Troubleshooting in extracorporeal life support.

Since the first clinical use of extracorporeal circulation in the last century [1] by John Gibbon and the first successful mechanical support of the left ventricular function by Forest Dodrill [2], the progress of techniques and technologies has helped to develop minimised systems for extracorporeal circulatory and respiratory support. However, the fact is that, despite the advanced technologies used for extracorporeal support, successful application in order to be benefit a critically ill population requires highly trained and skilled teams. Application of these highly sophisticated techniques in life-saving situations inside and/or outside the operating room is a procedure with certain pitfalls and dangers. The aim of this review is to provide a short overview of the technical aspects of extracorporeal circulation, with a look at the recent literature and clinical experiences focusing on technical as well surgical considerations regarding the urgent and/or emergent usage of a central as well as peripheral extracorporeal system

Zbirateljstvo vzhodnoazijske keramike na Slovenskem v 19. stoletju

Prispevek predstavlja pregled znanih lastnikov vzhodnoazijske keramike, posebno porcelana, v Sloveniji v 19. stoletju – natančneje od odprtja Regionalnega muzeja za Kranjsko (kasneje Narodnega muzeja Slovenije) leta 1821 do velikega potresa v Ljubljani leta 1895. Slovenski lastniki porcelana, ali 'navdušenci', ki so predstavljeni v raziskavi, so osebe slovenskih korenin, za katere lahko na podlagi zanesljivih virov potrdimo, da so v svoji lasti imeli keramične ali porcelanaste predmete vzhodnoazijskega izvora ter jih kasneje darovali Deželnem muzeju za Kranjsko. Z vključitvijo analize zbirke Narodnega muzeja in analizo primarnih virov, kot so publikacije, inventarji in slikovno gradivo, raziskujem, kaj nam posamezni predmeti povedo o lastnikih in kako nam lahko pomagajo pri rekonstrukciji zbirateljstva keramike in porcelana vzhodnoazijskega izvora v slovenski zgodovini

Raziskovanje izvora kamna za črnilo iz Zbirke Alme Karlin

There are several collections of East Asian objects kept in various Slovenian museums and private collections, some of which have become the subject of greater scholarly interest in recent years. This paper is a case study of an object––an ink stone––from the collection of personal objects acquired by Alma M. Karlin (1889–1950), now preserved at the Celje Regional Museum. Prior to this survey, there was little basic information about the object from the collection, and concrete data on its history was lacking. This case study determined the object’s provenance and basic data, and at the same time illustrates a methodological approach which was used for research and final confirmation of the origin of the object in question. The main part of the paper focuses on research into the meaning of the carved seal mark and deciphering of a handwritten inscription, both of which are located on the underside of the ink stone. Some of the problems of the research process were resolved through methods of analysis and comparison of photographic material, and the research revealed previously unknown data that helped to determine the correct place of origin of the ink stone, as well as a more precise timeframe in which the object was created. Both inscriptions were placed in the wider cultural and historical context of the East Asian region, as well as in the context of Alma Karlin’s travels.V različnih slovenskih muzejih in zasebnih zbirkah hranijo več zbirk vzhodnoazijskih predmetov, od katerih so v zadnjih letih nekateri postali objekt večjega znanstvenega zanimanja. V prispevku je predstavljen primer kamna za črnilo iz zbirke osebnih predmetov Alme M. Karlin (1889–1950), ki jo hrani Pokrajinski muzej Celje. Pred to raziskavo so bile osnovne informacije o predmetu iz omenjene zbirke redke, konkretni podatki o njegovi zgodovini pa pomanjkljivi. S to študijo primera je bila določena provenienca in osnovni podatki, hkrati pa predstavljen tudi metodološki aparat, uporabljen za raziskovanje in končno potrditev izvora obravnavanega predmeta. Osrednji del članka se osredotoča na raziskovanje pomena na kamnu izrezljanega pečata in na razrešitev ročno napisanega zapisa na spodnji strani predmeta. Oba zapisa sta tudi postavljena v širši kulturno­zgodovinski kontekst vzhodnoazijske regije in v kontekst potovanja Alme Karlin

Zbirateljstvo vzhodnoazijske keramike na Slovenskem v 19. stoletju

Prispevek predstavlja pregled znanih lastnikov vzhodnoazijske keramike, posebno porcelana, v Sloveniji v 19. stoletju – natančneje od odprtja Regionalnega muzeja za Kranjsko (kasneje Narodnega muzeja Slovenije) leta 1821 do velikega potresa v Ljubljani leta 1895. Slovenski lastniki porcelana, ali 'navdušenci', ki so predstavljeni v raziskavi, so osebe slovenskih korenin, za katere lahko na podlagi zanesljivih virov potrdimo, da so v svoji lasti imeli keramične ali porcelanaste predmete vzhodnoazijskega izvora ter jih kasneje darovali Deželnem muzeju za Kranjsko. Z vključitvijo analize zbirke Narodnega muzeja in analizo primarnih virov, kot so publikacije, inventarji in slikovno gradivo, raziskujem, kaj nam posamezni predmeti povedo o lastnikih in kako nam lahko pomagajo pri rekonstrukciji zbirateljstva keramike in porcelana vzhodnoazijskega izvora v slovenski zgodovini

Transaortic transcatheter aortic valve replacement with the Sapien™ valve and the first generations of Ascendra™

Traditionally, the transcatheter aortic valve replacement is performed through a transapical, a transfemoral or a trans-subclavian approach. Recently, the transaortic approach for transcatheter aortic valve replacement through the distal part of the ascending aorta was successfully implemented in order to avoid peripheral vascular access-related complications and apical life-threatening haemorrhage. The Sapien™ stent valve has great transaortic potential because it can be loaded ‘upside down' in different generations of delivery systems. However, because of their health regulatory systems and despite the launch, in 2012, of the latest generation of the Ascendra™ delivery system, the Ascendra+™, specifically designed for transapical and transaortic valve placements, several countries are still using the first generations of Ascendra™ (Ascendra™ 1 and 2). This device was specifically designed for transapical procedures, and retrograde stent-valve positioning through the stenotic aortic valve may be very challenging and risk the integrity of the aorta. We describe the manoeuvre required in order to pass the stenotic aortic valve safely in a retrograde direction using the Sapien™ stent valve and the first generations of Ascendra

Imaging for trans-catheter pulmonary stent-valve implantation without angiography: role of intravascular ultrasound

Patients with stenosed biologic pulmonary conduits require redo cardiac surgery to prevent severe right ventricular dysfunction. Following the latest trends, the trans-catheter pulmonary stent-valve implantation represents a new fascinating alternative carrying a lower operative risk, compared with the standard open-heart re-intervention. Traditionally, the pulmonary stent valve is positioned off pump, under fluoroscopic control, and requires angiographies. However, alternative tools not requiring contrast injections for the intra-operative cardiac imaging have to be also considered strongly. The usefulness of intravascular ultrasound for the positioning of aortic endoprosthesis has already been proven in previous reports and, following the same principle, we have started to routinely implant balloon-expandable stent valves (Edwards Sapien™ THV) in stenosed pulmonary valve conduits using intravascular ultrasound for the stent-valve positioning without angiography. We describe the intra-operative intravascular imaging technique with technical detail

Chimney grafts in renal arteries: a clinical model for coronary perfusion in future transcatheter aortic root repair techniques

OBJECTIVES: Given the similarities between coronary ostia and renal arteries, chimney grafts (CG) for kidney perfusion during abdominal endovascular aneurysm repair (EVAR) can be considered for coronary perfusion in future transcatheter aortic root repair (TARR) techniques. We analysed the results of renal CG and compared anatomic and technical details with root and coronary anthropometric data. METHODS: Current status of kidney perfusion with CG was reviewed from literature. Anatomic details, technical data, CG performance and clinical outcome were collected and analysed. Anatomic details of aortic landing zone and renal arteries were compared with human anthropometric data of aortic root, ascending aorta and coronary ostia. RESULTS: Seventeen articles reported 430 patients (mean age:74.5 ± 2.9 years) treated with renal CG. Mean length and diameter of proximal landing zone were 2.0 ± 2.0 mm and 26.4 ± 4.3 mm, respectively (anthropometric correspondence: ascending aorta diameter of 29.3 mm). Aortic endograft mean diameter was 26.4 ± 7.3 mm with reported oversize of 19.5 ± 6.0%. In total, 590 renal arteries were treated (left:325; right:265; bilateral:139 cases). Mean left and right renal artery diameters were 5.7 ± 0.6 mm and 5.8 ± 0.7 mm, respectively (anthropometric correspondence: coronary ostia diameters of 4.8 mm (left) and 3.7 mm (right)) with reported CG oversize of 19.75 ± 6% (left) and 18.1 ± 5.1% (right). Mean follow-up time was 16.5 ± 8.5 months, CG occlusion rate was 3.2% and endoleak I or II was reported in 83 patients (19.3%), requiring 7 procedures. CONCLUSIONS: CG provides satisfactory results in patients with suitable renal artery diameter. Based on aortic root and coronary anthropometric data, CG can be considered in future TARR technologies for coronary perfusion but further tests for flow evaluations are mandatory

Modified ‘dumbbell' technique: a simple and intuitive method to position balloon-expandable stent valves

Intraoperative cardiac imaging plays a key role during transcatheter aortic valve replacement. In recent years, new techniques and new tools for improved image quality and virtual navigation have been proposed, in order to simplify and standardize stent valve positioning and implantation. But routine performance of the new techniques may require major economic investments or specific knowledge and skills and, for this reason, they may not be accessible to the majority of cardiac centres involved in transcatheter valve replacement projects. Additionally, they still require injections of contrast medium to obtain computed images. Therefore, we have developed and describe here a very simple and intuitive method of positioning balloon-expandable stent valves, which represents the evolution of the ‘dumbbell' technique for echocardiography-guided transcatheter valve replacement without angiography. This method, based on the partial inflation of the balloon catheter during positioning, traps the crimped valve in the aortic valve orifice and, consequently, very near to the ideal landing zone. It does not require specific echocardiographic knowledge; it does not require angiographies that increase the risk of postoperative kidney failure in elderly patients, and it can be also performed in centres not equipped with a hybrid operating roo