Unusual indication for extracorporeal membrane oxygenation immediately after successful sequential bilateral lung transplantation: a case report.

BACKGROUND: Ischemia-reperfusion injury-induced primary graft dysfunction after lung transplantation is a major cause of early morbidity and mortality. CASE REPORT: We report an unusual case of primary graft dysfunction grade III following uneventful off-pump bilateral sequential lung transplantation caused by paradoxical left ventricular failure due to systolic anterior motion of the mitral valve-induced left ventricular outflow tract obstruction. Cardiac failure was precipitated by profound dehydration and administration of high doses of vasopressin and norepinephrine. Immediate connection to extracorporeal membrane oxygenation treated the graft failure-associated respiratory-pulmonary hypoxia and reversed the cardiogenic shock syndrome. CONCLUSIONS: Hypovolemia together with a hyperdynamic state resulting from catecholamine administration may result in the development of dynamic left ventricular outflow tract obstruction even if baseline cardiac evaluation is unremarkable. Early detection and intensive efforts to reverse the underlying conditions including cessation of catecholamine therapy and correction of hypovolemia are essential.

First report of the Port Access International Registry.

BACKGROUND: For minimally invasive cardiac operations to be widely applicable, the risks must be equivalent to those of standard open-chest operations. This study analyzed the outcomes of patients recorded in the multicenter Port Access (PA) International Registry to establish operative risks. METHODS: Data were analyzed for intent to treat in 583 patients who underwent PA coronary artery bypass grafting (CABG), 184 who underwent PA mitral valve replacement, and 137 who underwent PA mitral valve repair at 121 centers. RESULTS: Port Access was attempted in 1,063 patients and completed in 1,004 (94%). The operative mortality rate was 1% for PA CABG, 3.3% for PA mitral valve replacement, and 1.5% for PA mitral valve repair. Perioperative morbidity was low in all categories: stroke = 1.1% to 3.6%, myocardial infarction = 0 to 1%, primary procedure reoperation = 0 to 0.7%, renal failure = 0.2% to 0.7%, multiorgan failure = 0 to 0.5%, and atrial fibrillation = 5% to 7.3%. CONCLUSIONS: Data on 1,063 patients from 121 centers demonstrate that PA CABG and PA mitral valve operations can be performed safely, with morbidity and mortality rates similar to those associated with open-chest operations. Further studies are indicated to establish the long-term efficacy of this method and to analyze its effect on recovery time.

Laser Action from a 2,6,8-Position Trisubstituted 1,3,5,7-Tetramethylpyrromethene-BF(2) Complex: Part 3.

Some laser action properties of a new Pyrromethene-BF(2) complex, 1, 3, 5, 7-tetramethyl-8-ethyl-2, 6-dicyanopyrromethene-BF(2) complex are reported. This laser dye exhibits laser action in the green-yellow portion of the spectrum, and its laser action efficiency was ~350% higher compared with Coumarin 545. Exceptional photostability of the new laser dye was observed when a mixture of 1, 4-dioxane:heptane ratio of 1:4 was used as the solvent. Further, it is suggested that dye lasers can be upscaled to high average power output when surface-emitting laser diode arrays are used as pump (excitation) sources.

Efficient laser action from two cw laser-pumped pyrromethene-BF(2) complexes.

Two new pyrromethene-BF(2) dyes, P-556 and P-567, are tested for cw laser operation. P-556 demonstrates a significant advance in the 530-620-nm region over commercially currently available dyes, where the best cw dyes in any range have peak efficiencies of the order of 35% and dyes in this range typically have less then 25%. The P-556 has a cw efficiency of 45% at the peak.

Laser dye spectroscopy of some pyrromethene-BF(2) complexes.

To improve the laser action properties of the pyrromethene-BF(2) (P-BF(2)) complexes, we studied substitution effects at different positions of the dye molecule on the electronic spectra of several derivatives. Specifically, we used laser photoselection spectroscopy to measure the triplet-triplet (T-T) absorption and polarization spectra as well as the fluorescence and visible absorption singlet-singlet (S-S) spectra of the following compounds: 1,2,3,5,6,7,8-heptamethyl; 8-acetoxymethyl-1,3,5,7-tetramethyl-2,6-diethyl; 1,3,5,7-tetramethyl-8-p-methoxyphenyl; 3,5-dimethyl-1,7-diphenyl; and 1,3,5,7,8-pentamethyl- 2,6-diphenyl P-BF(2) complexes. The 1,3,5,7-tetramethyl P-BF(2) complex itself exhibits weak T-T absorption, which stretches from the green to the near-IR spectral region. This band consists of two overlapping (differently polarized) T-T transitions. Short molecular axis (i.e., 8 and 1,7 positions) substitution causes the positively polarized T-T transition to gain considerably in intensity. Significantly, the negatively, long-axis-polarized T-T transition was unaffected by the long-axis 2,6- position disubstitution. Therefore, only the 2,6-position disubstitution is expected to produce superior new P-BF(2) complex laser dyes. Substitution effects from strongly interacting groups with chromophores on S-S as well as T-T absorption spectra, together with cw laser photoselection spectroscopy, are briefly reviewed.

Laser action from 2,6,8-trisubstituted-1,3,5,7-tetramethyl-pyrromethene-BF(2) complexes: part 2.

In laser activity 1,3,5,7-tetramethyl-2,6-dicarboethoxy-8- cyanopyrromethene-BF(2)complex 5 under flash-lamp excitation was approximately 1.8 times more energy efficient than Rhodamine-B; about the same efficiency of Rhodamine-575 was found for 1,3,5, 7-tetramethyl-2,6,8-triethylpyrromethene- BF(2) complex 2.

Laser action from 2,6,8-position trisubstituted 1,3,5,7-tetramethylpyrromethene-BF(2) complexes: part 1.

Of the four new pyrromethene derivatives studied, 1,3,5,7,8-pentamethyl-2,6-diethylpyrromethene-BF(2) complex lased ~3 times more efficiently than rhodamine 560 under flashlamp excitation.