scholarly journals Angioplasty balloon occlusion of LIMA graft in reoperations of patients with prosthetic valve endocarditis and patent LIMA-LAD graft

2021 ◽  
Author(s):  
Ivilin Todorov ◽  
Zdravka P. Todorova ◽  
Dimitar P. Nikolov
Keyword(s):  
Cardiac Surgery ◽  
Prosthetic Valve ◽  
Prosthetic Valve Endocarditis ◽  
Balloon Occlusion ◽  
Coronary Surgery ◽  
Refractory Heart Failure ◽  
Group A ◽  
Long Term Prognosis ◽  
Group B ◽  
Design And Methods

Background: Myocardial protection in reoperations in cardiac surgery is extremely difficult in patients with previous coronary surgery and a working LIMA-LAD graft, and it largely determines the outcome of surgery and long-term prognosis. We use a the method of percutaneous angiographic balloon LIMA occlusion and cardioplegic arrest. Aims: The aim of this study was to compare the data of patients with angiographic balloon LIMA-occlusion and those without occlusion in operations related to PVE, and previous coronary surgery with permeable LIMA graft, determining the degree of safety and benefits of method. Study design and Methods: A total of 20 patients undergoing surgery for prosthesis valve endocarditis with patent LIMA-LAD graft were analyzed retrospectively. We divide the patients into 2 groups. Group A patients - with LIMA occlusion and Group B patients - without LIMA occlusion). The pre-, intra- and postoperative results were compared and the degree of safety and benefits of the application of the method were studied. Results: 80% of patients in group A needed only dopamine infusion and 20% needed the addition of a second catecholamine (Adrenaline) at the end of CPB. In group B, the need for double catecholamine maintenance is in 50% of patients. The need for implantation of an intra-aortic balloon pump due to refractory heart failure was registered in 10% of patients in group A and in 20% of patients in group B. It was found that the average duration of mechanical ventilation in group A is 10.5 hours postoperatively, and in group B - 12.5 hours. The mean duration of catecholamine infusion in both groups was 3 days. The average stay in intensive care is shorter for patients in Group A - 2.5 days, and in Group B is 3.5 days. In terms of survival - mortality in the group with LIMA occlusion is 0%, while in the group without LIMA occlusion is 20%. Conclusion: Our reported results from the use of the LIMA balloon occlusion method in patients with prosthetic valve endocarditis who are high-risk and complicated patients and nevertheless the mortality in this group studied by us is 0% and no serious complications of the applied method have been registered. Therefore, we believe that the angiographic balloon LIMA occlusion is a reliable, easily applicable and relatively safe technique that improves the surgical results and prognosis of patients in need of reoperative cardiac surgery.

scholarly journals Prophylactic temporary abdominal aortic balloon occlusion for patients with pernicious placenta previa: a retrospective study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Fei Huo ◽  
Hansheng Liang ◽  
Yi Feng
Keyword(s):  
Placenta Previa ◽  
Balloon Occlusion ◽  
Artery Embolism ◽  
Abdominal Aortic ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
Clinical Records ◽  
Group D ◽  
Central Placenta Previa

Abstract Background Pernicious placenta previa (PPP) can increase the risk of perioperative complications. During caesarean section in patients with adherent placenta, intraoperative blood loss, hysterectomy rate and transfusion could be reduced by interventional methods. Our study aimed to investigate the influence of maternal hemodynamics control and neonatal outcomes of prophylactic temporary abdominal aortic balloon (PTAAB) occlusion for patients with pernicious placenta previa. Methods This was a retrospective study using data from the Peking University People’s Hospital from January 2014 through January 2020. Clinical records of pregnant women undergoing cesarean section were collected. Patients were divided into two groups: treatment with PTAAB placement (group A) and no balloon placement (group B). Group A was further broken down into two groups: prophylactic placement (Group C) and balloon occlusion (group D). Results Clinical records of 33 cases from 5205 pregnant women underwent cesarean section were collected. The number of groups A, B, C, and D were 17, 16, 5 and 12.We found that a significant difference in the post-operative uterine artery embolism rates between group A and group B (0% vs.31.3%, p = 0.018). There was a significant difference in the Apgar scores at first minute between group A and group B (8.94 ± 1.43 vs 9.81 ± 0.75,p = 0.037),and the same significant difference between two groups in the pre-operative central placenta previa (29.4% vs. 0%,p = 0.044), complete placenta previa (58.8% vs 18.8%, p = 0.032),placenta implantation (76.5% vs 31.3%, p = 0.015). We could also observe the significant difference in the amount of blood cell (2.80 ± 2.68vs.10.66 ± 11.97, p = 0.038) and blood plasma transfusion (280.00 ± 268.32 vs. 1033.33 ± 1098.20, p = 0.044) between group C and group D. The significant differences in the preoperative vaginal bleeding conditions (0% vs 75%, p = 0.009), the intraoperative application rates of vasopressors (0% vs. 58.3%, p = 0.044) and the postoperative ICU (intensive care unit) admission rates (0% vs. 58.3%, p = 0.044) were also kept. Conclusions PTAAB occlusion could be useful in reducing the rate of post-operative uterine artery embolism and the amount of transfusion, and be useful in coping with patients with preoperative vaginal bleeding conditions, so as to reduce the rate of intraoperative applications of vasopressors and the postoperative ICU (intensive care unit) admission. In PPP patients with placenta implantation, central placenta previa and complete placenta previa, we advocate the utilization of prophylactic temporary abdominal aortic balloon placement.

Abstract 1667: Early Childhood Mental Development After Transfusion-free Cardiac Surgery On Cardiopulmonary Bypass: A Multi-institutional Study

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Tomohiko Ukai ◽  
Takenori Adachi ◽  
Atsusi Numaguchi ◽  
Daichi Fukumi ◽  
Toshiaki Yasuda ◽  
...  
Keyword(s):  
Early Childhood ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Brain Dysfunction ◽  
Hemoglobin Level ◽  
Mental Development ◽  
Blood Products ◽  
Surgical Closure ◽  
Group A ◽  
Group B

Background: The use of blood products is often necessary to prime the extracorporeal circuits for pediatric cardiac surgical patients. The use of blood products carries serious risks both in the acute and long-term aspects of patient care. However, excessive hemodilution during cardiopulmonary bypass (CPB) is associated with decreased oxygen carrying capacity, edema, and organ dysfunction. Especially, whether brain dysfunction after transfusion-free cardiac surgery on CPB occurred is unknown. Objective: This study aims to investigate whether excessive hemodilution affects child’s mental development. Methods: We studied 143 infants (24.2 +/− 15.8 months, 5 months ~ 3 years of age) had performed surgical closure of ventricular septal defect (VSD) in less than 12 months (4.8 +/− 2.6 months) of age in 7 children’s hospitals. Questionnaires mailed to the parents included the Tsumori-Inage Infant Developmental Scale estimating subjects’ behavioral developmental level as Developmental Quotients (DQ). The infants were divided into 3 groups; transfusion-free (Group A, n=52), transfusion during CPB (Group B, n=24) and transfusion after CPB (Group C, n=66). Results: Lower DQ was found for Group A (94.7 +/− 11.6) than Group B (103.5 +/− 16.0, p=0.008) and Group C (101.7 +/− 17.9, p=0.016). No correlation was found between DQ and minimum hemoglobin level during CPB (min-Hb) in Group A. The DQ was likely to be lower in the infants with below 6 g/dl (93.0 +/− 13.0) than with over 6 g/dl (98.7 +/− 8.3. p=0.10) of min-Hb. Conclusions: The results suggest that the infants after transfusion-free surgery of VSD on CPB delay in the mental development in their early childhood. Maintaining minimum hemoglobin level over 6 g/dl during CPB seems to prevent the mental development from delay.

scholarly journals Redo cardiac surgery for active prosthetic valve endocarditis associated with hereditary hemorrhagic telangiectasia: report of a case

Surgery Today ◽  
2014 ◽  
Vol 44 (12) ◽  
pp. 2378-2381 ◽  
Author(s):  
Yuki Nakamura ◽  
Fumiaki Shikata ◽  
Masahiro Ryugo ◽  
Toru Okamura ◽  
Takumi Yasugi ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Hereditary Hemorrhagic Telangiectasia ◽  
Prosthetic Valve ◽  
Prosthetic Valve Endocarditis

scholarly journals Effect of passive smoking on thyroid function in infants

1998 ◽  
pp. 379-382 ◽  
Author(s):  
A Gasparoni ◽  
M Autelli ◽  
MF Ravagni-Probizer ◽  
A Bartoli ◽  
M Regazzi-Bonora ◽  
...  
Keyword(s):  
Thyroid Gland ◽  
Thyroid Function ◽  
Passive Smoking ◽  
Serum Concentrations ◽  
Free T4 ◽  
Thyroxine Binding Globulin ◽  
Cord Serum ◽  
Group A ◽  
Group B ◽  
Design And Methods

OBJECTIVE: To evaluate the effect of passive smoking on thyroid function in infants. DESIGN AND METHODS: Cord serum tri-iodiothyronine (T3), free T3 (fT3), thyroxine (T4), free T4 (fT4), TSH, thyroxine binding globulin (TBG), thyroglobulin (TG) and cord plasma thiocyanate were measured at birth, and serum TG and thiocyanate after 1 year of life, in 18 infants born from parents who did not smoke (group A), in 18 infants with a father who smoked (group B) and in 18 infants with parents both being smokers (group C). RESULTS: No significant differences were observed in cord serum concentrations of T3, fT3, T4, fT4, TSH and TBG among the three groups. Median (range) TG concentrations (ng/ml) were 30.2 (5.0-102.0), 56.3 (20.5-208.0) and 76.0 (26.0-199.0) at birth (P=0.009 for groups A and B compared; P=0.0002 for groups A and C compared), and 14.9 (5.4-32.0), 19.5 (10.0-57.5) and 20.0 (14.0-40.7) at 1 year (P=0.017 for groups A and C compared), in the three groups respectively, and thiocyanate concentrations (mmol/l) were 3.3 (0.0-51.4), 12.9 (0.0-122.2) and 27.8 (3.3-184.5) at birth (P=0.015 for groups A and C compared), and 3.1 (0.0-32.7), 6.0 (0.0-47.3) and 20.3 (0.0-230.8) at 1 year (P=0.01 for groups A and C compared) in the three groups respectively. CONCLUSIONS: TG and thiocyanate concentrations at birth and at 1 year of age in infants of smoking parents are greater than in infants with non-smoking parents. These results indicate that the change in thyroid function as evaluated by serum TG concentrations observed at birth can persist at least for 1 year if the exposure to passive smoking from both parents is continued. Increased TG concentrations may be due to a direct effect of thiocyanate on the thyroid gland.

Comparison of early and late intravenous infusion of milrinone in children upto 1 year undergoing cardiac surgery.

2020 ◽  
Vol 7 (3) ◽  
pp. 67-72
Author(s):  
• Dr. Milind Pol ◽  
Dr. Kajalkumari Jain ◽  
Dr. Sunil Natha Mhaske
Keyword(s):  
Cardiac Surgery ◽  
Randomized Study ◽  
Central Venous Oxygen Saturation ◽  
Serum Lactate ◽  
Loading Dose ◽  
Low Cardiac Output Syndrome ◽  
Arterial Blood ◽  
Group A ◽  
Lactate Levels ◽  
Group B

Objective:  To compare the effects of early and late use of milrinone in children upto 1  year undergoing complex cardiac surgery. Study design:- prospective randomized study. Methods: A prospective study involved 30 children undergoing congenital corrective cardiac surgery,classified randomly into two groups. Group A: Milrinone infusion  was started without loading dose at  0.5mcg/kg/min at the beginning of CPB and continued postoperatively (0.5-0.75 mcg/kg/min) in the paediatric cardiac surgical ICU . Group B: Milrinone was started as a loading dose of 50mcg/kg over 10 min after aortic declamping and continued as infusion  postoperatively at 0.5-0.75 mcg/kg/min  in the pediatric cardiac surgical ICU.Data were collected at baseline, 1st ,6th  and  12th   postoperative hours in the ICU. Results: The inotropic supports and mechanical supports were needed more in group B than group A. The comparison of heart rate, CVP were insignificant between the two groups (P>0.05). The mean arterial blood pressure through the first 6 hours postoperatively was higher in group A than group B (P<0.05), but became insignificant through other timepoints. The urine output and central venous oxygen saturation were higher in group A than group B (P<0.05).The serum lactate levels were significantly higher in group B more than group A (P<0.05). Conclusion:Early use of milrinone, lead to easy weaning from Cardiopulmonary bypass, decreased requirement of pharmacological and mechanical support and decreased incidence of low cardiac output syndrome after pediatric cardiac surgery and there was no complications related to milrinone in our study patients.

Estrogen receptor in HER2-positive early breast cancer: Two different diseases?

2012 ◽  
Vol 30 (15_suppl) ◽  
pp. 642-642 ◽  
Author(s):  
Eva Maria Ciruelos Gil ◽  
Ismael Ghanem ◽  
Luis Manso ◽  
Sergio Hoyos ◽  
Carlos Castañeda ◽  
...  
Keyword(s):  
Breast Cancer ◽  
Study Groups ◽  
Her2 Overexpression ◽  
Her2 Positive ◽  
Ki 67 ◽  
Luminal B ◽  
Her2 Breast Cancer ◽  
Group A ◽  
Long Term Prognosis ◽  
Group B

642 Background: HER2+ breast cancer (BC) is a well characterized subtype of BC, due to the predictive value of HER2 overexpression for anti-HER2 targeted therapies. Nevertheless, around 50% of HER2+ BC are ER+ and clasiffied as luminal B/HER2+, but their biological and clinical behaviour may be different from HER2+/ER- tumors. Methods: We retrospectively reviewed 347 HER2+ (Herceptest +++ or FISH+) early BC patients (see Table) diagnosed at our institution in 1997-2007, and were divided into two study groups: HER2+/ER+ (group A) and HER2+/ER- (group B). ER+ was defined if expressed in > 10% tumor cells. Results: See table below. Mean age: 54.7 y (44.6 – 65). Mean Ki 67 was higher in B (37,2 vs 22,4%, p<0.0001). At the current FU, n¼ of events were insufficient to reach median DFS/OS. Mean DFS was 6.9 y (3.5 – 10.2); recurrent disease was higher (p 0.003) for B (54 pts, 43%) vs A (62 pts, 28%). 5-year DFS estimates: 78.4 % (95% CI 72.3 – 83.3) and 62.3 % (95% CI 53 – 70.27) for A and B, and 10-year DFS was 73.4% (95% CI 66.6 – 79) and 52.5% (95% CI 42.4 – 61.6) for A and B, respectively (p 0.0006). Most common recurrent sites were local (18) and bone (9) for HER2+/ER+ and liver (8) and lung (8) for HER2+/ER-. Mean OS was 8.03y (5.4 – 10.8); 28 (12,6%) pts died in A, vs 26 (21%) in B (p 0.043). 5-year OS estimates: 93.9 % (95% CI 89.7 – 96.4) and 87.6 % (95% CI 80.3 – 92.3) for A and B, and 10-year DFS was 84.2% (95% CI 77.5 – 89.0) and 74.1% (95% CI 63.4 – 82.2) for A and B, respectively (p 0.01). Conclusions: ER expression in HER2+ early BC defines two clinically distinct diseases with different long-term prognosis. These data may help to better individualize adjuvant therapies and future clinical trial designs. [Table: see text]

scholarly journals Clinical Outcome and Long-Term Prognosis of Late Prosthetic Valve Endocarditis: A 20-Year Experience

1997 ◽  
Vol 24 (3) ◽  
pp. 381-386 ◽  
Author(s):  
P. Tornos ◽  
B. Almirante ◽  
M. Olona ◽  
G. Permanyer ◽  
T. Gonzalez ◽  
...  
Keyword(s):  
Clinical Outcome ◽  
Prosthetic Valve ◽  
Prosthetic Valve Endocarditis ◽  
Long Term Prognosis

scholarly journals Is Additional Cardiac Procedure A Catastrophic Risk During Bentall Operation? Long Term Results in A Tertiary Center

2021 ◽  
Vol 16 (5) ◽  
Author(s):  
Mehmet Ali Yesiltas
Keyword(s):  
Cardiac Surgery ◽  
Long Term Results ◽  
Mortality And Morbidity ◽  
Single Center Experience ◽  
Bentall Procedure ◽  
Cardiac Procedure ◽  
Tertiary Center ◽  
Surgical Data ◽  
Group A ◽  
Group B

The aim of this study was to assess the influences of concomitant cardiac surgery on the risk for mortality and morbidity after Bentall procedure. This retrospective study was a review of patients who underwent Bentall procedure from a single center experience over a 7-year period. Demographic features, surgical data, postoperative period and outcomes were analyzed. Patients with isolated Bentall surgery (Group A) were compared and concomitant cardiac surgery with Bentall procedure were compared (Group B).

scholarly journals COMPARISON OF INTRANASAL DEXMEDETOMIDINE V/S MIDAZOLAM AS A PREMEDICATION IN CHIDREN WITH CONGENITAL HEART DISEASE UNDERGOING CARDIAC SURGERY

2021 ◽  
Vol 9 (01) ◽  
pp. 814-822
Author(s):  
Sanjay Kumar Morwal ◽  
Ajit Singh ◽  
C.K. Vyas ◽  
Neelu Sharma
Keyword(s):  
Congenital Heart Disease ◽  
Cardiac Surgery ◽  
Heart Disease ◽  
Congenital Heart ◽  
Arterial Blood ◽  
Sedative Effects ◽  
Group A ◽  
Child Separation ◽  
Group B ◽  
Intranasal Midazolam

Background: The intranasal route is a reliable way to administer preanaesthetics and sedatives to children. The aim of present study was to compare the anxiolytic and sedative effects of intranasal dexemedetomidine and midazolam as a premedication in children with congenital heart disease undergoing cardiac surgery.. Patients and Methods: Fifty chidrens 2-12 years of age group of either sex with congenital heart disease undergoing cardiac surgery were randomly allocated into two groups. Group A-(n=25) - received intranasal dexmedetomidine as premedication.(0.1 µg/kg diluted in 2ml NS ) Group B- (n=25)- received intranasal midazolam as premedication. (0.2 mg/kg diluted in 2ml NS) Heart rate, mean arterial blood pressure and oxygen saturation were monitored upto30 minute after drug administration. The sedation score, anxiety score and child separation score were recorded until the child taken to the OR. The postoperative agitation score was also observed. Results and Conclusion: Premedication with intranasal dexmedetomidine attained significant and satisfactory sedation with better parental separation and lower anxiety levels without any adverse effects as compared with intranasal midazolam in children with congenital heart disease undergoing cardiac surgery.

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