives the exact timing of aortic valve replacement (AVR) in asymptomatic patients with severe aortic stenosis (AS) remains a matter of debate. Therefore, we described the natural history of asymptomatic patients with severe AS, and the effect of AVR on long-term survival. Methods: Asymptomatic patients who were found to have severe AS between June 2006 and May 2009 were included. Severe aortic stenosis was defined as peak aortic jet velocity Vmax ≥ 4.0 m/s or aortic valve area (AVA) ≤ 1 cm2. Development of symptoms, the incidence of AVR, and all-cause mortality were assessed. Results: A total of 59 asymptomatic patients with severe AS were followed, with a mean follow-up of 8.9 ± 0.4 years. A total of 51 (86.4%) patients developed AS related symptoms, and subsequently 46 patients underwent AVR. The mean 1-year, 2-year, 5-year, and 10-year overall survival rates were higher in patients receiving AVR compared to those who did not undergo AVR during follow-up (100%, 93.5%, 89.1%, and 69.4%, versus 92.3%, 84.6%, 65.8%, and 28.2%, respectively; p < 0.001). Asymptomatic patients with severe AS receiving AVR during follow-up showed an incremental benefit in survival of up to 31.9 months compared to conservatively managed patients (p = 0.002). Conclusions: The majority of asymptomatic patients turn symptomatic during follow-up. AVR during follow-up is associated with better survival in asymptomatic severe AS patients.

Severe bicuspid aortic stenosis in pregnancy: balancing the risk of prematurity and maternal mortality

2018 ◽  
Vol 28 (5) ◽  
pp. 756-758
Author(s):  
Chinedu Nwabuobi ◽  
Megan McDowell ◽  
Sarah Običan
Keyword(s):  
Ventricular Tachycardia ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Caesarean Delivery ◽  
Severe Aortic Stenosis ◽  
Treatment Options ◽  
Pregnant Patient ◽  
Healthcare Team ◽  
History Of ◽  
In Pregnancy

AbstractWe report a case of combined severe aortic stenosis and regurgitation in a pregnant patient with a history of congenital bicuspid aortic valve. The patient presented at 22 weeks of gestation with angina and pre-syncopal symptoms. During her admission, she experienced intermittent episodes of non-sustained ventricular tachycardia and hypotension. A multi-disciplinary healthcare team was assembled to decide on the appropriate medical and surgical treatment options. At 28 weeks of gestation, the patient underwent a caesarean delivery immediately followed by a mechanical aortic valve replacement.

Aortic Valve Surgery

2019 ◽  
pp. 23-28
Author(s):  
Heather Reed ◽  
Stefan Lombaard ◽  
Samantha Arzillo
Keyword(s):  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Stenosis ◽  
Severe Aortic Stenosis ◽  
Valve Surgery ◽  
Aortic Valve Surgery ◽  
Postoperative Assessment ◽  
Class 1 ◽  
History Of ◽  
Perioperative Transesophageal Echocardiography

Aortic valve stenosis is the most common primary valvular disease today. The natural history of aortic valve stenosis is most commonly described as a long latent period without symptoms as the disease progresses from mild to severe, followed by a shorter period with symptoms; ultimately, death will result if the stenosis is left untreated. Today, severe aortic stenosis is a class 1 indication for surgery. Classic symptoms include dyspnea, syncope, and angina. Diagnostic options include echocardiography, cardiac catheterization, computed tomography, and magnetic resonance imaging. Perioperative transesophageal echocardiography is necessary for preoperative and postoperative assessment of the patient who has severe aortic stenosis.

scholarly journals Outcomes in asymptomatic, severe aortic stenosis

PLoS ONE ◽  
2021 ◽  
Vol 16 (4) ◽  
pp. e0249610
Author(s):  
Anette Borger Kvaslerud ◽  
Kenan Santic ◽  
Amjad Iqbal Hussain ◽  
Andreas Auensen ◽  
Arnt Fiane ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Severe Aortic Stenosis ◽  
Asymptomatic Patients ◽  
History Of ◽  
Artery Disease

Background and aim of the study Patients with asymptomatic, severe aortic stenosis are presumed to have a benign prognosis. In this retrospective cohort study, we examined the natural history of contemporary patients advised against aortic valve replacement due to a perceived lack of symptoms. Materials and methods We reviewed the medical records of every patient given the ICD-10-code for aortic stenosis (I35.0) at Oslo University Hospital, Rikshospitalet, between Dec 1st, 2002 and Dec 31st, 2016. Patients who were evaluated by the heart team due to severe aortic stenosis were categorized by treatment strategy. We recorded baseline data, adverse events and survival for the patients characterized as asymptomatic and for 100 age and gender matched patients scheduled for aortic valve replacement. Results Of 2341 patients who were evaluated for aortic valve replacement due to severe aortic stenosis, 114 patients received conservative treatment due to a lack of symptoms. Asymptomatic patients had higher mortality than patients who had aortic valve replacement, log-rank p<0.001 (mean follow-up time: 4.0 (SD: 2.5) years). Survival at 1, 2 and 3 years for the asymptomatic patients was 88%, 75% and 63%, compared with 92%, 83% and 78% in the matched patients scheduled for aortic valve replacement. 28 (25%) of the asymptomatic patients had aortic valve replacement during follow-up. Age, previous history of coronary artery disease and N-terminal pro B-type natriuretic peptide (NT-proBNP) were predictors of mortality and coronary artery disease and NT-proBNP were predictors of 3-year morbidity in asymptomatic patients. Conclusions In this retrospective study, asymptomatic patients with severe aortic stenosis who were advised against surgery had significantly higher mortality than patients who had aortic valve replacement.

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