scholarly journals Hypertrophied Papillary Muscle causing Mid Cavity Left Ventricular Obstruction after Cardiac Surgery

2015 ◽  
Vol 3 (1) ◽  
pp. 32-34
Author(s):  
Ajay Bahl ◽  
Shyam Singh Thingnum
Keyword(s):  
Elderly Patient ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Papillary Muscle ◽  
Muscle Hypertrophy ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Left Ventricular ◽  
Atypical Presentation ◽  
Contractile State

ABSTRACT A rare cause of mid cavity left ventricular obstruction can be a hypertrophied and/or a malformed papillary muscle. Hypertrophy of papillary muscle can be atypical presentation of hypertrophic obstructive cardiomyopathy. Most of these patients do not have a resting gradient, but a dynamic gradient can occur in hypovolumia or increased contractile state. We present a case of elderly patient who had a hypertrophied anterolateral papillary muscle and developed mid left ventricular obstruction after weaning the patient from cardiopulmonary bypass. How to cite this article Dutta V, Raj R, Bahl A, Thingnum SS, Puri GD. Hypertrophied Papillary Muscle causing Mid Cavity Left Ventricular Obstruction after Cardiac Surgery. J Perioper Echocardiogr 2015;3(1):32-34.

scholarly journals 83 The predictive role of neutrophil-to-lymphocyte ratio in post-operative cardiopulmonary bypass surgery

2021 ◽  
Vol 23 (Supplement_G) ◽  
Author(s):  
Valentina Bucciarelli ◽  
Francesco Bianco ◽  
Annaclara Blasi ◽  
Martina Primavera ◽  
Baldinelli Alessandra ◽  
...  
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Pediatric Patients ◽  
Septal Defect ◽  
Left Ventricular ◽  
Conduction System ◽  
Neutrophil To Lymphocyte Ratio ◽  
Lymphocyte Ratio ◽  
Predictive Role

Abstract Aims Postoperative arrhythmias (POA) are a common complication after cardiac surgical repairs for congenital heart disease (CHD), representing a substantial source of morbidity, mortality, and prolonged total in-hospital stay, with an incidence of 7.5–48% in postoperative pediatric cardiac patients. The etiology is multifactorial, and it has been related to the direct surgical manipulation of the cardiac conduction system, to the local tissue inflammation in the myocardium adjacent to the conduction system and to the arrhythmogenic effects of cardiopulmonary bypass (CPB), inotropes, and electrolyte disturbances. Recently, the prognostic role of neutrophil-to-lymphocyte ratio (NLR), a novel inflammation marker, has been evaluated in pediatric patients after CPB surgery. To evaluate the predictive role of NLR in POA in a population of pediatric CHD patients after CPB. Methods and results We retrospectively collected perioperative clinical and laboratory data of 146 patients (age 8.27 ± 10.79 years; male gender: 60.8%) consecutively admitted to the cardiac surgery intensive care unit (ICU) of our institute after elective cardiac surgery with CPB in 2018. We grouped and analyzed our population over NLR tertiles evaluated at 24 h from CPB and types of POA: supraventricular (SVT) and junctional (JET). The prognostic value of NLR and its association with POA was analyzed. Diagnoses of 146 patients included atrial septal defect (n = 36), ventricular septal defect (n = 20), pulmonary atresia/stenosis (n = 10), tetralogy of Fallot (n = 20), endocardial cushion defect (n = 8), left ventricular outflow tract obstruction (n = 14), anomalous origin of coronary artery (n = 6), complex CHD (n = 13), interrupted/hypoplastic aortic arch (n = 12), anomalous pulmonary venous return (n = 3). The mean CPB time was 121.6 ± 84.6 min. The median ICU hospitalization was 48 h [Q1, Q3: 24, 96]. Twelve patients experienced POA: 6 SVT and 6 JET. The frequency of POA incremented over NLR-tertiles (P-Trend 0.017), while SVT onset was associated with higher values of NLR and C-reactive protein (P = 0.034 and P = 0.011, respectively). Patients in the second and third tertiles of NLR had a prolonged hospitalization (log-rank, P = 0.029), especially when associated with POA (log-rank, P = 0.012). At the multivariable analysis, higher age and NLR values were independently associated with SVT [OR per year 1.22; 95% CI (1.02, 1.25), P = 0.043 and OR per point 1.91; 95% CI (1.29, 2.82), P = 0.012, respectively], but not with JET. Conclusions 24-h post-CPB NLR can predict postoperative SVT in a population of pediatric CHD patients. Our data suggest that the NLR could be a useful, easy-to-obtain marker for postoperative outcome in pediatric patients who had undergone elective CPB.

scholarly journals Muscular Mitral Chord Contribution to Left Ventricular Outflow Tract Obstruction in HOCM

2019 ◽  
Vol 08 (01) ◽  
pp. e18-e19
Author(s):  
Olayinka Ogunmuyiwa ◽  
Philipp Rellecke ◽  
Artur Lichtenberg ◽  
Alexander Assmann
Keyword(s):  
Papillary Muscle ◽  
Ventricular Outflow Tract ◽  
Hypertrophic Obstructive Cardiomyopathy ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Systolic Anterior Motion ◽  
Mitral Leaflet ◽  
Anterior Mitral Leaflet ◽  
Septal Myectomy ◽  
Left Ventricular Outflow

AbstractPapillary muscle anomaly with a muscular chord directly attached to the anterior mitral leaflet is a rare mitral valve disease. A 62-year-old man with systolic anterior motion of the anterior mitral leaflet and hypertrophic obstructive cardiomyopathy presented to surgical intervention after unsuccessful transcoronary ablation of septal hypertrophy with alcohol. Intraoperative findings revealed a primarily not detected anomalous muscular mitral chord (0.8 × 2.2 cm) connecting the base of the A1 segment to the anterolateral papillary muscle. Resection of this chord and additional septal myectomy treated systolic anterior motion and obstruction of the outflow tract. In spite of the infrequent occurrence, anomalies of the subvalvular apparatus, such as muscular chords, should be ruled out by thorough transesophageal echocardiography imaging before decision on the therapeutical strategy.

Anesthetic Management of an Elderly Patient with Dilated Cardiomyopathy and Hypothyroidism for Inter-Trochanteric Fracture

2019 ◽  
Vol 9 (3) ◽  
pp. 97-99
Author(s):  
Deepika Subedi ◽  
Diptesh Aryal ◽  
Anil Shrestha
Keyword(s):  
Elderly Patient ◽  
Cardiac Surgery ◽  
Dilated Cardiomyopathy ◽  
Spinal Anesthesia ◽  
Surgical Repair ◽  
Anesthetic Management ◽  
Trochanteric Fracture ◽  
Anaesthetic Management ◽  
Left Ventricular ◽  
Perioperative Morbidity

   Dilated cardiomyopathy is a primary myocardial disease charac­terized by left ventricular or biventricular dilation and impaired contractility. The anesthetic management of a patient with dilat­ed cardiomyopathy undergoing a non-cardiac surgery is always challenging and may be associated with high mortality. Further­more, perioperative morbidity becomes more frequent in the el­derly with steep increases after the age of 75. We are reporting the successful anaesthetic management of a 93 years old patient with severe dilated cardiomyopathy planned for surgical repair of inter-trochanteric fracture under combined spinal anesthesia.

Abstract 1553: Comparative Gene Expression Analysis of Blood and Heart Identifies Genomic Predictors of Myocardial Injury Following Cardiopulmonary Bypass and Cardioplegic Arrest in the Rat

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Mihai V Podgoreanu ◽  
Kenji Yoshitani ◽  
Adrian Dobra ◽  
Qing Ma ◽  
Bin Zhu ◽  
...  
Keyword(s):  
Gene Expression ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Myocardial Injury ◽  
Expression Profiles ◽  
Left Ventricular ◽  
Male Rats ◽  
Cardioplegic Arrest ◽  
Fatty Acid Binding ◽  
Tissue Specific

Background: Perioperative myocardial injury (PMI) complicating cardiac surgery remains poorly predicted by clinical risk factors. In a novel rat model of cardiopulmonary bypass (CPB) and cardioplegic arrest (CA) we tested the hypothesis that microarray expression profiles in peripheral blood leukocytes (PBL) can accurately predict degree of PMI, and compared genomic signatures in left ventricular myocardium (LVM) and PBL to identify PMI-associated genes that generalize across tissues. Methods: Male rats subjected to CPB only (75 min), CPB with CA (30 min), and sham surgery (n=5 each) had plasma heart fatty acid binding protein (HFABP) and cardiac troponin I (cTnI) measured 1 hour post CPB and microarray profiling of total RNA from LVM and PBL. PMI genomic classification models were constructed using shotgun stochastic search approach and Bayesian model averaging and their accuracy tested by five-fold cross validation. Results: A spectrum of PMI was observed in the experimental groups as well as robust deregulation of gene expression in a stimulus and tissue-specific manner (Figure ). Estimates of PMI classification accuracy from PBL and LVM are presented in Table . Conclusions: Cardiac surgery induces changes in leukocyte gene expression that predict the spectrum of PMI, with potential applications in perioperative risk stratification and selection of cardioprotective strategies. Predictive accuracy of tissue-specific myocardial injury genomic classifiers

Factors Facilitating the Success of Fast Endotracheal Extubation after Cardiac Surgery

2021 ◽  
Vol 104 (3) ◽  
pp. 388-395
Keyword(s):  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Low Dose ◽  
Heart Surgery ◽  
Left Ventricular ◽  
Left Ventricular Ejection ◽  
Factors Influencing ◽  
Post Cardiopulmonary Bypass ◽  
One Year ◽  
Endotracheal Extubation

Objective: To study factors influencing fast endotracheal extubation after cardiac surgery. Materials and Methods: A one-year retrospective cohort study conducted via hospital medical informatics, included patients aged over 15 years old that underwent elective valvular heart surgery by means of cardiopulmonary bypass under general anesthesia. Results: Fifty-seven patients were enrolled in the present study including nine (15.8%) as fast endotracheal extubation in the operating theatre, 18 (31.6%) within eight hours postoperatively, and 30 (52.6%) non-fast endotracheal extubation eight hours after surgery. The preoperative and intraoperative factors were a younger age (p=0.018), high % left ventricular ejection function (LVEF) (p=0.023), and low creatinine level (p=0.026), as well as post cardiopulmonary bypass dexmedetomidine (p=0.01), reversal of muscle relaxant (p=0.004), and low dose dobutamine (p=0.003), respectively. However, multiple logistic regression analyses showed only two favorable factors, which were preoperative % LVEF of 60 or more (adjusted OR 11.266, 95% CI 1.700 to 74.664, p=0.012), and the intraoperative low dose dobutamine of 3 μg/kg/minute or less (adjusted OR 6.896, 95% CI 1.463 to 32.510, p=0.015). In addition, there were no significant complications. Conclusion: The factors influencing fast endotracheal extubation were preoperative% LVEF of 60 or more and intraoperative low dose dobutamine of 3 μg/kg/minute or less. Keywords: Cardiac surgery, Fast endotracheal extubation, Valvular heart disease

scholarly journals Kairiojo skilvelio geometrijos ir tūrio atkūrimo operacija: priešoperaciniai ir operaciniai rizikos veiksniai

2007 ◽  
Vol 5 (3) ◽  
pp. 0-0
Author(s):  
Gintaras Kalinauskas ◽  
Robertas Samalavičius ◽  
Arūnas Valaika ◽  
Gediminas Norkūnas ◽  
Jurgis Verižnikovas ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cardiac Surgery ◽  
Cardiopulmonary Bypass ◽  
Coronary Artery ◽  
Hospital Mortality ◽  
Emergency Surgery ◽  
Left Ventricular ◽  
University Hospital ◽  
Dor Procedure ◽  
Vilnius University

Gintaras Kalinauskas1, Robertas Samalavičius2, Arūnas Valaika1, Gediminas Norkūnas1, Jurgis Verižnikovas3, Giedrius Uždavinys11 Vilniaus universiteto Širdies chirurgijos centras, Santariškių g. 2, LT-08661 Vilnius2 Vilniaus universiteto ligoninės Santariškių klinikos, Anesteziologijos,intensyviosios terapijos ir skausmo gydymo centras, Santariškių g. 2, LT-08661 Vilnius3 Vilniaus universiteto ligoninės Santariškių klinikos Širdies chirurgijos centras,Santariškių g. 2, LT-08661 VilniusEl paštas: [email protected] Įvadas / tikslas Ligoniams, kuriems yra poinfarktinė kairiojo skilvelio remodeliacija, reikalinga kairiojo skilvelio geometrijos ir tūrio atkūrimo operacija (Dor procedūra). Parenkant ligonius operacijai svarbu išsiaiškinti, kurie iš priešoperacinių ir operacinių rizikos veiksnių labiausiai turi įtakos operaciniam mirštamumui. Ligoniai ir metodai Tai retrospektyvus tyrimas. Ligoniai buvo operuoti laikotarpiu nuo 2000 metų sausio 1 dienos iki 2006 metų gruodžio 31 dienos. Išnagrinėti 88 ligonių, 69 vyrų ir 19 moterų, kurių amžiaus vidurkis 64,5±9,8 metų ir jiems atliktos aortos vainikinių arterijų jungčių suformavimo ir kairiojo skilvelio geometrijos ir tūrio atkūrimo operacijos (Dor procedūra), priešoperaciniai ir operaciniai duomenys. Rezultatai Iš 88 operuotų ligonių šeši ligoniai mirė, mirštamumas 6,8%. Mirusių ligonių priešoperacinės būklės EuroSCORE įvertinimo balas reikšmingai skyrėsi nuo išgyvenusiųjų (p = 0,0180), tai buvo sunkesni, didesnės rizikos ligoniai. Išaiškėjo, kad mirę ligoniai buvo dažniau operuoti skubos tvarka (p = 0,0077). Jų operacijos truko ilgiau, ilgesnė buvo ir jų dirbtinė kraujo apytaka. Išvados EuroSCORE balais vertinamas priešoperacinės būklės sunkumas, skubi operacija, ilgas operacijos ir dirbtinės kraujo apytakos laikas yra gana reikšmingi veiksniai vertinant operacijos riziką. Pagrindiniai žodžiai: kairiojo skilvelio geometrijos ir tūrio atkūrimo operacija Left ventricular reconstruction: preoperative and operative risk factors Gintaras Kalinauskas1, Robertas Samalavičius2, Arūnas Valaika1, Gediminas Norkūnas1, Jurgis Verižnikovas3, Giedrius Uždavinys11 Vilnius University, Cardiac Surgery Centre, Santariškių str. 2, LT-08661 Vilnius, Lithuania2 Vilnius University Hospital „Santariškių klinikos“, Centre of Anaesthesiology,Intensive Therapy and Pain Management, Santariškių str. 2, LT-08661 Vilnius, Lithuania3 Vilnius University Hospital „Santariškių klinikos“,Cardiac Surgery Centre,Santariškių str. 2, LT-08661 Vilnius, LithuaniaE-mail: [email protected] Background / objective The dor procedure is a surgical option in patients with coronary artery disease and postinfarction left ventricular aneurysm. The aim of this study was to evaluate our clinical experience in this procedure and determine risk factors for in-hospital mortality. Patients and methods This was a retrospective investigation. From January 1, 2000 to December 31, 2006, surgical ventricular restoration was performed in 88 patients (69 males), mean age 64.5 ± 9.8 (42–80) years. Patient with valve repair or replacement were excluded from the study. Results All patients underwent the Dor procedure with coronary artery bypass grafting. Crude mortality rate was 6.8%. Higher EuroSCORE, longer operation and cardiopulmonary bypass time and emergency surgery were univariate predictors of in-hospital mortality. Conclusions The Dor procedure with myocardial revascularization can be performed with acceptable mortality in this high risk group of patients. Higher EuroSCORE, longer operation and cardiopulmonary bypass time and emergency surgery increase the risk of in-hospital mortality. Key words: Dor procedure

scholarly journals Size of Left Cardiac Chambers Correlates with Cerebral Microembolic Load in Open Heart Operations

2010 ◽  
Vol 2010 ◽  
pp. 1-5 ◽  
Author(s):  
Elena Z. Golukhova ◽  
Anna G. Polunina ◽  
Svetlana V. Zhuravleva ◽  
Natalia P. Lefterova ◽  
Alexey V. Begachev
Keyword(s):  
Carbon Dioxide ◽  
Cardiac Surgery ◽  
Risk Factor ◽  
Cardiopulmonary Bypass ◽  
Left Ventricular ◽  
Open Heart ◽  
Left Heart ◽  
Carbon Dioxide Insufflation ◽  
Doppler System ◽  
Cerebral Microembolism

Background. Microemboli are a widely recognized etiological factor of cerebral complications in cardiac surgery patients. The present study was aimed to determine if size of left cardiac chambers relates to cerebral microembolic load in open heart operations.Methods. Thirty patients participated in the study. Echocardiography was performed in 2-3 days before surgery. A transcranial Doppler system was used for registering intraoperative microemboli.Results. Preoperative left atrium and left ventricular end-systolic and end-diastolic sizes significantly correlated with intraoperative microembolic load (, 0.57 and 0.53, , resp.). The associations between left ventricular diameters and number of cerebral microemboli remained significant when cardiopulmonary bypass time was included as a covariate into the analysis.Conclusions. The present results demonstrate that increased size of left heart chambers is an influential risk factor for elevated cerebral microembolic load during open heart operations. Mini-invasive surgery and carbon dioxide insufflation into wound cavity may be considered as neuroprotective approaches in patients with high risk of cerebral microembolism.

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