What range of extra-cardiac conduit flow velocity is detectable intraoperatively following the completion of a total cavo-pulmonary connection?

Abstract Background Very few studies have investigated the blood flow velocity from the inferior vena cava (IVC) to the pulmonary artery following the Fontan operation using an extra-cardiac conduit (ECC). No studies at all have investigated the velocity immediately after the circulation is established. The purpose of this retrospective study was to find an acceptable flow velocity at the ECC following the completion of a total cavo-pulmonary connection (TCPC) via transesophageal echocardiography. Findings We measured the mean velocity (m-V) of the blood flow proximal to the anastomosis between the IVC and ECC in eight patients and compared the results with theoretically predicted values based on assumptions regarding the cardiac output, the ratio of the IVC flow to the superior vena cava flow, and the cross-sectional form of the ECC. Mean velocities ranging from about 15 to 60 cm/s were detected in the absence of any observable stenosis. The measured m-V was significantly faster than the predicted value in our study, both collectively and in every patient individually. The shrinking and compression of the ECC might account for the faster velocities measured in our cases. Conclusion The observed range of m-V at the ECC, about 15-60cm/s, may be acceptable for the establishment of TCPC circulation

Esophageal submucosal hematoma developed after endovascular surgery for unruptured cerebral aneurysm under general anesthesia: a case report

Abstract Background Esophageal submucosal hematoma is a rare complication after endovascular surgery. We report a case of an esophageal submucosal hematoma which may have been caused by rigorous cough during extubation. Case presentation A 75-year-old woman underwent endovascular treatment for unruptured cerebral aneurysm under general anesthesia. The patient received aspirin and clopidogrel before surgery and heparin during surgery. Activated clotting time was 316 s at the end of surgery. Protamine was not administered and continuous infusion of argatroban was started after surgery. She had a rigorous cough during removal of the tracheal tube and reported retrosternal discomfort postoperatively. She developed hemorrhagic shock after massive hematemesis. A diagnosis of esophageal submucosal hematoma was made by endoscopic examination and computed tomography. Hemostasis was achieved by compression with a Sengstaken-Blakemore tube and endoscopic cauterization. Blood pressure was recovered by blood transfusion. Endoscopic examination performed 7 days after surgery showed that esophageal submucosal hematoma had almost disappeared and slough had adhered to the mucosal laceration. The patient showed good recovery and was discharged 21 days after surgery. Conclusions Careful extubation and postoperative observation are required in patients receiving antiplatelet and anticoagulant therapy

Esophageal submucosal hematoma developed after endovascular surgery for unruptured cerebral aneurysm under general anesthesia: a case report

Abstract Background Esophageal submucosal hematoma is a rare complication after endovascular surgery. We report a case of an esophageal submucosal hematoma which may have been caused by rigorous cough during extubation. Case presentation A 75-year-old woman underwent endovascular treatment for unruptured cerebral aneurysm under general anesthesia. The patient received aspirin and clopidogrel before surgery and heparin during surgery. Activated clotting time was 316 s at the end of surgery. Protamine was not administered and continuous infusion of argatroban was started after surgery. She had a rigorous cough during removal of the tracheal tube and reported retrosternal discomfort postoperatively. She developed hemorrhagic shock after massive hematemesis. A diagnosis of esophageal submucosal hematoma was made by endoscopic examination and computed tomography. Hemostasis was achieved by compression with a Sengstaken-Blakemore tube and endoscopic cauterization. Blood pressure was recovered by blood transfusion. Endoscopic examination performed 7 days after surgery showed that esophageal submucosal hematoma had almost disappeared and slough had adhered to the mucosal laceration. The patient showed good recovery and was discharged 21 days after surgery. Conclusions Careful extubation and postoperative observation are required in patients receiving antiplatelet and anticoagulant therapy

Clinical features and risk assessment for cardiac surgery in adult congenital heart disease: Three years at a single Japanese center

Purpose: The aims of our study are twofold: first, to retrospectively identify the demographic characteristics and outcomes in cardiac surgery for adult congenital heart disease (ACHD); second, to explore whether certain preoperative examinations are useful for assessing the risk of perioperative mortality and morbidity. Methods: Ninety-two ACHD patients who underwent cardiac surgery from 2009 to 2011 were enrolled in the study. The subjects were classified into three groups based on the complexity of the ACHD. We retrospectively collected data on demographics, operations, and postoperative courses. We also collected the results of examinations performed in the three months leading up to the cardiac surgery, including exercise tolerance testing and measurement of brain natriuretic peptide (BNP). Results: The 30-day mortality was 3.3%. A remarkable discrepancy was found between subjective assessment and the severity of exercise intolerance by exercise tolerance testing. The NYHA class was 1 or 2 in all but one of 13 patients with moderate-severe exercise intolerance and a high mortality/major complication rate (53.8%). Patients with BNP ≧ 100 pg/ml had a significantly higher mortality/major complication rate than patients with BNP < 100 (34.8% vs. 11.5%, p < 0.05), but the sensitivity (53.3%) and positive predictive value (34.8%) were not high enough in themselves to identify patients at high risk of poor outcome. Conclusion: Cardiac surgery could be safely performed in most ACHD cases. Exercise tolerance testing can be useful in identifying patients at high risk of mortality or major complications. BNP can be valuable in predicting poor outcomes after cardiac surgery