A study of maternal and fetal outcome in meconium-stained amniotic fluid-a prospective hospital-based study

Background: Meconium is a collection of secretions and desquamated cells from the digestive tract, and waste products from ingested amniotic fluid. It is a viscous, dark-green substance composed of intestinal epithelial cells, lanugo, mucus, and intestinal secretions. Intra uterine passage of meconium occurs in case of fetal distress; Important causes of in utero passage of meconium are oligohydramnios, placental insufficiency, preeclampsia.Methods: The present prospective observational study is conducted at department of obstetrics and gynecology of tertiary care centre, Lokmanya Tilak municipal medical college and hospital, Mumbai. All antenatal women attending hospital in active phase of labour who fulfilled the inclusion criteria of single term pregnancy in cephalic presentation were included. A predesigned pretested interview schedule questionnaire was prepared in accordance with study objectives and was conducted in the language which they best understood. Permission was obtained from the institutional ethics committee. Maternal outcome: Increased incidence of cesarean and instrumental deliveries, wound infection, post-partum hemorrhage. Perinatal outcome: Birth asphyxia, meconium aspiration syndrome (MAS), respiratory distress syndrome (RSD), septicemia.Results: Maximum women 71% were having gestational age of 37-40 weeks. most common maternal high-risk factors were post-dated pregnancy (29%) followed by oligohydramnios (19%). Deliveries by caesarean section were more (71.4%), most common indication being fetal distress (44.7%). Perinatal complications were birth asphyxia, MAS, RDS, low Apgar score.Conclusions: Early identification of meconium-stained amniotic fluid (MSAF) in labouring women during intra-partum monitoring and availability of operation theatre for immediate intervention is required to reduce the perinatal morbidity and mortality

Prevalence of patients with severely reduced aortic valve area and low gradient despite a preserved ejection fraction. Results from a cath-lab data base.

Prevalence of patients with severely reduced aortic valve area and low gradient despite a preserved ejection fraction. Results from a cath-lab data base

Is transfemoral aortic valve implantation possible without contrast medium in patients with renal and multiorgan failure?

Transfemoral aortic valve implantation has recently emerged as a therapeutic option for patients with symptomatic, severe aortic stenosis for whom standard surgical aortic valve surgery is not suitable. Aortic valvuloplasty and valve positioning is normally performed under fluoroscopy and requires several injections of contrast medium. In critically ill patients with advanced renal insufficiency, contrast media administration can further increase renal damage; therefore, an echocardiogram and fluoroscopy-guided procedure, using the calcified contours of the stenotic aortic valve as a landmark may be a useful alternative. We report the first successful transfemoral aortic valve implantation procedure performed under fluoroscopy and transesophageal echocardiogram control, without administration of contrast medium injections in a patient with severe renal insufficiency and multiorgan failure

Is transfemoral aortic valve implantation possible without contrast medium in patients with renal and multiorgan failure?

Transfemoral aortic valve implantation has recently emerged as a therapeutic option for patients with symptomatic, severe aortic stenosis for whom standard surgical aortic valve surgery is not suitable. Aortic valvuloplasty and valve positioning is normally performed under fluoroscopy and requires several injections of contrast medium. In critically ill patients with advanced renal insufficiency, contrast media administration can further increase renal damage; therefore, an echocardiogram and fluoroscopy-guided procedure, using the calcified contours of the stenotic aortic valve as a landmark may be a useful alternative. We report the first successful transfemoral aortic valve implantation procedure performed under fluoroscopy and transesophageal echocardiogram control, without administration of contrast medium injections in a patient with severe renal insufficiency and multiorgan failure

"Polarizing" microplegia improves cardiac cycle efficiency after CABG for unstable angina.

BACKGROUND: Myocardial protection during coronary artery bypass grafting (CABG) for unstable angina (UA) still represents a major challenge, ought to the risk for further ischemia/reperfusion injury. Few studies investigate the biochemical, hemodynamic and echocardiographic results of microplegia (Mic) in UA. METHODS: Eighty UA-patients undergoing CABG were randomized to Mic (Mic-Group) or standard 4:1 blood Buckberg-cardioplegia (Buck-Group). Troponin-I and lactate were sampled from coronary sinus at reperfusion (T1), and from peripheral blood preoperatively (T0), at 6 (T2), 12 (T3) and 48 (T4) hours. Cardiac index (CI), indexed systemic vascular resistances (ISVR), \u394p/\u394t, cardiac cycle efficiency (CCE), and central venous pressure (CVP) were collected preoperatively (T0), and since Intensive Care Unit (ICU)-arrival (T1) to 24h (T5). Echocardiographic E-wave (E), A-wave (A), E/A, peak early-diastolic TDI-mitral annular-velocity (Ea), and E/Ea investigated the diastolic function and Wall Motion Score Index (WMSI) the systolic function, preoperatively (T0) and at 96h (T1). RESULTS: Mic-Group showed lower troponin-I and lactate from coronary sinus (p=.0001 for both) and during the postoperative course (between-groups p=.001 and .0001, respectively). WMSI improved only after Mic (time-p=.001). Higher CI \u394p/\u394t and CCE (between-groups p=.0001), with comparable CVP and ISVR (p=N.S.) were detected after Mic. Diastolic function improved in both groups, but better after Mic (between-groups p=.003, .001, and .013 for E, E/A, and Ea, respectively). Mic resulted in lower transfusions (p=.006) and hospitalization (p=.002), and a trend towards lower need/duration of inotropes (p=.04 and p=.041, respectively), and ICU-stay (p=.015). CONCLUSION: Microplegia attenuates myocardial damage in UA, reduces transfusions, improves postoperative systo-diastolic function, and shortens hospitalization

"Polarizing" microplegia improves cardiac cycle efficiency after CABG for unstable angina.

BACKGROUND: Myocardial protection during coronary artery bypass grafting (CABG) for unstable angina (UA) still represents a major challenge, ought to the risk for further ischemia/reperfusion injury. Few studies investigate the biochemical, hemodynamic and echocardiographic results of microplegia (Mic) in UA. METHODS: Eighty UA-patients undergoing CABG were randomized to Mic (Mic-Group) or standard 4:1 blood Buckberg-cardioplegia (Buck-Group). Troponin-I and lactate were sampled from coronary sinus at reperfusion (T1), and from peripheral blood preoperatively (T0), at 6 (T2), 12 (T3) and 48 (T4) hours. Cardiac index (CI), indexed systemic vascular resistances (ISVR), \u394p/\u394t, cardiac cycle efficiency (CCE), and central venous pressure (CVP) were collected preoperatively (T0), and since Intensive Care Unit (ICU)-arrival (T1) to 24h (T5). Echocardiographic E-wave (E), A-wave (A), E/A, peak early-diastolic TDI-mitral annular-velocity (Ea), and E/Ea investigated the diastolic function and Wall Motion Score Index (WMSI) the systolic function, preoperatively (T0) and at 96h (T1). RESULTS: Mic-Group showed lower troponin-I and lactate from coronary sinus (p=.0001 for both) and during the postoperative course (between-groups p=.001 and .0001, respectively). WMSI improved only after Mic (time-p=.001). Higher CI \u394p/\u394t and CCE (between-groups p=.0001), with comparable CVP and ISVR (p=N.S.) were detected after Mic. Diastolic function improved in both groups, but better after Mic (between-groups p=.003, .001, and .013 for E, E/A, and Ea, respectively). Mic resulted in lower transfusions (p=.006) and hospitalization (p=.002), and a trend towards lower need/duration of inotropes (p=.04 and p=.041, respectively), and ICU-stay (p=.015). CONCLUSION: Microplegia attenuates myocardial damage in UA, reduces transfusions, improves postoperative systo-diastolic function, and shortens hospitalization

First successful management of aortic valve insufficiency associated with HeartMate II left ventricular assist device support by transfemoral CoreValve implantation: the Columbus's egg?

Description of the First Successful Management of Aortic Valve Insufficiency Associated With HeartMate II Left Ventricular Assist Device Support by Transfemoral CoreValve Implantation, worldwide

Transfemoral Edwards-Novaflex valve implantation in a patient with aorto-iliac endoprosthesis and severely tortuous bilateral external iliac arteries-"Railing track".

Transcatheter aortic valve implantation (TAVI) has nowadays been introduced as an alternative for surgical aortic valve replacement as a treatment for high risk aortic stenosis patients. This procedure is not free of complications: the SOURCE registry, indeed, showed that vascular complications are more frequent with the transfemoral approach. We present the case of an 82-year-old man with known history of severe aortic stenosis at high-risk for surgery. Pre-TAVI screening shows bilateral severely tortuous iliac arteries and aorto-bi-iliac endoprosthesis. Transapical TAVI as a first choice was rejected due to severe lung disease. The patient was then treated by Transfemoral TAVI using a dedicated interventional technique that is described in this case-report

First successful management of aortic valve insufficiency associated with HeartMate II left ventricular assist device support by transfemoral CoreValve implantation: the Columbus's egg?

First successful management of aortic valve insufficiency associated with HeartMate II left ventricular assist device support by transfemoral CoreValve implantation: the Columbus's egg