scholarly journals Novel surgical management of an extensive recurrent Hickman line thrombosis involving the SVC and right atrium

2021 ◽  
Author(s):  
Anna Zingale ◽  
Danai Karamanou ◽  
Pietro Malvindi ◽  
Suvitesh Luthra ◽  
Sunil Ohri
Keyword(s):  
Cardiopulmonary Bypass ◽  
Small Bowel ◽  
Right Atrium ◽  
Circulatory Arrest ◽  
Anticoagulation Therapy ◽  
Venous Drainage ◽  
Central Line ◽  
Venous Cannulation ◽  
Cannulation Site ◽  
Intracardiac Thrombosis

Intravenous central line catheters are often at risk of line-related thrombosis. We report on how the cardiopulmonary bypass strategy was tailored to the particular anatomical challenges with the use of an unconventional venous cannulation site to optimise intraoperative venous drainage, improve surgical exposure and avoid circulatory arrest in a case with a complex intracardiac thrombosis. This report also highlights the importance of assiduously monitoring the efficacy of anticoagulation therapy, especially in the context of small bowel syndrome.

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.

scholarly journals Unusual abdominal tumors with intracardiac extension. Two cases with successful surgical resection

1999 ◽  
Vol 54 (5) ◽  
pp. 159-164 ◽  
Author(s):  
Noedir A. G. Stolf ◽  
Gilmar Geraldo dos Santos ◽  
Victor L. S. Haddad
Keyword(s):  
Cardiopulmonary Bypass ◽  
Surgical Resection ◽  
Right Atrium ◽  
Circulatory Arrest ◽  
Vena Cava ◽  
Radical Resection ◽  
Abdominal Tumors ◽  
Cardiac Symptoms ◽  
Intracardiac Extension ◽  
The Right

Abdominal tumors that can grow through vascular lumen and spread to the right heart are rare. Although these tumors have different histologic aspects, they may cause similar abdominal and cardiac symptoms and are a serious risk factor for pulmonary embolism and sudden death when they reach the right atrium and tricuspid valve. The best treatment is radical surgical resection of the entire tumor using cardiopulmonary bypass with or without deep hypothermia and total circulatory arrest. We report the cases of two patients, the first with leiomyosarcoma of the inferior vena cava and the other with intravenous leiomyomatosis of the uterus that showed intravascular growth up to right atrium and ventricle, who underwent successful radical resection in a one-stage procedure with the use of cardiopulmonary bypass. We discuss the clinical and histologic aspects and imaging diagnosis and review the literature.

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.

Single Venous Return for Mitral Valve Operations

2006 ◽  
Vol 1 (4) ◽  
pp. 165-166 ◽  
Author(s):  
James S. Gammie ◽  
Thomas J. Vander Salm
Keyword(s):  
Mitral Valve ◽  
Right Atrium ◽  
Venous Return ◽  
Venous Drainage ◽  
Venous Cannulation ◽  
Right Heart ◽  
The Right ◽  
Cardiac Surgeons

Objective Most cardiac surgeons routinely perform bicaval venous cannulation for mitral valve operations. We describe the technique and advantage of a single-venous cannulation strategy. Methods/Results Single venous cannulation with a 29-French small-bore cannula (facilitated by vacuum-assisted venous drainage) yields reliable decompression of the right heart and affords outstanding exposure of the mitral valve. Conclusions We recommend and use this technique for all mitral valve operations not requiring opening the right atrium.

A clinical comparison of bubble elimination in Quadrox and Polystan oxygenators

Perfusion ◽  
2009 ◽  
Vol 24 (6) ◽  
pp. 423-427 ◽  
Author(s):  
Mario Jirschik ◽  
Cornelius Keyl ◽  
Friedhelm Beyersdorf
Keyword(s):  
Heart Surgery ◽  
Fiber Material ◽  
Venous Drainage ◽  
Venous Cannulation ◽  
Neurocognitive Dysfunction ◽  
Cannulation Site ◽  
Membrane Oxygenators ◽  
Possible Cause ◽  
Bubble Counter ◽  
Study Hypothesis

Background: Microbubbles generated during heart surgery on extracorporeal circulation have been implicated as a possible cause of postoperative neurocognitive dysfunction and negative outcome. The main sources of microbubbles in the extracorporeal circuit are air leaking from the venous cannulation site, air delivered by drug and volume administration, during the taking of blood samples, during hemofiltration, and by using vacuum-assisted venous drainage (VAVD). Membrane oxygenators, although not designed for the elimination of gaseous microbubbles, can eliminate much of this air. Aim of the study / hypothesis: The aim of this study was to test the hypothesis that the amount of microbubbles passing through the oxygenator varies depending on the oxygenator design. Methods: one hundred patients undergoing aortic valve replacement with cardiopulmonary bypass (CPB) were included in a retrospective clinical trial assessing the bubble elimination of the two oxygenators routinely used in our clinic. The oxygenators (Quadrox-i Adult / Polystan Safe Maxi) are manufactured with the same hollow-fiber material, but display different designs. Bubbles were detected by a two-channel ultrasound bubble counter. The probes were placed directly at the inlet and the outlet of the oxygenators. The filtration index was calculated by the bubble counter as a measure of the percentage reduction of bubble volume and number. Results: The Quadrox has a significantly higher filtration index (92.3% [89.7; 95.1], median [25th,75th percentile]) than the Polystan (74.9% [64.2;80.9], p<0.001), indicating the superior ability of the Quadrox to eliminate microbubbles. Conclusion: Our study demonstrates major differences in the capacity of bubble elimination of the oxygenators being investigated, possibly depending on oxygenator design.

Removal of Renal Cell Carcinoma Extending into the Right Atrium using Cardiopulmonary Bypass, Profound Hypothermia and Circulatory Arrest

1984 ◽  
Vol 131 (5) ◽  
pp. 945-947 ◽  
Author(s):  
Robert J. Krane ◽  
Ralph Devere White ◽  
Sev Davis ◽  
Rosalyn Sterling ◽  
Dusan B. Dobnik ◽  
...  
Keyword(s):  
Renal Cell Carcinoma ◽  
Cardiopulmonary Bypass ◽  
Cell Carcinoma ◽  
Right Atrium ◽  
Renal Cell ◽  
Circulatory Arrest ◽  
Profound Hypothermia ◽  
The Right

scholarly journals Inflammatory Myofibroblastic Tumor of the Right Atrium

2010 ◽  
Vol 2010 ◽  
pp. 1-4 ◽  
Author(s):  
Neerod K. Jha ◽  
Michel Trudel ◽  
Gregory P. Eising ◽  
Peter Lange ◽  
Awatif Al Sousi ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Right Atrium ◽  
Inflammatory Myofibroblastic Tumor ◽  
Circulatory Arrest ◽  
Vena Cava ◽  
Diagnostic Tools ◽  
Cardiac Tumors ◽  
Molecular Features ◽  
Biological Potential ◽  
The Right

Cardiac inflammatory myofibroblastic tumor (IMT) is a rare entity and is associated with distinct clinical, pathological and molecular features. The clinical behavior, natural history, biological potential, management and prognosis of such tumors are unclear. We present herewith an adolescent girl who presented with similar entity involving the junction of the right atrium and the inferior vena cava (IVC) in association with thrombocytosis and IVC thrombosis leading to obstruction of blood flow. Diagnostic tools included imaging and immuno-histopathology studies. Surgical management included resection of the tumor and thrombo-embolectomy of the IVC under cardiopulmonary bypass. This case is unique due to association of complete obstruction of IVC caused by the strategic location of the tumor, thrombosis of vena cava and association of thrombocytosis. These features have not been reported yet in relation to the cardiac IMT. This report will help in better understanding and management of similar cases in terms of planning cannulation of femoral veins or application of total hypothermic circulatory arrest during cardiopulmonary bypass and prompt us to look for recurrence or metastasis during follow up using echocardiography and laboratory investigations. The possibility of IMT should be kept in the differential diagnosis of cardiac tumors especially in children and adolescents.

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