A Successful Resection of Cardiac Metastasis of Round Cell Liposarcoma

Myxoid is a common type of liposarcoma. Cardiac metastasis of sarcoma is a rare diagnosis. Transthoracic echocardiography is a useful tool for beginning the diagnosis. Curative resection of metastasis and then combination systemic chemotherapy for advanced disease is recommended. We report a 50 year old woman who presented with a cardiac metastasis of high grade round cell liposarcoma to right atrium and right ventricle. The tumor was diagnosed with computed tomography and transthoracic echocardiography. The tumor size was 10*10 cm. This is the second report of successful resection of a large intracardiac metastasis of liposarcoma

A Successful Resection of Cardiac Metastasis of Round Cell Liposarcoma

Myxoid is a common type of liposarcoma. Cardiac metastasis of sarcoma is a rare diagnosis. Transthoracic echocardiography is a useful tool for beginning the diagnosis. Curative resection of metastasis and then combination systemic chemotherapy for advanced disease is recommended. We report a 50 year old woman who presented with a cardiac metastasis of high grade round cell liposarcoma to right atrium and right ventricle. The tumor was diagnosed with computed tomography and transthoracic echocardiography. The tumor size was 10*10 cm. This is the second report of successful resection of a large intracardiac metastasis of liposarcoma

Problems of Cold Agglutinins in Cardiac Surgery: How to Manage Cardiopulmonary Bypass and Myocardial Protection

Cold agglutinins are of unique relevance in cardiac surgerybecause of the use of hypothermic cardiopulmonary bypass (CPB). Cold autoimmune diseases are defined by the presence of abnormal circulating proteins (usually IgM or IgA antibodies) that agglutinate in response to a decrease in body temperature. These disorders include cryoglobulinemia and cold hemagglutinin disease.Immunoglobulin M autoantibodies to red blood cells, which activateat varying levels of hypothermia, can cause catastrophic hemagglutination,microvascular thrombosis, or hemolysis. Management of anesthesia in these patients includes strict maintenance of normothermia. Patients scheduled for the surgery requiring cardiopulmonary bypass present significant challenges. Use of systemic hypothermia may be contraindicated, and cold cardioplegia solutions may precipitate intracoronary hemagglutination with consequent thrombosis, ischemia, or infarction. Management of CPB andmyocardial protection requires individualized planning. We describea case of MV repair and CABG in a patient with high titercold agglutinins and high thermal amplitude for antibody activation.Normothermic CPB and continuous warm blood cardioplegia weresuccessfully used

Emergency Conversion from Off Pump to Cardiopulmonary Bypass in Patients with Coronary Artery Bypass Graft Surgery

Introduction: As off pump Coronary artery bypass grafting surgery (CABG) is a developing method in coronary cardiac surgery, most surgeons are anxious about the danger of emergency crash conversion. In this observational study we tried to show the rate and outcome of conversion . Material and methods: In this descriptive study about 477 coronary off-pump CABG patients were operated in Ghaem hospital in Mashhad, Iran, from Jan 2012 to Jan 2013.In this group 20 patients needed to convert to Cardiopulmonary Bypass (CPB) immediately .We analyzed these 20 patients and produced the results. Results: There was no cerebrovascular accident (CVA) and no neurologic problems.There was one death among these 20 patients.  There was one case of renal failure who was the same patient that expired. 75% of these 20 patients had hypertension and 45%  had  diabetes .  Conclusion: 20 patients (4.19%) had an emergency switch to On-pump CABG and only one death  occurred among 20 patients

Moderate hypothermia and its effects in reducing the applied dose of anesthetics for patients with opium dependence in cardiac surgery: A randomized controlled trial

Background: An increasing number of patients addicted to opium are experiencing awareness during coronary artery bypass surgery (CABG) as a result of tolerance to anesthetics. Objectives: This research was primarily intended to determine the potential diminishing effects of moderate hypothermia on anesthetic dosage and recall of anesthesia during the procedure. Methods: In this double-blind randomized controlled trial, a total of 80 CABG candidates with known addiction to opium were divided into two groups: one normothermic (N) and the other moderately hypothermic (H), both undergoing induction as well as close monitoring from September 2014 to January 2016. The candidates were initially set for a target bispectral index (BIS) score of between 40 and 60. As the score rose to 60, an additional dose of propofol was administered, alongside rise in blood pressure and tear-shedding. To enhance the accuracy of our evaluation of anesthetic depth, we also used two questionnaires to test candidates’ recall filled with the assistance of a colleague 24 hours following surgery. Independent-samples t-test and chi-square test were used by SPSS v 18 for data analysis. Results: Eighty patients were studied in two groups of normothermic (N) (n = 40) and hypothermic (H) (n = 40). Given similar demographic data as well as the duration of surgery, we arrived at a propofol dose of 122.52±13.11 cc for normothermic patients and 101.28±14.06 cc for hypothermic subjects (p=0.001). As for fentanyl, the total required sum came up to 39.60±21.04 cc and 31.72±5.81 cc for the above-mentioned groups in order (p=0.025). Moreover, the post-operative interview showed that there was no report of a patient with memory recall following surgery. Conclusions: Moderate hypothermia can substantially reduce the need for anesthetics in patients with addiction to opium when undergoing CABG surgery. Trial registration: This study is registered in Iranian Registry of Clinical Trials with registration number of IRCT2014050513159N5. Funding: This research was supported financially by the Research Council of Mashhad University of Medical Sciences (grant number 920405)

Unusual management of parturient patient with severe bicuspid aortic valve stenosis and congestive heart failure

BACKGROUND: Critical aortic stenosis (AS) is an unusual cardiac pathology in pregnancy, but has significant impact on the fetal and maternal outcomes of pregnancy. Pregnant patients with aortic stenosis and heart failure represent a major challenge for the heart team and anesthesiologist who should balance the risks and benefits of different treatment strategies and their effects on the mother and fetus.CASE REPORT: We present a 26-year-old parturient who underwent cesarean section at 30 weeks of gestation under general anesthesia in the presence of cardiac surgical team followed by deferred aortic valve replacement after two weeks.CONCLUSION: This report describes the importance of multidisciplinary preoperative evaluation, and careful surgical and anesthetic planning to avoid the deterioration of perioperative cardiac condition in such patients.</p

Prooxidant-antioxidant balance and cardiac function in patients with cardiovascular disease following cardiac surgery

BACKGROUND AND AIM OF THE STUDY: Cardiopulmonary bypass (CPB) is used during on-pump coronary artery bypass grafting (CABG) and heart valvular replacement surgery, and is associated with the induction of oxidative stress. The aim of the study was to assess the association between indices of cardiac function and prooxidant-antioxidant balance (PAB) values in patients undergoing valve replacement surgery and on-or off-pump CABG. METHODS: Data were obtained from 44, 33, and 41 patients undergoing off-pump CABG, on-pump CABG, and valve replacement surgery, respectively. The PAB values were measured 24 h before and after the operative procedure, and at the time of discharge. Echocardiography was performed before surgery and before discharge. RESULTS: The changes in E/E', end-diastolic volume, end-systolic volume, left ventricular diastolic and systolic diameter were significantly related to baseline PAB values. In the valve replacement group, neither baseline nor changes in PAB values were associated with echocardiographic measurements. Also, neither off-pump nor on-pump CABG were significantly different in inducing oxidative stress (p = 0.596). When PAB values were measured in CABG patients, there was a significant difference in values between the three time points (p = 0.013). In the valve replacement group, PAB values were not significantly different between the preoperative and postoperative samples. CONCLUSION: The inverse association between the level of oxidative stress and cardiac function measurement may indicate that high levels of oxidative stress may be a predictor of the deterioration of cardiac function in CABG patients. However, in valvular heart disease patients the serum PAB value was not associated with changes in cardiac function. Levels of oxidative stress, as assessed by the PAB assay, were not significantly different for patients undergoing surgery with or without CPB