scholarly journals Case report: Diagnosis and emergency surgery on a young patient with extensive aortic dissection without any risk factors

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Masoud Shafiee ◽  
Mohsen Shafiee ◽  
Noorollah Tahery ◽  
Omid Azadbakht ◽  
Zeinab Nassari ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Aortic Dissection ◽  
Heart Surgery ◽  
Heart Diseases ◽  
Open Heart Surgery ◽  
Rare Condition ◽  
Underlying Disease ◽  
Case Presentation ◽  
History Of

Abstract Background Type A aortic dissection is a very dangerous, fatal, and emergency condition for surgery. Acute aortic dissection is a rare condition, such that many patients will not survive without reconstructive surgery. Case presentation We present a case 24-year-old male who came with symptoms of shortness of breath and cough. The patient underwent ECG, chest radiology, and ultrasound, where the patient was found to have right pleural effusion while his ECG was normal. In the history taken from the patient, he had no underlying disease, no history of heart diseases in his family. For a better diagnosis, ETT and aortic CT angiography was performed on the patient which confirmed the evidence of dissection. Immediately after the diagnosis, necessary arrangements were made for open heart surgery and the patient was prepared for surgery. The patient was admitted in the cardiac surgery ICU for 5 days and his medication was carefully administered. After the conditions were stabilized, the patient was transferred to the post-cardiac surgery ICU ward. The patient was discharged from the hospital one week after the surgery and returned to the office as an OPD one week after his discharge. Conclusion Various risk factors can play a role in creating aortic dissection. Therefore, it is necessary to pay attention to patients’ history for achieving a quick and definitive diagnosis. Therefore, to control the complications of placing the cannula as well as the duration of the surgery, it is very important to reduce the duration of pumping on the patient and to be very careful during the cannula placement.

scholarly journals Gastrointestinal Complications Following Cardiac Surgery.

2019 ◽  
Vol 3 (1) ◽  
Author(s):  
Alfred Ibrahimi ◽  
Saimir Kuçi ◽  
Ervin Bejko ◽  
Stavri Llazo ◽  
Jonela Burimi ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Intestinal Ischemia ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Morbidity And Mortality ◽  
Gastrointestinal Complication ◽  
High Morbidity ◽  
Low Cardiac Output Syndrome ◽  
Gastrointestinal Complications

Purpose: gastrointestinal complication (GIC) following open heart surgery usually are rare but with high morbidity and mortality. The aim of this study was to see the outcome of these patients after complication, compared with a similar study found in literature. Identifying risk factors preoperatively and postoperatively in our patient’s series, for GIC.Materials and methods: Between January 2012 and December 2017 from 1990 operated cardiac patient 34 of them developed GIC, presenting gastro duodenal bleeding due to active ulcer, liver failure, pancreatitis, cholecystitis, or intestinal ischemia. We performed a retrospective analysis.Results: From all consecutive patient only 1.7 % developed GIC. Mortality rate was 55.8%, especially 100 % mortality in intestinal ischemia patient. Regarding risk factors, those were the same found in other similar study (age, atherosclerosis disease, by pass time, postoperative ARF, Low cardiac output syndrome.)Conclusion: GIC after cardiac surgery are rare but when it happens the mortality is very high not even of late diagnosis. In ages patients, diabetes, long by pass time, long hypoperfusion state. It is recommended to be alert for GIC for detection in early phase, and for reducing as much as possible morbidity and mortality.

Psychological Adjustment and Response to Open-Heart Surgery: Some Methodological Considerations

1972 ◽  
Vol 120 (558) ◽  
pp. 491-496 ◽  
Author(s):  
Theodore F. Henrichs ◽  
William F. Waters
Keyword(s):  
Cardiac Surgery ◽  
Psychological Adjustment ◽  
Psychological Factors ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Open Heart ◽  
History Of ◽  
Methodological Considerations ◽  
Psychiatric Complications ◽  
Psychiatric Problems

Psychological factors have long been posited as having a role in determining a person's response to open-heart surgery. As early as 1956 Bolton and Bailey reported a high correlation between a history of psychiatric problems and psychiatric complications following cardiac surgery.

Acute renal failure following open heart surgery: risk factors and prognosis

Perfusion ◽  
2005 ◽  
Vol 20 (6) ◽  
pp. 317-322 ◽  
Author(s):  
Ilknur Bahar ◽  
Ahmet Akgul ◽  
Mehmet Ali Ozatik ◽  
Kerem M Vural ◽  
Ali E Demirbag ◽  
...  
Keyword(s):  
Risk Factors ◽  
Renal Failure ◽  
Acute Renal Failure ◽  
Cardiac Surgery ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Left Ventricular ◽  
High Morbidity ◽  
Open Heart ◽  
Preoperative Serum

Background: Acute renal failure (ARF) development after cardiac surgery carries high mortality and morbidity. Methods: Out of 14 437 consecutive patients undergoing open-heart surgery between January 1991 and May 2001, 168 (1.16%) developed postoperative ARF mandating hemodialysis. Possible perioperative risk factors, and the prognosis of this dreadful, often fatal complication were investigated. Results: The mortality rate in this group was 79.7% (134 patients). The risk factors associated with postoperative ARF were advanced age (p-0.000), diabetes mellitus (p-0.000), hypertension (p-0.000), high preoperative serum creatinine levels (p-0.004), impaired left ventricular function (p-0.002), urgent operation (p-0.000) or reoperation (p-0.007), prolonged cardiopulmonary bypass (CPB) (p-0.000) and aortic cross-clamp (ACC) (p-0.000) periods, level of hypothermia (p-0.000), concomitant procedures (p-0.000), low cardiac output state (p-0.000), re-exploration for bleeding or pericardial tamponade (p-0.000), and deep sternal or systemic infection (p-0.000). Of those who could be discharged from hospital, renal functions were restored in 21 patients (12.5%); however, eight patients (4.7%) became hemodialysis dependent. The mean follow-up period was 5.79/3.2 years (range: 4 months to 13 years; a total of 195 patient-years), and 10-year survival was 58.69/10.2% in the discharged patients. Conclusions: ARF development after cardiac surgery often results in high morbidity and mortality. Recognizing risk factors permits the timely institution of proper treatment, which is the key to reducing untoward outcomes.

scholarly journals Comparative assessment of the frequency and risk factors of purulent-septic infections in adult patients after various types of open and closed heart surgery

2020 ◽  
Vol 25 (2) ◽  
pp. 78-87
Author(s):  
Victor I. Sergevnin ◽  
Larisa G. Kudryavtseva
Keyword(s):  
Risk Factors ◽  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Incidence Rates ◽  
Comparative Assessment ◽  
Open Heart ◽  
Patient Stay ◽  
Subsequent Patient

BACKGROUND: The widespread increase in the number and types of cardiac surgery necessitate the study of frequency and risk factors of postoperative purulent-septic infections (PSIs). AIM: to provide a comparative assessment of the PSI frequency and risk factors in adult patients after various types of cardiac surgery. MATERIALS AND METHODS: Based on the cardiac surgery hospital materials, medical records of 4.815 patients over 18 years of age, who underwent open (n = 1.540) and closed (n = 3.275) heart surgeries within 1 year, were analyzed. The typical and prenosological forms of PSIs were taken into account in accordance with the epidemiological standard of case definition. RESULTS: The incidence rates for typical and prenosological PSI forms amounted to 39.6 and 72.7 per 1000 surgeries after open heart surgery, respectively, and 3.1 and 3.9 after minimally invasive endovascular surgical interventions, respectively. The main clinical forms of PSI after open and closed heart surgeries were surgical site infections, nosocomial pneumonia, urinary tract infection, and bloodstream infection. In an open heart surgery, the maximum incidence rates for typical and prenosological forms of PSIs were recorded after surgeries on the aorta and less often after heart valve replacement or coronary artery bypass grafting. The increased incidence rate after aortic surgery was mainly due to urinary tract infection and nosocomial pneumonia. In the case of closed heart surgery, no statistically significant differences were detected between the incidence rates of PSIs after coronary artery stenting, cardiac arrhythmia and carotid artery stenosis surgery, and other interventions. The duration of both the surgery itself and the subsequent patient stay in the intensive care unit was found to be important as risk factors for PSIs after cardiac surgery. CONCLUSION: The incidence rate of PSIs after open heart surgery is significantly higher than after closed heart surgery, which is mostly associated with the duration of surgical intervention and the subsequent patient stay in the intensive care unit.

scholarly journals dr Jovan Mijuskovic, precursor of cardiac surgery in Serbia

2020 ◽  
Vol 148 (1-2) ◽  
pp. 124-128
Author(s):  
Dusan Velimirovic
Keyword(s):  
Cardiac Surgery ◽  
World War Ii ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
City Hospital ◽  
Military Academy ◽  
School Of Medicine ◽  
Heart Lung Machine ◽  
History Of ◽  
The City

The beginnings of cardiac surgery in Serbia date back to the aftermath of World War II, when the first ?closed heart surgery? was performed in Belgrade. It was done by Professor Vojislav Stojanovic at the Second Surgical Clinic, and shortly afterwards, during the 1950s, by Professor Izidor Papo at the Medical Military Academy, also in Belgrade. ?Open heart surgery,? using heart-lung machine, was introduced in Serbia in 1960, and performed by the same cardiac surgery pioneers. Some of the very first heart operations in the world had been done before cardiac surgery was even officially recognized as a surgical discipline. Therefore, they were performed only as lifesaving procedures in patients with heart wounds. This article describes the first successful surgical treatment of heart wound in Serbia. It was a penetrating revolver wound, and the operation took place on April 7, 1928, at Valjevo City hospital, performed by Dr. Jovan Mijuskovic, who had received his degree from the School of Medicine in Vienna in 1917, and over the years worked as director and chief of surgical departments in various hospitals ? Cuprija, Valjevo, as well as in the City Hospital in Belgrade. He was elected Professor of History of Medicine at Belgrade School of Medicine in 1936. In 1941 he was appointed Minister of Health in the pre-war Serbian Government. Sadly, upon liberation of Belgrade in 1944, this surgical pioneer was arrested and executed.

Establishing Cardiac Surgery in Eastern Nepal: Early Results

2018 ◽  
Vol 16 (3) ◽  
pp. 257-263 ◽  
Author(s):  
Lokesh Shekher Jaiswal ◽  
Jagat Narayan Prasad ◽  
Prashant Shah ◽  
Narendra Pandit
Keyword(s):  
Intensive Care Unit ◽  
Cardiac Surgery ◽  
Intensive Care ◽  
Heart Surgery ◽  
Heart Diseases ◽  
Nyha Class ◽  
Open Heart Surgery ◽  
Left Atrial Myxoma ◽  
Early Results ◽  
The Mean

Background: Only few dedicated cardiac centres provide cardiac surgery service in Nepal. We are the only government affiliated centre outside the capital providing this service. In this study, we aim to present our early results of cardiac surgery.Methods: This retrospective study was conducted at B P Koirala Institute of Health Sciences with objective of analysing the early results of cardiac surgery in the patients operated from July 2016 to March 2017.The data were analysed for patient demographics, type of surgery and cardiac disease, mortality, hospital and intensive care unit stay, valve related complications.Results: Total 51 major cardiac surgeries (42 on pump and nine off pump) were performed. There were 27 (53%) males and 24 (47%) females with median age of 36 years (range: 1 to 70 years). The cardiac diseases consisted of 28 rheumatic heart disease, 12 congenital heart diseases, five coronary artery disease, five chronic constrictive pericarditis and one left atrial myxoma. The mean cardiopulmonary bypass and cross clamp times were 106 ±35 and 80±26 minutes respectively. The mean intensive care unit and hospital stay was 4±2 and 8±3 days respectively. Two (4%) patients required re-exploration for mediastinal bleeding. There was no prosthetic valve thrombosis or infection.Two patients (4%) had superficial wound infections.There were four (7.8%) in hospital mortalities. Remaining 47 patients (91.8%) are in NYHA class I aftermean follow up duration of five months.Conclusions: Our early result of cardiac surgery is encouraging and has established the safety and feasibility of starting open heart surgery in other parts of Nepal.

scholarly journals Management of COVID-19 Patient in Cardiac Surgery with Cardiopulmonary Bypass.

2021 ◽  
Vol 5 (1) ◽  
pp. 779-783
Author(s):  
Alfred Ibrahimi ◽  
Saimir Kuci ◽  
Ervin Bejko ◽  
Stavri Llazo ◽  
Marsela Goga ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Respiratory Failure ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Laboratory Findings ◽  
Early Intubation ◽  
History Of ◽  
High Doses ◽  
Respiratory Assistance

Introduction; The diagnosis of COVID-19 is quite challenging due to the inconsistent correlation between laboratory findings, radiological imaging, and the clinical picture and contact history of the patient. The patients who underwent cardiac surgery with cardiopulmonary bypass (CPB) face double risk because CBP triggers an intense inflammatory response and the leading cause of mortality in COVID-19 patients is “cytokine storm”. In our institution 15 confirmed cases operated on with open-heart surgery. 9 cases isolated CABG, 4 cases valvular combined with CABG, and 1 valvular disease. Materials and method; All patients undergoing elective or urgent cardiac surgery at “Mother Theresa” ’s Hospital from 11 March to 30 November 2020 were included in this study. Patients diagnosed with COVID-19 infection via positive throat swab taken due to clinical suspicion postoperatively were reviewed. Patients characteristics, type of intervention, date of COVID-19 diagnosis. Results: 9 patients (72%) normal recovery, no respiratory failure, only 3-5 days of fever (max 39,4). 3 of them a moderate respiratory failure. 3 patients with severe respiratory failure. Only 3 deaths (26,6%). Recommendation: It's important to a preoperative screening for COVID-19 patients. The outcome of cardiac surgical patients who contracted COVID-19 infection perioperatively is extremely poor. Aggressive respiratory assistance (early intubation), high doses of corticosteroids, and anticoagulation, better results.

Selective Polymyxin Hemoperfusion in Complex Therapy of Sepsis in Children after Cardiac Surgery

2020 ◽  
pp. 1-8
Author(s):  
Michail Yaroustovsky ◽  
Marina Abramyan ◽  
Ekaterina Rogalskaya ◽  
Ekaterina Komardina
Keyword(s):  
Cardiac Surgery ◽  
Intensive Care ◽  
Heart Surgery ◽  
Heart Diseases ◽  
Intensive Therapy ◽  
Survival Rates ◽  
Open Heart Surgery ◽  
Oxygenation Index ◽  
Infectious Complications ◽  
Microbiological Analysis

<b><i>Background:</i></b> To date, sepsis remains one of the main challenges of intensive care in pediatrics. Newborns with low birth weight and infants with chronic diseases and congenital disorders are particularly at risk. The incidence of infectious complications in pediatric cardiac surgery is known to be approximately 15–30%. The main etiological factor of sepsis is endotoxin. <b><i>Aim:</i></b> To evaluate the efficiency and safety of polymyxin (PMX) B-immobilized column-direct hemoperfusion in complex intensive therapy of sepsis in children after cardiac surgery with cardiopulmonary bypass. <b><i>Design:</i></b> Prospective cohort study. <b><i>Methods:</i></b> This study enrolled 15 children, aged 9–96 months, with congenital heart diseases and with body weights of 6.2–22.5 kg. The criteria for admission were body weight &#x3e;6 kg and clinical and laboratory signs of sepsis (microbiological analysis, procalcitonin [PCT] &#x3e;2 ng/mL, and endotoxin activity assay [ЕАА] &#x3e;0.6). Intensive care included inotropic and vasopressor support, mechanical ventilation, broad-spectrum antibiotic therapy, and PMX hemoperfusion procedures. Extracorporeal therapy was initiated within 24 h following the sepsis diagnosis. Every patient underwent 2 hemoperfusion sessions with the use of a PMX B-immobilized column; the session duration was 180 min. <b><i>Results:</i></b> We noted improvements in hemodynamic parameters, oxygenation index, and laboratory signs of sepsis, with decreases in the endotoxin concentration according to the EAA, PCT, and presepsin levels. The 28-day survival of the patients in this severely affected group was 80%. <b><i>Main Conclusion:</i></b> The inclusion of extracorporeal methods of blood purification, aimed at the selective elimination of circulating endotoxin, in the treatment of sepsis increases the survival rates of children after open heart surgery. <b><i>Second Conclusion:</i></b> The obtained results of sepsis therapy with PMX hemoperfusion in children after cardiac surgery enable us to suggest the sufficient safety and efficiency of the procedures in this category of severely affected patients.

scholarly journals Development and Validation of Nomogram Models for Postoperative Pneumonia in Adult Patients Undergoing Elective Cardiac Surgery

2021 ◽  
Vol 8 ◽  
Author(s):  
Dashuai Wang ◽  
Xing Chen ◽  
Jia Wu ◽  
Sheng Le ◽  
Fei Xie ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Heart Surgery ◽  
Laboratory Data ◽  
Open Heart Surgery ◽  
Postoperative Pneumonia ◽  
Elective Cardiac Surgery ◽  
Logistic Regression Models ◽  
Model Based ◽  
Development And Validation

Background: Postoperative pneumonia (POP) is a frequent complication following cardiac surgery, related to increased morbidity, mortality and healthcare costs. The objectives of this study were to investigate the risk factors associated with POP in adults undergoing elective cardiac surgery and to develop and validate nomogram models.Methods: We conducted a multicenter retrospective study in four cardiac centers in China. Adults operated with elective open-heart surgery from 2016 to 2020 were included. Patients were randomly allocated to training and validation sets by 7:3 ratio. Demographics, comorbidities, laboratory data, surgical factors, and postoperative outcomes were collected and analyzed. Risk factors for POP were identified by univariate and multivariate analysis. Nomograms were constructed based on the multivariate logistic regression models and were evaluated with calibration, discrimination and decision curve analysis.Results: A total of 13,380 patients meeting the criteria were included and POP developed in 882 patients (6.6%). The mortality was 2.0%, but it increased significantly in patients with POP (25.1 vs. 0.4%, P &lt; 0.001). Using preoperative and intraoperative variables, we constructed a full nomogram model based on ten independent risk factors and a preoperative nomogram model based on eight preoperative factors. Both nomograms demonstrated good calibration, discrimination, and were well validated. The decision curves indicated significant clinical usefulness. Finally, four risk intervals were defined for better clinical application.Conclusions: We developed and validated two nomogram models for POP following elective cardiac surgery using preoperative and intraoperative factors, which may be helpful for individualized risk evaluation and prevention decisions.

Leadless pacemaker implant in patients with a history of open heart surgery: experience with the Micra transcatheter pacemaker

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
C Garweg ◽  
S Iacopino ◽  
M.F El-Chami ◽  
C Veltmann ◽  
N Clementy ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Major Complication ◽  
Valve Surgery ◽  
Funding Source ◽  
Open Heart ◽  
Surgery Group ◽  
History Of

Abstract Background The Micra transcatheter pacemaker has demonstrated a favorable safety and efficacy profile relative to transvenous pacing. Patients with a history of open heart surgery have a higher risk of complications with transvenous pacemakers during follow-up. The experience with leadless pacemakers among a large cohort of patients with a history of open heart surgery has not been reported. Objective To report outcomes in patients with a history of open heart surgery undergoing Micra implant. Methods Patients undergoing Micra implant from the Micra Transcatheter Pacing Post-Approval Registry (PAR) were included in the analysis. Baseline and procedural characteristics, major complications, and electrical performance were compared among patients with vs. without history of cardiac surgery. Results A total of 331 out of 1815 (18.2%) patients had a history of open heart surgery, underwent Micra implant, and were followed for 19.4±10.4 months. The mean age was 74.6±13.5 years, 40% were female. The most common cardiac surgery was aortic valve surgery (71%) followed by mitral valve surgery (39%). Patients with prior open-heart surgery were more likely to have contraindications to transvenous pacing, were more likely to be on oral anticoagulants, and had more co-morbidities including atrial fibrillation, heart failure, and coronary artery disease (all p&lt;0.005). Implantation was successful in 327 of 331 patients (98.8%) with a median procedure time of 29 minutes. Mean pacing capture thresholds (PCTs) at implant were 0.66±0.51V and remained stable through follow-up. There were 11 major complications in 10 cardiac surgery patients, with no device or procedure-related infections reported. The major complication rate was 3.1% (Figure) and was not significantly different than that of patients without a history of open heart surgery (HR: 0.85, P=0.640). There was 1 cardiac perforation (with no intervention required) in the open heart surgery group (0.3%) and there were 14 cardiac perforations (0.94%, P=0.332) in the non-open heart surgery group of which 10 required intervention. Conclusion The Micra transcatheter pacemaker can be safely implanted in patients with a history of open heart surgery, with a similar long-term safety profile to patients without a history of open heart surgery. Importantly, there were no device-related infections reported in either group. Risk of Major Complication Funding Acknowledgement Type of funding source: Private company. Main funding source(s): Medtronic, Inc.

Sign in / Sign up

Export Citation Format

Share Document