Surgical management for the late onset lifethreatening tachycardia after open heart surgery.

Background: Cardiac device-related endocarditis has emerged as a serious complication in the era of advanced medical technology. Pacemaker related infections are rare and life-threatening with incidence from 0.06% to 7% and high mortality rate (30-35%). Diagnosis is hard, frequently delayed and could be even missed due to poor clinical findings. The average delay in diagnosis is 5.5 month. We report a case of the late-onset of pacemaker lead endocarditis caused by S. epidermidis successfully treated with open heart surgery. Case Report: Patient with persistent high fever for 11 month and suspicion for infective endocarditis was admitted in Cardiovascular Institute. No clinical signs of endocarditis were observed. TTE revealed large vegetation 30 × 17 mm attached to the atrial electrodes with high embolic potential. This finding was verified by transesophageal echocardiography (TEE), although CT scan did not reveal vegetation. Blood cultures were negative. A sternotomy with cardiopulmonary bypass was performed and electrodes were extracted with large vegetation. Intraoperative finding revealed large thrombus with vegetation around pacemaker leads. Cultures of the electrodes and vegetation revealed Staphylococcus epidermidis. Surgery was followed up with antibiotic treatment for 6 weeks. He has been followed up for the next 2 years, and without complications. Conclusion: The absence of criteria for endocarditis and negative blood cultures should not keep the physician from ruling out lead endocarditis. This complication carries high risk of mortality if left untreated.

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Posttraumatic Growth following Open-heart Surgery: The Role of Religious Coping and the Underlying Mechanism

PsycEXTRA Dataset ◽

10.1037/e576422013-001 ◽

2013 ◽

Author(s):

Amy Ai

Keyword(s):

Posttraumatic Growth ◽

Religious Coping ◽

Heart Surgery ◽

Open Heart Surgery ◽

Underlying Mechanism ◽

Open Heart

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The Hemostatic Mechanism after Open-Heart Surgery

Thrombosis and Haemostasis ◽

10.1055/s-0038-1646707 ◽

1978 ◽

Vol 39 (02) ◽

pp. 474-487 ◽

Cited By ~ 2

Author(s):

E R Cole ◽

F Bachmann ◽

C A Curry ◽

D Roby

Keyword(s):

Extracorporeal Circulation ◽

Heart Surgery ◽

Polyacrylamide Gel Electrophoresis ◽

Open Heart Surgery ◽

Coagulation System ◽

Open Heart ◽

Time Activity ◽

Post Surgery ◽

Plasma Fractions ◽

The Mean

SummaryA prospective study in 13 patients undergoing open-heart surgery with extracorporeal circulation revealed a marked decrease of the mean one-stage prothrombin time activity from 88% to 54% (p <0.005) but lesser decreases of factors I, II, V, VII and X. This apparent discrepancy was due to the appearance of an inhibitor of the extrinsic coagulation system, termed PEC (Protein after Extracorporeal Circulation). The mean plasma PEC level rose from 0.05 U/ml pre-surgery to 0.65 U/ml post-surgery (p <0.0005), and was accompanied by the appearance of additional proteins as evidenced by disc polyacrylamide gel electrophoresis of plasma fractions (p <0.0005). The observed increases of PEC, appearance of abnormal protein bands and concomitant increases of LDH and SGOT suggest that the release of an inhibitor of the coagulation system (similar or identical to PIVKA) may be due to hypoxic liver damage during extracorporeal circulation.

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Blood Coagulation Studies and Extracorporeal Circulation in Man

Thrombosis and Haemostasis ◽

10.1055/s-0038-1655073 ◽

1967 ◽

Vol 18 (03/04) ◽

pp. 634-646 ◽

Cited By ~ 6

Author(s):

N Thurnherr

Keyword(s):

Blood Coagulation ◽

Extracorporeal Circulation ◽

Blood Clotting ◽

Heart Surgery ◽

Open Heart Surgery ◽

Fibrinolytic System ◽

Open Heart ◽

Clotting Factors ◽

Blood Clotting Factors

SummaryBlood clotting investigations have been executed in 25 patients who have undergone open heart surgery with extracorporeal circulation. A description of alterations in the activity of blood clotting factors, the fibrinolytic system, prothrombin consumption and platelets during several phases of the operation is given.

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Coagulation- and fibrinolysis-alterations in open heart surgery

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2005-922376 ◽

2005 ◽

Vol 53 (S 3) ◽

Author(s):

U Boeken ◽

P Feindt ◽

J Litmathe ◽

E Gams

Keyword(s):

Heart Surgery ◽

Open Heart Surgery ◽

Open Heart ◽

Coagulation And Fibrinolysis

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Open heart surgery and repair of complex abdominal aortic aneurysms – early and long-term results of a simultaneous approach

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2007-967411 ◽

2007 ◽

Vol 55 (S 1) ◽

Author(s):

A Rastan ◽

M Luduena ◽

R Battelini ◽

T Walther ◽

J Kempfert ◽

...

Keyword(s):

Heart Surgery ◽

Open Heart Surgery ◽

Abdominal Aortic Aneurysms ◽

Aortic Aneurysms ◽

Long Term Results ◽

Open Heart ◽

Simultaneous Approach ◽

Abdominal Aortic

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Open heart surgery in patients with cold agglutinins: Is the fear justified?

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-2007-967644 ◽

2007 ◽

Vol 55 (S 1) ◽

Author(s):

N Madershahian ◽

T Wittwer ◽

J Strauch ◽

J Wippermann ◽

UFW Franke ◽

...

Keyword(s):

Heart Surgery ◽

Open Heart Surgery ◽

Open Heart ◽

Cold Agglutinins

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Evaluation of Positive Inotropic Drug Effects on Thyroid Hormone Levels after Open Heart Surgery

The Heart Surgery Forum ◽

10.1532/hsf98.20121084 ◽

2015 ◽

Vol 16 (2) ◽

pp. 78

Author(s):

Umit Kervan ◽

Anil Ozen ◽

Utku Unal ◽

Irfan Tasoglu ◽

Mahmut Mustafa Ulas ◽

...

Keyword(s):

Drug Therapy ◽

Thyroid Hormone ◽

Heart Surgery ◽

Open Heart Surgery ◽

Open Heart ◽

Inotropic Drug ◽

Hormone Levels ◽

Inotropic Drugs ◽

Positive Inotropic Drug ◽

Thyroid Hormone Levels

Objective: The aim of this study was to examine the effects of positive inotropic drugs, including adrenaline, dopamine, and dobutamine on thyroid hormone levels following open heart surgery.Methods: We analyzed free thyroid hormones (FT3 and FT4) and thyroid-stimulating hormones (TSH) in 200 consecutive patients undergoing open heart surgery. Patients were divided into 5 groups according to the inotropic drug administration as follows: Group A (n = 46) received dopamine alone; Group B (n = 40), dopamine and dobutamine; Group C (n = 36), dopamine, dobutamine, and adrenaline; Group D (n = 32), adrenaline alone; and Group E (n = 46), placebo. Procedural factors affecting thyroid hormones were recorded and included cardiopulmonary bypass (CPB) time, cross-clamping time, degree of hypothermia, and the duration and doses of positive inotropic drugs. Blood samples for hormone assays were collected before initiation of inotropic drug therapy (baseline) and postoperatively at 24, 72, and 120 hours after drug therapy.Results: FT3, FT4, and TSH levels at baseline were similar in all groups. Although there was a trend showing very slight increases in thyroid hormone levels from baseline to the 24th, 72nd, and 120th postoperative hours after drug therapy, these changes were not significant, and there were also no significant differences between the groups. There was also no significant statistical difference in CPB time, cross-clamping time, degree of hypothermia, and duration and doses of positive inotropic drugs between groups.Conclusion: Although thyroid hormone levels were affected by positive inotropic drug usage after open heart surgery, this effect was not significant and thyroid hormone levels remained within normal ranges.

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