ABSTRACT
A left-sided inferior vena cava poses a unique challenge when cannulating for cardiopulmonary bypass during thoracoabdominal aortic aneurysm repair, and how to effectively and safely do so has not been previously described. A 51-year-old woman with a history of Loeys-Dietz syndrome and a left-sided inferior vena cava underwent open Crawford extent II thoracoabdominal aortic aneurysm repair. Cardiopulmonary bypass cannulation was performed using the right axillary artery, left common femoral artery, and right internal jugular vein. The patient's repair was successful, and she was ultimately discharged back to her home.
Subject(s)
Fibroma , Heart Neoplasms , Heart Valve Diseases , Humans , Aortic Valve/diagnostic imaging , Aortic Valve/surgerySubject(s)
Atrial Appendage , Atrial Fibrillation , Endocarditis , Atrial Appendage/diagnostic imaging , Atrial Appendage/surgery , Atrial Fibrillation/complications , Atrial Fibrillation/diagnostic imaging , Atrial Fibrillation/surgery , Echocardiography, Transesophageal , Endocarditis/complications , Endocarditis/diagnostic imaging , Endocarditis/surgery , HumansSubject(s)
Coronary Sinus , Coronary Vessel Anomalies , Persistent Left Superior Vena Cava , Coronary Sinus/diagnostic imaging , Coronary Sinus/surgery , Coronary Vessel Anomalies/complications , Coronary Vessel Anomalies/diagnostic imaging , Coronary Vessel Anomalies/surgery , Humans , Vena Cava, Superior/diagnostic imagingABSTRACT
Intraaortic balloon pump (IABP) counterpulsation, introduced more than 50 years ago, remains the most commonly utilized mechanical circulatory support device for patients with cardiogenic shock and myocardial ischemia, despite lack of definitive proof regarding its outcome in these patients. Part I of this review focused on the history of counterpulsation, physiologic principles, technical considerations, and evidence for its use in cardiogenic shock; Part II will discuss periprocedural uses for IABP counterpulsation and review advances in technology, including the emergence of alternative mechanical circulatory support devices that have influenced IABP utilization.
Subject(s)
Heart-Assist Devices/trends , Hemodynamics , Intra-Aortic Balloon Pumping/trends , Myocardial Ischemia/therapy , Myocardial Revascularization , Shock, Cardiogenic/therapy , Diffusion of Innovation , Humans , Intra-Aortic Balloon Pumping/adverse effects , Intra-Aortic Balloon Pumping/instrumentation , Intra-Aortic Balloon Pumping/mortality , Myocardial Ischemia/mortality , Myocardial Ischemia/physiopathology , Myocardial Revascularization/adverse effects , Myocardial Revascularization/mortality , Recovery of Function , Risk Factors , Shock, Cardiogenic/mortality , Shock, Cardiogenic/physiopathology , Treatment Outcome , Ventricular FunctionABSTRACT
Intraaortic balloon pump counterpulsation is the most common form of mechanical circulatory support used in patients with myocardial ischemia and cardiogenic shock. The physiologic principles of counterpulsation include diastolic augmentation of aortic pressure and systolic reduction of left ventricular afterload, resulting in hemodynamic benefits through increased coronary perfusion pressure and improved myocardial oxygen balance in patients with myocardial ischemia. Major trials have failed to conclusively demonstrate improvements in morbidity and mortality with counterpulsation therapy for patients with acute myocardial infarction (MI), cardiogenic shock, and/or severe coronary artery disease undergoing revascularization therapy, and the debate over its applications continues. Part I of this review focuses on the history of the development of counterpulsation, technical considerations, and complications associated with its use, its physiologic effects, and evidence for its use in myocardial ischemia and cardiogenic shock.
Subject(s)
Coronary Artery Disease/therapy , Intra-Aortic Balloon Pumping , Myocardial Infarction/therapy , Myocardial Revascularization , Shock, Cardiogenic/therapy , Animals , Contraindications, Procedure , Coronary Artery Disease/history , Coronary Artery Disease/mortality , Coronary Artery Disease/physiopathology , Hemodynamics , History, 20th Century , History, 21st Century , Humans , Intra-Aortic Balloon Pumping/adverse effects , Intra-Aortic Balloon Pumping/history , Intra-Aortic Balloon Pumping/mortality , Myocardial Infarction/history , Myocardial Infarction/mortality , Myocardial Infarction/physiopathology , Myocardial Revascularization/adverse effects , Myocardial Revascularization/mortality , Recovery of Function , Risk Assessment , Risk Factors , Shock, Cardiogenic/history , Shock, Cardiogenic/mortality , Shock, Cardiogenic/physiopathology , Treatment Outcome , Ventricular FunctionABSTRACT
The under-representation of women in academic leadership roles, including in anaesthesiology, is a well-documented phenomenon that has persisted for decades despite more women attending medical school, participating in anaesthesiology residencies, and joining academic faculties. The percentage of female anaesthesiologists who hold senior academic ranks or leadership roles, such as chair, lags behind the percentage of female anaesthesiologists overall. Trends towards increasing the numbers of women serving in educational leadership roles, specifically residency programme directors, suggest that there are areas in which academic anaesthesiology has been, and can continue, improving gender imbalance. Continued institutional efforts to recruit women into anaesthesiology, reduce gender bias, and promote interventions that foster gender equity in hiring and promotion will continue to benefit women, academic anaesthesiology departments, and the healthcare system overall.
