Your browser doesn't support javascript.
loading
Show: 20 | 50 | 100
Results 1 - 19 de 19
Filter
Add more filters










Publication year range
1.
Clin Med Insights Circ Respir Pulm Med ; 14: 1179548420957451, 2020.
Article in English | MEDLINE | ID: mdl-32952405

ABSTRACT

BACKGROUND: Novel coronavirus 2019 (COVID-19) has been the focus of the medical world since being declared a pandemic in March 2020. While the pathogenesis and heterogeneity of COVID-19 manifestations is still not fully understood, viral evasion of cellular immune responses and inflammatory dysregulation are believed to play essential roles in disease progression and severity. CASE PRESENTATION: We present the first case of a patient with COVID-19 with massive pulmonary embolism treated successfully with systemic thrombolysis, VA-ECLS, and bail out catheter directed thrombolysis. He was discharged from the hospital after an eventful hospital course on therapeutic anticoagulation with warfarin. CONCLUSIONS: We present the first case of a patient with COVID-19 with massive pulmonary embolism (PE) treated successfully with systemic thrombolysis, VA-ECLS and bail out catheter directed thrombolysis. In our experience catheter directed thrombolysis comes with an acceptable bleeding risk despite use of mechanical circulatory support, particularly with meticulous attention to vascular access and dose response monitoring.

2.
Ann Transplant ; 16(1): 5-13, 2011.
Article in English | MEDLINE | ID: mdl-21436768

ABSTRACT

BACKGROUND: Obesity is a risk factor for heart failure (HF) and associated with poor outcomes after cardiac transplantation. We assessed change in total body weight, morbidity and mortality in obese heart failure patients after implantation of a left ventricular assist device (LVAD) compared to medical management. MATERIAL/METHODS: Nineteen patients (9 females, age 51.3 ± 10 years) with a body mass index (BMI) ≥ 30.0 kg/m² and advanced HF (NYHA class III-IV, stage D) were evaluated. Thirteen (group 1) received insertion of a LVAD as bridge to transplantation. The remaining patients (group 2) were medically managed. All were advised on lifestyle modification. RESULTS: At baseline, group 1 (49.1 ± 10.7 years) had a total body weight (BW) of 246.6 ± 34.9 pounds (mean ± SD) and a BMI of 36.1 ± 4 kg/m². Group 2 (56 ± 6.7 yrs) had a BW of 238.8 ± 73.6 pounds and a BMI of 39.1 ± 9.3 kg/m2 (n.s. compared to group 1). All patients were alive at 12 months. At 6 months, BW in group 1 was reduced to 216.3 ± 20.8 pounds, and BMI to 31.8 ± 3.3 kg/m² (p < 0.05). At 6 months, BW in group 2 was 238.2 ± 84.6 pounds, and BMI was 39.1 ± 11.6 kg/m² (n.s. vs. baseline, p < 0.05 compared to group 1). The decrease in BW in group 1 was 12.3 ± 12% (30.3 ± 28.5 pounds). There was no change in BW in group 2 (0.3 ± 8.7%, 0.6 ± 21 pounds, p < 0.05 vs. group 1). At 12 months, 7 patients in group 1 (54%) underwent cardiac transplantation. CONCLUSIONS: LVAD insertion resulted in weight loss in obese patients not considered for heart transplantation compared to medically managed patients.


Subject(s)
Heart Failure/complications , Heart Failure/surgery , Heart Transplantation , Heart-Assist Devices , Obesity/complications , Adult , Aged , Body Mass Index , Cardiac Output , Contraindications , Energy Intake , Energy Metabolism , Female , Heart Failure/mortality , Heart Failure/physiopathology , Humans , Male , Middle Aged , Obesity/pathology , Risk Factors , Treatment Outcome , Weight Loss
3.
J Am Coll Cardiol ; 57(4): 455-65, 2011 Jan 25.
Article in English | MEDLINE | ID: mdl-21251587

ABSTRACT

OBJECTIVES: The purpose of this study was to test the safety and efficacy of direct injection of cardiosphere-derived cells (CDCs) and their 3-dimensional precursors, cardiospheres, for cellular cardiomyoplasty in a mini-pig model of heart failure after myocardial infarction. BACKGROUND: Intracoronary administration of CDCs has been demonstrated to reduce infarct size and improve hemodynamic indexes in the mini-pig model, but intramyocardial injection of CDCs or cardiospheres has not been assessed in large animals. METHODS: Autologous cardiospheres or CDCs grown from endomyocardial biopsies were injected through thoracotomy 4 weeks after anteroseptal myocardial infarction. Engraftment optimization with luciferase-labeled CDCs guided the choice of cell dose (0.5 million cells/site) and target tissue (20 peri-infarct sites). Pigs were randomly allocated to placebo (n = 11), cardiospheres (n = 8), or CDCs (n = 10). Functional data were acquired before injection and again 8 weeks later, after which organs were harvested for histopathology. RESULTS: Beyond the immediate perioperative period, all animals survived to protocol completion. Ejection fraction was equivalent at baseline, but at 8 weeks was higher than placebo in both of the cell-treated groups (placebo vs. CDC, p = 0.01; placebo vs. cardiospheres, p = 0.01). Echocardiographic and hemodynamic indexes of efficacy improved disproportionately with cardiospheres; likewise, adverse remodeling was more attenuated with cardiospheres than with CDCs. Provocative electrophysiologic testing showed no differences among groups, and no tumors were found. CONCLUSIONS: Dosage-optimized direct injection of cardiospheres or CDCs is safe and effective in preserving ventricular function in porcine ischemic cardiomyopathy. Although CDCs and cardiospheres have equivalent effects on left ventricular ejection fraction, cardiospheres are superior in improving hemodynamics and regional function, and in attenuating ventricular remodeling.


Subject(s)
Heart Failure/surgery , Mesenchymal Stem Cell Transplantation/methods , Myocardial Infarction/complications , Myocytes, Cardiac/transplantation , Ventricular Remodeling/physiology , Analysis of Variance , Animals , Disease Models, Animal , Female , Heart Failure/etiology , Heart Failure/mortality , Injections, Intralesional , Random Allocation , Reference Values , Risk Factors , Stroke Volume , Survival Rate , Swine , Swine, Miniature , Thoracostomy/methods , Transplantation, Autologous , Treatment Outcome
4.
J Relig Health ; 50(4): 872-9, 2011 Dec.
Article in English | MEDLINE | ID: mdl-20191322

ABSTRACT

Deciding who should receive maximal technological treatment options and who should not represents an ethical, moral, psychological and medico-legal challenge for health care providers. Especially in patients with chronic heart failure, the ethical and medico-legal issues associated with providing maximal possible care or withholding the same are coming to the forefront. Procedures, such as cardiac transplantation, have strict criteria for adequate candidacy. These criteria for subsequent listing are based on clinical outcome data but also reflect the reality of organ shortage. Lack of compliance and non-adherence to lifestyle changes represent relative contraindications to heart transplant candidacy. Mechanical circulatory support therapy using ventricular assist devices is becoming a more prominent therapeutic option for patients with end-stage heart failure who are not candidates for transplantation, which also requires strict criteria to enable beneficial outcome for the patient. Physicians need to critically reflect that in many cases, the patient's best interest might not always mean pursuing maximal technological options available. This article reflects on the multitude of critical issues that health care providers have to face while caring for patients with end-stage heart failure.


Subject(s)
Cardiopulmonary Resuscitation/ethics , Heart Failure/therapy , Heart Transplantation/ethics , Heart-Assist Devices/ethics , Sick Role/ethics , Cardiopulmonary Resuscitation/psychology , Disease Management , Humans , Patient Selection , Quality of Life
5.
Ann Thorac Surg ; 90(5): 1630-6, 2010 Nov.
Article in English | MEDLINE | ID: mdl-20971278

ABSTRACT

BACKGROUND: Gastroesophageal reflux and aspiration contribute to the development of bronchiolitis obliterans and accelerate graft deterioration after lung transplantation (LTx). We evaluated LTx candidates for esophageal motor abnormalities and gastroesophageal reflux. METHODS: Consecutive patients evaluated for LTx underwent 24-hour pH monitoring using a dual-channel pH probe and high-resolution esophageal manometry. High-resolution manometry was also performed in healthy control subjects. The prevalence of abnormal acid exposure was noted in the LTx candidates. RESULTS: Thirty LTx candidates and 10 control subjects were evaluated. Lung transplantation candidates had higher residual upper and lower esophageal sphincter pressures. The mean proportion of peristaltic swallows was 21% lower in LTx candidates. Both hypotensive and aperistaltic swallows were sixfold more prevalent in LTx candidates than in control subjects. All control subjects had normal high-resolution manometry whereas 23 LTx candidates (76.7%) had esophageal peristaltic dysfunction. Abnormal acid exposure time was seen in the proximal and distal esophagus in 25% and 36% of LTx candidates, respectively. Lung transplantation candidates with idiopathic pulmonary fibrosis had more aperistaltic contractions, more negative minimum intrathoracic pressure, and a higher frequency of abnormal distal esophagus acid exposure. The majority of patients with complications after LTx demonstrated motor, anatomic, or pH abnormalities. CONCLUSIONS: Disordered esophageal motor function and gastroesophageal reflux are common in LTx candidates. We believe high-resolution esophageal manometry is a valid tool to use and the abnormalities we identified may be representative of this unique patient population. The role of this study in predicting a worse outcome should be further studied in patients after LTx.


Subject(s)
Esophageal Motility Disorders/epidemiology , Gastroesophageal Reflux/epidemiology , Lung Transplantation/adverse effects , Adult , Aged , Case-Control Studies , Esophageal Sphincter, Lower/physiopathology , Esophageal Sphincter, Upper/physiopathology , Female , Humans , Hydrogen-Ion Concentration , Male , Manometry , Middle Aged
6.
J Cardiovasc Pharmacol Ther ; 15(3): 231-43, 2010 Sep.
Article in English | MEDLINE | ID: mdl-20595625

ABSTRACT

Recent advances in heart failure therapy include a variety of mechanical and device-based technologies that target structural aspects of heart failure that cannot be treated with drug therapy alone; these newer therapies can collectively be described as interventional heart failure therapy. This article is the second in a 2-part series reviewing interventional heart failure therapy. Interventions included in this discussion include those indicated for the treatment of end-stage refractory heart failure, including interventional medical therapy, interventional treatment of valvular disease, mechanical assist devices, and heart transplantation. Also included is a review of the currently available catheter-based pumps, which are intended to provide temporary support in patients with acute hemodynamic compromise. The use of cellular or stem cell therapy for the treatment of heart failure is an emerging interventional therapy and data supporting its use for the treatment heart failure will also be presented, as will a discussion of the role of palliative care and self-care in heart failure therapy.


Subject(s)
Heart Failure/therapy , Heart Valve Diseases/therapy , Cardiotonic Agents/therapeutic use , Heart Failure/drug therapy , Heart Failure/surgery , Heart Transplantation , Heart Valve Diseases/drug therapy , Heart Valve Diseases/surgery , Heart-Assist Devices , Humans , Palliative Care , Self Care , Stem Cell Transplantation
7.
J Cardiovasc Med (Hagerstown) ; 11(9): 695-9, 2010 Sep.
Article in English | MEDLINE | ID: mdl-19910801

ABSTRACT

BACKGROUND: Obesity is a worldwide health problem that is often worsened after organ transplantation. As obesity is associated with increased incidence of metabolic syndrome, cardiovascular events and death, it is essential to control weight and avoid weight gain in patients especially following cardiac transplantation. Of the various strategies that are available for weight reduction, bariatric surgery seems to be the most effective in achieving weight loss and in maintaining the reduced body weight. However, this has not been frequently performed in organ-transplant recipients. CASE REPORT: We are reporting a unique case of a bariatric surgery procedure performed in a patient after cardiac transplantation. A 30-year-old African-American man with a history of end-stage heart failure due to idiopathic dilated cardiomyopathy underwent orthotopic cardiac transplantation. Three years after transplantation, the patient underwent laparoscopic adjustable gastric banding surgery for morbid obesity. Two months later, the patient presented with severe heart failure and was diagnosed with acute cellular rejection as evidenced by endomyocardial biopsy results despite continued combined immunosuppressive therapy that had not been changed but with significantly reduced blood levels of calcineurin inhibitors. CONCLUSION: We hypothesize that the altered gastro-intestinal motility and delayed gastric emptying due to laparoscopic adjustable gastric banding may have caused incomplete absorption of the administered immunosuppressant drugs in this particular case, as evidenced by the low tacrolimus level, resulting in acute cellular rejection of the transplanted heart, which has never been described before.


Subject(s)
Bariatric Surgery/adverse effects , Cardiomyopathy, Dilated/surgery , Graft Rejection/immunology , Heart Transplantation/adverse effects , Immunity, Cellular , Obesity, Morbid/surgery , Acute Disease , Adult , Biopsy , Cardiomyopathy, Dilated/complications , Gastric Emptying , Gastrointestinal Motility , Graft Rejection/pathology , Graft Rejection/physiopathology , Humans , Immunity, Cellular/drug effects , Immunosuppressive Agents/pharmacokinetics , Immunosuppressive Agents/therapeutic use , Male , Obesity, Morbid/complications
8.
Interact Cardiovasc Thorac Surg ; 10(1): 150-1, 2010 Jan.
Article in English | MEDLINE | ID: mdl-19797475

ABSTRACT

We present the case of a man with heparin-induced thrombocytopenia (HIT) and acute idiopathic decompensated cardiomyopathy who underwent successful heart transplantation with the use of bivalirudin as anticoagulant.


Subject(s)
Anticoagulants/therapeutic use , Cardiomyopathies/surgery , Heart Transplantation , Peptide Fragments/therapeutic use , Adult , Anticoagulants/adverse effects , Blood Transfusion, Autologous , Cardiopulmonary Bypass , Heparin/adverse effects , Hirudins , Humans , Immunosuppressive Agents/therapeutic use , Male , Recombinant Proteins/therapeutic use , Thrombocytopenia/chemically induced , Transplantation, Homologous , Treatment Outcome
9.
J Am Soc Echocardiogr ; 23(5): 580.e1-3, 2010 May.
Article in English | MEDLINE | ID: mdl-19880279

ABSTRACT

Mycotic pseudoaneurysm of the ascending aorta is a rare and potentially fatal complication of cardiac surgery, particularly in immunosuppressed heart transplantation patients. In this case, a 70-year-old man who underwent heart transplantation 4 months earlier was incidentally found to have a large pseudoaneurysm of the ascending aorta at the level of the aortic suture line. Surgical repair of the pseudoaneurysm was undertaken, and cultures from the pseudoaneurysm were found to be positive for Aspergillus fumigatus.


Subject(s)
Aneurysm, Infected/diagnostic imaging , Aneurysm, Infected/microbiology , Aortitis/diagnostic imaging , Aspergillosis/diagnostic imaging , Aspergillosis/microbiology , Heart Transplantation/adverse effects , Heart Transplantation/diagnostic imaging , Aged , Aortitis/microbiology , Aspergillus fumigatus , Echocardiography, Doppler/methods , Humans , Incidental Findings , Male
10.
Interact Cardiovasc Thorac Surg ; 9(5): 888-90, 2009 Nov.
Article in English | MEDLINE | ID: mdl-19720659

ABSTRACT

We present a case report of a ruptured sinus of Valsalva aneurysm (SVA) that presented as aortic insufficiency following bacterial endocarditits in a cardiac transplant patient. Cardiac computed tomographic angiography (CCTA) including volume rendered images predicted the appearance of the fistula entrance and defined spatial relationships facilitating the surgical approach. CCTA ability to define the coronary anatomy obviated the need for invasive coronary angiography. The use of this imaging modality especially with three-dimensional spatial visualization, and multiphase cine angiography can add significant value to the care of a patient with ruptured sinus of Valsalva.


Subject(s)
Aneurysm, False/diagnostic imaging , Aortic Aneurysm/diagnostic imaging , Aortic Rupture/diagnostic imaging , Cardiac Catheterization , Cineangiography , Coronary Angiography/methods , Sinus of Valsalva/diagnostic imaging , Tomography, X-Ray Computed , Aneurysm, False/etiology , Aneurysm, False/surgery , Aortic Aneurysm/etiology , Aortic Aneurysm/surgery , Aortic Rupture/etiology , Aortic Rupture/surgery , Aortic Valve Insufficiency/diagnostic imaging , Aortic Valve Insufficiency/etiology , Bioprosthesis , Endocarditis, Bacterial/complications , Endocarditis, Bacterial/diagnostic imaging , Heart Diseases/diagnostic imaging , Heart Diseases/etiology , Heart Valve Prosthesis , Heart Valve Prosthesis Implantation/instrumentation , Heart Ventricles/diagnostic imaging , Humans , Male , Middle Aged , Pericardium/transplantation , Predictive Value of Tests , Sinus of Valsalva/surgery , Treatment Outcome , Vascular Fistula/diagnostic imaging , Vascular Fistula/etiology
11.
Interact Cardiovasc Thorac Surg ; 9(5): 919-20, 2009 Nov.
Article in English | MEDLINE | ID: mdl-19706718

ABSTRACT

Left ventricular assist device (LVAD) insertion has been used more frequently within the recent years either as a bridge to transplant or as destination therapy in patients with advanced heart failure who fail medical therapy. We present a report of a 60-year-old male patient with end-stage heart failure and cardiomyopathy with a history of human immunodeficiency virus (HIV) infection who underwent LVAD placement as destination therapy. To our knowledge, LVAD placement in this fashion has not been reported previously. Following LVAD implantation, the patient recovered during the course of five weeks and was discharged home from the hospital in good condition. The patient was alive and free of any activity limitations sixteen months postoperatively. We conclude that LVAD placement for end-stage heart failure may be a feasible option as destination therapy in patients with HIV.


Subject(s)
Cardiomyopathy, Dilated/therapy , HIV Infections/drug therapy , Heart Failure/therapy , Heart-Assist Devices , Antiretroviral Therapy, Highly Active , Cardiomyopathy, Dilated/physiopathology , Cardiomyopathy, Dilated/virology , Fatal Outcome , HIV Infections/virology , Heart Failure/physiopathology , Heart Failure/virology , Humans , Male , Middle Aged , Prosthesis Design , Prosthesis Failure , Treatment Outcome , Ventricular Function, Left
12.
Eur J Cardiothorac Surg ; 34(4): 918-9, 2008 Oct.
Article in English | MEDLINE | ID: mdl-18678506

ABSTRACT

We present the case of a man who underwent successful heart transplantation with an allograft that was obtained from a donor who had already received heart transplantation.


Subject(s)
Heart Transplantation/methods , Tissue and Organ Harvesting/methods , Adult , Brain Death , Cerebral Hemorrhage/etiology , Humans , Male , Middle Aged , Postoperative Complications , Tissue Donors
13.
Transplantation ; 81(6): 862-5, 2006 Mar 27.
Article in English | MEDLINE | ID: mdl-16570009

ABSTRACT

BACKGROUND: Controversy exists regarding the optimal use of bilateral lung transplant (BLT) in older recipients in diseases where either single or bilateral transplant is appropriate. International Society for Heart and Lung Transplant (ISHLT) guidelines suggest an upper age limit of 60 for BLT, despite limited data regarding outcomes with BLT in patients over 60. We hypothesize that BLT offers comparable, if not superior, clinical outcomes to SLT in all patients independent of recipient age. METHODS: In order to test our hypothesis, we conducted a case-control study to compare the effect of transplant operation on survival and the onset of bronchiolitis obliterans syndrome (BOS) in consecutive lung transplant recipients 61 years of age or older using Kaplan- Meier analysis and Cox proportional hazard models. RESULTS: We identified 107 consecutive lung transplant recipients 61 or older at the time of transplant. Patients received SLT (n=46) or BLT (n=61) based on donor organ availability. Comparable survival was achieved with BLT in older patients vs. SLT P=0.19). One-, two-, and five-year survival estimates in BLT were 82%, 75% and 68%, respectively, vs. in SLT 78%, 70% and 44%, respectively. A comparable onset of BOS was also observed in the patients who received BLT vs. SLT (P=0.23). CONCLUSION: Successful short- and medium-term outcomes are achieved with BLT in older recipients and are comparable to those achieved with SLT. Our results suggest that age over 60 should not exclude patients from consideration of BLT.


Subject(s)
Lung Transplantation , Age Factors , Aged , Bronchiolitis Obliterans/etiology , Case-Control Studies , Female , Humans , Lung Transplantation/adverse effects , Lung Transplantation/mortality , Male , Middle Aged
14.
Interact Cardiovasc Thorac Surg ; 5(3): 202-6, 2006 Jun.
Article in English | MEDLINE | ID: mdl-17670548

ABSTRACT

Microwave energy allows thoracoscopic beating-heart ablation for the treatment of atrial fibrillation. However, there is a paucity of data on the histologic effects of microwave energy on the beating human heart. This study aims to histopathologically characterize microwave lesions on the beating human atrium. Microwave energy was applied prior to cardiectomy on the beating native right atrium in eight patients undergoing heart transplantation and as a circumferential left atrial 'box' lesion in one patient undergoing heart-lung transplantation. Lesions were applied following heparinization and cannulation, but before initiation of cardiopulmonary bypass. Following cardiectomy, specimens were resected, fixed and subjected to histologic preparation. Grossly, all atrial lesions were 'comma-shaped' with an area of maximum injury on the surface. Microscopically, myocyte injury manifested as acute coagulation necrosis with hypereosinophilic myocytes with both nuclear loss and pyknosis. Contraction bands were noted at the periphery of lesions. The injury was transmural in all right atrial lesions. The left atrial sample contained a circumferential lesion ranging from 0.1 to 0.8 cm in width. The cut edge demonstrated lesion depths of 0.2-0.6 cm, maximum (transmural) in the inferior margin. Microwave ablation represents an acceptable energy source to create characteristic lesions on the beating human atrium.

15.
Ann Thorac Surg ; 80(5): 1872-9; discussion 1879-80, 2005 Nov.
Article in English | MEDLINE | ID: mdl-16242472

ABSTRACT

BACKGROUND: Primary graft failure remains a significant source of mortality after lung transplantation. Extracorporeal membrane oxygenation (ECMO) provides treatment for affected recipients. We hypothesized that venovenous membrane oxygenation provides a safer alternative than venoarterial support for lung recipients suffering from primary graft failure. METHODS: We conducted an analysis of 522 patients who underwent lung transplantation from April 1992 to July 2004. Twenty-three (4.5%) patients required membrane oxygenation secondary to primary graft failure unresponsive to conventional treatment. Of these recipients, 15 (65%) were treated with venoarterial, while 8 (35%) underwent venovenous membrane oxygenation. RESULTS: Median days to initiation and duration of membrane oxygenation did not differ between groups. Eight of 15 patients (53%) from the venoarterial group were successfully weaned from life support, with one surviving greater than 45 days. This lone long-term survivor required retransplantation 4 days after initial transplant. In contrast, all venovenous patients were weaned from support, with 7 of 8 surviving greater than 30 days. The 30-day survival for venovenous recipients (88%) approximates that of all lung recipients at our center (94%, p = 0.42). Noted complications for ECMO patients included renal failure (n = 16), neurologic catastrophes (n = 8), sepsis (n = 5), and hemorrhage (n = 10). The venoarterial recipients suffered 30 of 39 total complications. Most of the complications for venovenous recipients involved renal failure, but by hospital discharge these patients demonstrated a mean creatinine of 0.9 mg/dL. CONCLUSIONS: For lung recipients with primary graft failure, venovenous membrane oxygenation provides better outcomes, with fewer complications, than venoarterial membrane oxygenation.


Subject(s)
Extracorporeal Membrane Oxygenation/methods , Graft Rejection/therapy , Female , Graft Rejection/mortality , Humans , Lung Transplantation/statistics & numerical data , Male , Middle Aged
16.
Ann Thorac Surg ; 80(2): 717-9, 2005 Aug.
Article in English | MEDLINE | ID: mdl-16039240

ABSTRACT

Doxorubicin-induced cardiomyopathy is not uncommon and may progress to end-stage heart failure. Treatment of this condition with heart transplantation, however, requires that the primary malignancy be deemed "cured." We present the case of a 55- year-old woman who had doxorubicin-induced cardiomyopathy and non-Hodgkin's lymphoma. The active status of her lymphoma precluded heart transplantation. She had end-stage heart failure and underwent the insertion of a left ventricular assist device as a destination therapy.


Subject(s)
Antibiotics, Antineoplastic/adverse effects , Cardiomyopathies/chemically induced , Doxorubicin/adverse effects , Heart Failure/surgery , Heart-Assist Devices , Cardiomyopathies/surgery , Female , Heart Failure/chemically induced , Humans , Lymphoma, Non-Hodgkin/drug therapy , Middle Aged
18.
Crit Care Med ; 31(9): 2324-31, 2003 Sep.
Article in English | MEDLINE | ID: mdl-14501963

ABSTRACT

OBJECTIVE: To determine whether near infrared spectroscopic measurement of tissue pH and Po2 has sufficient accuracy to assess variation in tissue perfusion resulting from changes in blood pressure and metabolic demand during cardiopulmonary bypass. DESIGN: Prospective clinical study. SETTING: Academic medical center. SUBJECTS: Eighteen elective cardiac surgical patients. INTERVENTION: Cardiac surgery under cardiopulmonary bypass. MEASUREMENTS AND MAIN RESULTS: A near infrared spectroscopic fiber optic probe was placed over the hypothenar eminence. Reference Po2 and pH sensors were inserted in the abductor digiti minimi (V). Data were collected every 30 secs during surgery and for 6 hrs following cardiopulmonary bypass. Calibration equations developed from one third of the data were used with the remaining data to investigate sensitivity of the near infrared spectroscopic measurement to physiologic changes resulting from cardiopulmonary bypass. Near infrared spectroscopic and reference pH and Po2 measurements were compared for each subject using standard error of prediction. Near infrared spectroscopic pH and Po2 at baseline were compared with values during cardiopulmonary bypass just before rewarming commenced (hypotensive, hypothermic), after rewarming (hypotensive, normothermic) just before discontinuation of cardiopulmonary bypass, and at 6 hrs following cardiopulmonary bypass (normotensive, normothermic) using mixed-model analysis of variance. Near infrared spectroscopic pH and Po2 were well correlated with the invasive measurement of pH (R2 =.84) and Po2 (R 2 =.66) with an average standard error of prediction of 0.022 +/- 0.008 pH units and 6 +/- 3 mm Hg, respectively. The average difference between the invasive and near infrared spectroscopic measurement was near zero for both the pH and Po2 measurements. Near infrared spectroscopic Po2 significantly decreased 50% on initiation of cardiopulmonary bypass and remained depressed throughout the bypass and monitored intensive care period. Near infrared spectroscopic pH decreased significantly during cardiopulmonary bypass, decreased significantly during rewarming, and remained depressed 6 hrs after cardiopulmonary bypass. Diabetic patients responded differently than nondiabetic subjects to cardiopulmonary bypass, with lower muscle pH values (p =.02). CONCLUSIONS: Near infrared spectroscopic-measured muscle pH and Po2 are sensitive to changes in tissue perfusion during cardiopulmonary bypass.


Subject(s)
Carbon Dioxide , Cardiopulmonary Bypass/methods , Hydrogen-Ion Concentration , Monitoring, Intraoperative/methods , Muscle, Skeletal/metabolism , Spectroscopy, Near-Infrared , Aged , Coronary Artery Bypass/methods , Coronary Disease/surgery , Female , Humans , Male , Middle Aged , Oxygen Consumption/physiology , Postoperative Period , Predictive Value of Tests , Prospective Studies , Sensitivity and Specificity
19.
Ann Thorac Surg ; 75(5): 1635-7, 2003 May.
Article in English | MEDLINE | ID: mdl-12735596

ABSTRACT

Splenic abscess is a rare clinical entity that is most commonly associated with infective endocarditis. Valve replacement in the setting of an unaddressed splenic abscess is associated with a high incidence of prosthetic valve infection and death. We describe 2 patients with infective endocarditis and splenic abscess treated by laparoscopic splenectomy followed by valve replacement.


Subject(s)
Abscess/surgery , Endocarditis, Bacterial/surgery , Heart Valve Prosthesis Implantation , Laparoscopy , Splenectomy , Splenic Diseases/surgery , Abscess/complications , Adult , Aged , Humans , Male , Splenic Diseases/complications
SELECTION OF CITATIONS
SEARCH DETAIL
...