Concomitant Intraoperative Radiofrequency and Microwave Ablation of Atrial Fibrillation and Repair of Atrial Septal Defect

Atrial fibrillation (AF) is the most frequent form of atrial arrhythmias in adults with congenital heart disease. Some serious complications are related with the presence of AF after surgery. Because of the complexity and the risk of bleeding, the Maze III procedure has been largely replaced by alternative energy sources. A patient with multiple atrial septal defects (ASD) and AF underwent surgical closure with autologous pericardial patch and radiofrequency and microwave ablation of AF

Microcirculation and Macrocirculation in Cardiac Surgical Patients

Background. The aim of our study was to investigate the relationship between microcirculatory alterations after open cardiac surgery, macrohemodynamics, and global indices of organ perfusion. Methods. Patients' microcirculation was assessed with near-infrared spectroscopy (NIRS) and the vascular occlusion technique (VOT). Results. 23 patients undergoing open cardiac surgery (11 male/12 female, median age 68 (range 28–82) years, EuroSCORE 6 (1–12)) were enrolled in the study. For pooled data, CI correlated with the tissue oxygen consumption rate as well as the reperfusion rate (r = 0.56, P < 0.001 and r = 0.58, P < 0.001, resp.). In addition, both total oxygen delivery (DO2, mL/min per m2) and total oxygen consumption (VO2, mL/min per m2) also correlated with the tissue oxygen consumption rate and the reperfusion rate. The tissue oxygen saturation of the thenar postoperatively correlated with the peak lactate levels during the six hour monitoring period (r = 0.50, P < 0.05). The tissue oxygen consumption rate (%/min) and the reperfusion rate (%/min), as derived from the VOT, were higher in survivors compared to nonsurvivors for pooled data [23 (4–54) versus 20 (8–38) P < 0.05] and [424 (27–1215) versus 197 (57–632) P < 0.01], respectively. Conclusion. Microcirculatory alterations after open cardiac surgery are related to macrohemodynamics and global indices of organ perfusion

Use of continuous subcutaneous anesthetic infusion in cardiac surgical patients after median sternotomy

The use of opioid analgesics to control pain after median sternotomy in cardiac surgical patients is worldwide accepted and established. However, opioids have a wide range of possible side effects, concerning prolonged extubation time, gastrointestinal tract dyskinesia and urinary tract disorders mostly retention. All these may lead to a prolonged ICU stay or overall hospitalization time increase

Acute pressure overload of the right ventricle. Comparison of two models of right-left shunt. Pulmonary artery to left atrium and right atrium to left atrium: experimental study

<p>Abtract</p> <p>Background</p> <p>In right ventricular failure (RVF), an interatrial shunt can relieve symptoms of severe pulmonary hypertension by reducing right ventricular preload and increasing systemic flow. Using a pig model to determine if a pulmonary artery - left atrium shunt (PA-LA) is better than a right atrial - left atrial shunt (RA-LA), we compared the hemodynamic effects and blood gases between the two shunts.</p> <p>Methods</p> <p>Thirty, male Large White pigs weighting in average 21.3 kg ± 0.7 (SEM) were divided into two groups (15 pigs per group): In group 1, banding of the pulmonary artery and a pulmonary artery to left atrium shunt with an 8 mm graft (PA-LA) was performed and in group 2 banding of the pulmonary artery and right atrial to left atrial shunt (RA-LA) with a similar graft was performed. Hemodynamic parameters and blood gases were measured from all cardiac chambers in 10 and 20 minutes, half and one hour interval from the baseline (30 min from the banding). Cardiac output and flow of at the left anterior descending artery was also monitored.</p> <p>Results</p> <p>In both groups, a stable RVF was generated. The PA-LA shunt compared to the RA-LA shunt has better hemodynamic performance concerning the decreased right ventricle afterload, the 4 fold higher mean pressure of the shunt, the better flow in left anterior descending artery and the decreased systemic vascular resistance. Favorable to the PA-LA shunt is also the tendency - although not statistically significant - in relation to central venous pressure, left atrial filling and cardiac output.</p> <p>Conclusion</p> <p>The PA-LA shunt can effectively reverse the catastrophic effects of acute RVF offering better hemodynamic characteristics than an interatrial shunt.</p

Acute pressure overload of the right ventricle. Comparison of two models of right - left shunt. Pulmonary artery to left atrium and right atrium to left atrium: experimental study

In right ventricular failure (RVF), an interatrial shunt can relieve symptoms of severe pulmonary hypertension by reducing right ventricular preload and increasing systemic flow. Using a pig model to determine if a pulmonary artery – left atrium shunt (PA‐LA) is better than a right atrial – left atrial shunt (RALA), we compared the hemodynamic effects and blood gases between the two shunts. Thirty experiments were performed, (two groups of fifteen experiments each), in male Large White pigs weighting in average 38.3 ± 1.7 kg (ranges 30‐45Kg): In group 1, banding of the pulmonary artery and a pulmonary artery to left atrium shunt with an 8mm graft (PA‐LA) was performed and in group 2 banding of the pulmonary artery and right atrial to left atrial shunt (RA‐LA) with a similar graft was performed. Hemodynamic parameters and blood gases were measured from all cardiac chambers in 10 and 20 minutes, after 30 min from the banding. Cardiac output and flow of the left anterior descending artery was also monitored. In both groups, a stable right ventricle failure (RVF) was generated. The PA‐LA shunt compared to the RA‐LA shunt has better hemodynamic performance concerning the decreased right ventricle afterload, the 4 fold higher mean pressure of the shunt, the better flow in left anterior descending artery and the decreased systemic vascular resistance. Favorable to the PA‐LA shunt is also the tendency ‐ although not statistically significant ‐ in relation to central venous pressure, left atrial filling and cardiac output. The PA‐LA shunt can effectively reverse the catastrophic effects of acute RVF offering better hemodynamic characteristics than an interatrial shuntΣτην ανεπάρκεια της δεξιάς κοιλίας, μια μεσοκολπική επικοινωνία μπορεί να ανακουφίσει τα συμπτώματα της σοβαρής πνευμονικής υπέρτασης, μειώνοντας το προφόρτιο της δεξιάς κοιλίας αυξάνοντας συγχρόνως τη συστη‐ ματική παροχή. Δημιουργήσαμε πειραματικά σε χοίρους μια οξεία δεξιά καρδιακή ανεπάρκεια με υπερφόρτωση πίεσης της δεξιάς κοιλίας μετά από περίσφυξη της πνευμονικής αρτηρίας. Ακολούθως δημιουργήσαμε δύο ειδών δεξιο‐αριστερές επικοινωνίες: α) δεξιού κόλπου με αριστερό κόλπο και β) στελέχους πνευμονικής αρτηρίας με αριστερό κόλπο. Ακολούθως έγινε σύγκριση των αιμοδυναμικών αποτελεσμάτων καθώς και των αερίων αίματος μεταξύ των δύο δεξιο‐αριστερών διαφυγών. Πραγματοποιήσαμε τριάντα (30) οξέα πειράματα, (δύο ομάδες των 15 πειραμάτων καθεμία), σε χοίρους σωματικού βάρους 30‐45kg (μέσος όρος βάρους 38,3±1,7Kg). Στην ομάδα 1, διενεργήθηκε περίσφυξη της πνευμονικής αρτηρίας και τοποθετήθηκε μόσχευμα 8mm μεταξύ πνευμονικής αρτηρίας και αριστερού κόλπου (PA‐LA), και στην ομάδα 2 περίσφυξη της πνευμονικής αρτηρίας και τοποθετήθηκε μόσχευμα 8mm μεταξύ του δεξιού κόλπου και του αριστερού (RA‐LA). Έγινε καταγραφή όλων των αιμοδυναμικών παραμέτρων και των αερίων αίματος από όλες τις καρδιακές κοιλότητες στα 10 και 20 min λειτουργίας των shunts (preconditioning 30 min μετά την περίσφυξη). Έγινε επίσης καταγραφή της καρδιακής παροχής καθώς και της ροής στον πρόσθιο κατιόντα με ροόμετρο. Και στις δύο ομάδες, επιτεύχθηκε μια σταθερή υπερφόρτωση όγκου ‐ πίεσης της δεξιάς κοιλίας. Το PA‐LA shunt σε σχέση με το RA‐ LA παρουσίασε καλύτερη αιμοδυναμική συμπεριφορά καθώς και μεγαλύτερη μείωση του μεταφόρτιου της δεξιάς κοιλίας. Η μέση πίεση του PA‐LA shunt ήταν 4 φορές μεγαλύτερη από αυτήν του RA‐LA. Επιπρόσθετα κατά τη ροομετρία του πρόσθιου κατιόντα διαπιστώθηκε αυξημένη ροή στο PA‐LA shunt και μεγαλύτερη μείωση των συστηματικών αγγειακών αντιστάσεων. Επιπρόσθετα φάνηκε ότι το PA‐LA shunt υπερτερεί (όχι όμως στατιστικά σημαντικά) όσον αφορά τις τιμές της 140 κεντρικής φλεβικής πίεσης, της πίεσης πλήρωσης του αριστερού κόλπου καθώς και της καρδιακής παροχής. Συμπερασματικά, φαίνεται ότι η δημιουργία διαφυγής από την πνευμονική αρτηρία στον αριστερό κόλπο σε πειραματικό μοντέλο οξείας υπερφόρτωσης πίεσης της δεξιάς κοιλίας είναι εφικτή και μπορεί να μετριάσει αποτελεσματικά τις καταστροφικές συνέπειες της οξείας υπερφόρτωσης προσφέροντας ικανοποιητικά αν όχι καλύτερα αιμοδυναμικά χαρακτηριστικά από μια κολπο‐κολπική διαφυγή

Pyrexia in patients with uncontrolled systemic hypertension: could they have an aortic dissection?

Aortic dissection can present in a variety of ways and one of the most documented risk factors includes systemic hypertension. Occasionally aortic dissection can be diagnosed late due to an insidious presentation. Fever has been described in people with aortic dissection but rarely as the main presenting feature. We present the cases of two patients with type B aortic dissections who shared three pertinent features which could have alerted the clinicians of the potential diagnosis; systemic hypertension, small left sided pleural effusion and a fever of unknown origin