Skrzeplina w lewej komorze u pacjentki z wrodzonym skorygowanym przełożeniem wielkich pni tętniczych

A 27 year-old woman with congenitally corrected transposition of the great arteries (ccTGA), which had been diagnosed five years previously, was admitted to our department because of severe heart failure and a suspected left ventricular thrombus. During the emergency operation, thrombi were removed from the left ventricle and tricuspid annuloplasty was performed. To the best of our knowledge, this is the first case report describing thrombus formation in the pulmonary ventricle in a patient with ccTGA. Most probably, the coexistence of multiple risk factors contributed to the thrombus formation

Dynamic left ventricular outflow tract obstruction : underestimated cause of hypotension and hemodynamic instability

Zawężanie drogi odpływu z lewej komory, kojarzone tradycyjnie z kardiomiopatią przerostową, jest trzecią co do częstości przyczyną niewyjaśnionej hipotensji. Ten niedoceniany problem może występować przejściowo w różnych jednostkach chorobowych (dotyczy nawet <1% pacjentów bez uchwytnej choroby serca) oraz sytuacjach klinicznych (hipowolemia, znieczulenie ogólne). Obecnie przyjmuje się, że zawężanie drogi odpływu z lewej komory to zjawisko dynamiczne, do którego wystąpienia konieczne jest współistnienie predysponujących czynników anatomicznych i wywołującego to zjawisko stanu fizjologicznego. Rozpoznanie zawężania drogi odpływu z lewej komory powinno prowadzić do natychmiastowego wdrożenia ukierunkowanej terapii i wyeliminowania czynników potencjalnie nasilających zawężanie. Podstawową rolę zarówno w diagnostyce zawężania drogi odpływu z lewej komory, jak i prowadzeniu leczenia odgrywa badanie echokardiograficzne. W niniejszej pracy przedstawiono opis czterech przypadków, w których natychmiastowe zastosowanie przyłóżkowego badania echokardiograficznego umożliwiło postawienie szybkiego rozpoznania zawężania drogi odpływu z lewej komory i wdrożenie odpowiedniego leczenia.Left ventricular outflow tract obstruction, which is typically associated with hypertrophic cardiomyopathy, is the third most frequent cause of unexplained hypotension. This underestimated problem may temporarily accompany various diseases (it is found in even <1% of patients with no tangible cardiac disease) and clinical situations (hypovolemia, general anesthesia). It is currently assumed that left ventricular outflow tract obstruction is a dynamic phenomenon, the occurrence of which requires the coexistence of predisposing anatomic factors and a physiological condition that induces it. The diagnosis of left ventricular outflow tract obstruction should entail immediate implementation of the therapy to eliminate the factors that can potentially intensify the obstruction. Echocardiography is the basic modality in the diagnosis and treatment of left ventricular outflow tract obstruction. This paper presents four patients in whom the immediate implementation of bedside echocardiography enabled a rapid diagnosis of left ventricular outflow tract obstruction and implementation of proper treatment

Skrzeplina w lewej komorze u pacjentki z wrodzonym skorygowanym przełożeniem wielkich pni tętniczych

A 27 year-old woman with congenitally corrected transposition of the great arteries (ccTGA), which had been diagnosed five years previously, was admitted to our department because of severe heart failure and a suspected left ventricular thrombus. During the emergency operation, thrombi were removed from the left ventricle and tricuspid annuloplasty was performed. To the best of our knowledge, this is the first case report describing thrombus formation in the pulmonary ventricle in a patient with ccTGA. Most probably, the coexistence of multiple risk factors contributed to the thrombus formation. Kardiol Pol 2011; 69, 2: 181-18

Ultrasound in critical care

Ultrasound has been revolutionising our specialty. The introduction of new, portable machines and goal-directed protocols has led many anaesthetists to use this diagnostic tool in their daily practice. Immediate, bedside ultrasound diagnosis of many life-threatening emergencies (pneumothorax, cardiac tamponade, or internal haemorrhage) enables not only the institution of proper treatment, but also the monitoring of its effectiveness. Ultrasound guided invasive procedures (such as vascular cannulations, toraco- and pericardiocentesis) have superseded the old anatomical landmarks-based techniques due to a greater safety margin. In order to perform a credible ultrasound examination, a proper level of competence is required. In this review article, the authors present various critical ultrasound applications

Ultrasonographic caval indices do not significantly contribute to predicting fluid responsiveness immediately after coronary artery bypass grafting when compared to passive leg raising

IVC_PLR_dataset (XLSX 15 kb

Practical possibilities in using q SOFA scale by Emergency Medical Teams

Sepsis is a life-threatening dysfunction of the body that causes a host to respond incorrectly to an infection. Sepsis and septic shock are a major health issue affecting millions of people each year worldwide. Every fourth person with sepsis dies. Multi-organ trauma, acute myocardial infarction or stroke, early diagnosis and management in the first hours after the onset of sepsis improve survival rate. The Sequential Organ Failure Assessment (SOFA) scale is mainly used to assess sepsis. SOFA helps medical staff to assess the risk of morbidity and mortality due to sepsis. The basic parameters of SOFA are: assessment of the respiratory system based on partial oxygen pressure in the blood (PaO2), assessment of the nervous system based on the Glasgow Coma scale (GCS), assessment of the cardiovascular system based on the average blood pressure or after vasopressor administration (any dose), assessment of liver function based on the level of bilirubin in the blood, assessment of kidney function based on the level of creatinine in the urine, assessment of blood clotting based on the amount of thrombocytes contained in the plasma. This scale is used in hospital settings. qSOFA (Quick Sequential Organ Failure Assessment score) is a simplified version of the SOFA score as the first way to identify high-risk patients due to poor results associated with infection. qSOFA simplifies the SOFA score drastically, taking into account only three clinical criteria and introducing "any change" instead of requiring GCS ≤13. It uses three criteria, assigning one point for low blood pressure (SBP ≤100 mmHg), high respiratory rate (≥ 22 breaths per minute) or changed mentation (GC

New diastolic cardiomyopathy in patients with severe accidental hypothermia after ECMO rewarming : a case-series observational study

INTRODUCTION: Accidental hypothermia is a condition associated with significant morbidity and mortality. Hypothermia has been reported to affect left ventricular systolic and diastolic function. However, most of the data come from animal experimental studies. AIM OF THE STUDY: The purpose of the present study was to assess the impact of severe accidental hypothermia on systolic and diastolic ventricular function in patients treated using veno-arterial extracorporeal membrane oxygenation (ECMO). METHODS: We prospectively assessed nine hypothermic patients (8 male, age 25–78 years) who were transferred to the Severe Accidental Hypothermia Center and treated with ECMO. Transthoracic echocardiography was performed on admission (in patients without cardiac arrest) and on discharge from ICU after achieving cardiovascular stability. Cardiorespiratory stability and full neurologic recovery was achieved in all patients. RESULTS: Biomarkers of myocardial damage (CK, CKMB, hsTnT) were significantly elevated in all study patients. Admission echocardiography performed in patients in sinus rhythm, revealed moderate-severe bi-ventricular systolic dysfunction and moderate bi-ventricular diastolic dysfunction. Discharge echocardiography showed persistent mild bi-ventricular diastolic dysfunction, although systolic function of both ventricles returned to normal. Discharge echocardiography in patients admitted with cardiac arrest showed normal (5 patients) or moderately impaired (1 patient) global LV systolic function on discharge. However, mild or moderate LV diastolic dysfunction was observed in all 6 patients. Discharge RV systolic function was normal, whereas mild RV diastolic dysfunction was present in these patients. CONCLUSION: After severe accidental hypothermia bi-ventricular diastolic dysfunction persists despite systolic function recovery in survivors treated with ECMO