Minute ventilation stabilization during all pressure-control / support mechanical ventilation modes.

The main goal of our prospective randomized study was comparing compare the effectiveness of ventilation control method "Automatic proportional minute ventilation (APMV) "versus manually set pressure control ventilation modes in relationship to lung mechanics and gas exchange. 80 patients undergoing coronary artery bypass grafting (CABG) were randomized into 2 groups. 40 patients in the first group No.1 (APMV group) were ventilated with pressure control (PCV) or pressure support ventilation (PSV) mode with APMV control. The other 40 patients (control group No.2) were ventilated with synchronized intermittent mandatory ventilation (SIMV-p) or pressure control modes (PCV) without APMV. Ventilation control with APMV was able to maintain minute ventilation more precisely in comparison with manual control (p<0.01), similarly deviations of ETCO(2) were significantly lower (p<0.01). The number of manual corrections of ventilation settings was significantly lower when APMV was used (p<0.01). The differences in lung mechanics and hemodynamics were not statistically significant. Ventilation using APMV is more precise in maintaining minute ventilation and gas exchange compared with manual settings. It required less staff intervention, while respiratory system mechanics and hemodynamics are comparable. APMV showed as effective and safe method applicable on top of all pressure control ventilation modes.

Relationship between dynamic expiratory time constant tau(edyn) and parameters of breathing cycle in pressure support ventilation mode.

Study of the relationship between ventilation parameters: monitored expiratory time constant - tau(edyn) and breathing - trigger frequency (f(trig)) and time of breathing cycle (T(cy)) are main goals of this article. Parameters were analyzed during last 4+/-2 h before weaning from ventilation in 66 patients ventilated in pressure support mode (PSV). We have found out, that there exist mathematical relationships, observed during adequate gas exchange, yet not described. Monitored parameters are represented by tau(edyn), f(trig) and T(cy). The analysis showed close negative correlation between T(cy) and f(trig) (R(2)=0.903). This implies that each increasing of tau(edyn) causes decreasing of f(trig) and vice versa. The calculation of regression equation between tau(edyn) and T(cy) outlined that T(cy) = 5.2625 * tau(edyn) + 0.1242 (R(2)=0.85). Regulation of respiratory cycles by the respiratory center in the brain is probably based on evaluation of tau(edyn) as the tau(edyn) probably represents a regulatory element and T(cy) regulated element. It can be assumed, that respiratory center can optimize the work of breathing in order to minimize energy in system patient + ventilator. The unique relationship, described above could be useful in clinical practice for development of new ventilation modes.

Knee contact forces and lower extremity support moments during running in young individuals post-partial meniscectomy.

PURPOSE: While partial meniscectomy results in a compromised tibiofemoral joint, little is known regarding tibiofemoral joint loading during running in individuals who are post-partial meniscectomy. It was hypothesized that individuals post-partial meniscectomy would run with a greater hip support moment, yielding reduced peak knee extension moments and reduced tibiofemoral joint contact forces. METHODS: 3-D Treadmill running mechanics were evaluated in 23 athletic individuals post-partial meniscectomy (37.5 ± 19.0 months post-partial meniscectomy) and 23 matched controls. Bilateral hip, knee and ankle contributions to the total support moment and the peak knee extension moment were calculated. A musculoskeletal model estimated peak and impulse tibiofemoral joint contact forces. Knee function was quantified with the Knee injury and Osteoarthritis Outcome Score (KOOS). RESULTS: During running, the partial meniscectomy group had a greater hip support moment (p = 0.002) and a reduced knee support moment (p < 0.001) relative to the total support moment. This movement pattern was associated with a 14.5 % reduction (p = 0.019) in the peak knee extension moment. Despite these differences, there were no significant group differences in peak or impulse tibiofemoral joint contact forces. Lower KOOS Quality of Life scores were associated with greater hip support moment (p = 0.004, r = -0.58), reduced knee support moment (p = 0.006, r = 0.55) and reduced peak knee extension moment (p = 0.01, r = 0.52). CONCLUSIONS: Disordered running mechanics are present long term post-partial meniscectomy. A coordination strategy that shifts a proportion of the total support moment away from the knee to the hip reduces the peak knee extension moment, but does not equate to reduced tibiofemoral joint contact forces during running in individuals post-partial meniscectomy. LEVEL OF EVIDENCE: III.

One-stage surgical approach to coarctation of the aorta and ascending aortic aneurysm.

BACKGROUND: Aortic coarctation in adults is sometimes associated with concomitant cardiovascular pathologies which require intervention. The optimal operative approach for such patients remains unsettled. An extra-anatomic aortic bypass from the ascending aorta to the descending aorta via median sternotomy allows simultaneous performance of repair of complex aortic coarctation and concomitant cardiac operation. CASE REPORT: We present herein an adult female with coarctation of the aorta combined with an ascending aortic aneurysm associated with concomitant aortic valve regurgitation. We performed a single-stage operation which consisted of Bentall's procedure and extra-anatomic bypass from the ascending to the descending aorta. The patient's postoperative period was uneventful and twelve months after the surgery she is doing well.The conclusions of our work resulted in one essential experience, namely that clinically serious, previously almost intractable conditions can be successfully resolved in unusual ways. Extra-anatomic reconstruction of aorta coarctation that for various reasons could not have been solved by resection of the affected aortic segment allowed us to achieve a structurally as well as functionally excellent outcome. Therefore, we recommend to consider this option in appropriate patients and/or incorporate it into the therapeutic armamentarium of cardiosurgical centers (Fig. 5, Ref. 11).

Aortic valve-sparing operation versus Bentall and mechanical aortic valve replacement--midterm results.

OBJECTIVES: The primary aim of this retrospective study was to evaluate short-term (one-to-six months) and mid-term (six-to-forty-eight months) results of aortic valve-sparing procedures. The second endpoint was to compare the results with the group of patients undergoing mechanical aortic valve replacement during the same period. METHODS: Between April 2008 and May 2012 at our institution, we treated 76 patients either with ascending aorta/root aneurysm/dissection or with isolated aortic regurgitation. A total of seventy-six patients undergoing aortic valve surgery. RESULTS: Analyzed parameters were divided into two parts as function of time. In the first part, i.e. during hospitalization, the mortality, duration of hospitalization, duration of extra corporeal circulation (ECC), and duration of cardiac arrest (CA) were compared and assessed. In the second part, i.e. during monitoring of the patients after their discharge from hospital (one-to-six months, and six-to-forty-eight months), the grade of postoperative AR aimed mainly at the group of aortic valve-sparing operations (subgroups A1, A2, A3), postoperative peak gradient, presence of thromboembolic and bleeding complications, postoperative endocarditis and need for reoperation or hospitalization due to cardiac reasons were analyzed. CONCLUSION: Based on our first experience, we believe that in spite of higher technical difficulty, the aortic valve-sparing operations can be possibly performed with the same or respectively lower rate of postoperative morbidity and mortality. Presented results show that compared with the aortic valve replacement, the aortic valve-sparing operation is a promising method, and an interesting therapeutic alternative for patients. After proper indications, we consider it to be a method of choice (Tab. 6, Fig. 7, Ref. 28).

[Recurrent prosthetic endocarditis in a 21-year old patient with renal transplantation treated with allogeneic homograft]. / Recidivujúca protetická endokarditída u 21-rocného pacienta s transplantovanou oblickou riesená alogénnym homograftom.

Prosthetic infective endocarditis is a possible complication of implantation of a prosthetic cardiac valve. Without early and effective treatment, it can have fatal consequences. One treatment option is use of an allogeneic cryopreserved homograft. This case report presents a 21-year old patient after kidney transplantation due to hereditary nephrotic syndrome and aortic valve replacement with aortic conduits. After fever was noted in the patient, prosthetic infective endocarditis was diagnosed by echocardiography and also confirmed by CT-3D examination. The cryopreserved aortic homograft was implanted at the Department of Cardiac Surgery. This along with additional conservative management effectively treated the infection. Based on literature data and our own experience, we believe that the treatment of prosthetic endocarditis after aortic valve replacement with cryopreserved homograft can be a method of choice.