RESUMO
A 24-year-old female developed heart failure within four months of delivering her first child. Echocardiogram revealed a moderately dilated left ventricle with severely reduced systolic function. She continued to decompensate, requiring intubation and inotropic support. When the use of an intra-aortic balloon pump failed to stabilize the patient, the decision was made to place her on ECMO. The circuit consisted of a Quadrox D membrane oxygenator and a CentriMag centrifugal pump. After 11 days of support, the patient met the weaning criteria and was successfully removed from ECMO. She was discharged one month after her admission. The new technology available allows for ECMO to be considered as an earlier option for the treatment and management of these patients as a bridge to recovery.
Assuntos
Cardiomiopatia Dilatada/terapia , Oxigenação por Membrana Extracorpórea/métodos , Insuficiência Cardíaca/terapia , Transtornos Puerperais/terapia , Disfunção Ventricular Esquerda/terapia , Feminino , Coração Auxiliar , Humanos , Oxigenadores de Membrana , Adulto JovemRESUMO
Surgery for the repair of a type I aortic dissection presents several difficulties for the surgeon and the perfusionist. One must safely support the patient, while at the same time provide the surgeon with a bloodless field in which to operate. Often, this requires cessation of the circulation for varying amounts of time. Deep hypothermia allows for an extension of the arrest period, while other techniques-- retrograde cerebral perfusion and antegrade cerebral perfusion--provide an additional degree of cerebral protection. Recently, we utilized these techniques concurrently on a 43-year-old female who presented for a reoperation for a type I aortic dissection. Combining these techniques allowed us to adequately support the patient during an anticipated lengthy period of circulatory arrest and insured a successful operation without any adverse cerebral or other organ dysfunction.
Assuntos
Aneurisma Aórtico/cirurgia , Dissecção Aórtica/cirurgia , Ponte Cardiopulmonar/instrumentação , Parada Cardíaca Induzida , Hipotermia Induzida , Adulto , Dissecção Aórtica/complicações , Aneurisma Aórtico/complicações , Implante de Prótese Vascular , Circulação Cerebrovascular , Transtornos Relacionados ao Uso de Cocaína/complicações , Desenho de Equipamento , Feminino , Comunicação Interatrial/complicações , Comunicação Interatrial/cirurgia , Humanos , Hipertensão/induzido quimicamente , Hipertensão/complicações , Infarto da Artéria Cerebral Média/complicações , ReoperaçãoRESUMO
Ultrafiltration has been shown to affect cardiac drug concentrations during cardiopulmonary bypass (CPB), based on their respective pharmacological properties. In an attempt to understand the aetiology of sternal wound infections, a study was performed to eliminate the use of ultrafiltration as a possible cause. We compared cefazolin levels at three time intervals during the course of routine CPB with ultrafiltration to those levels in a control group in which ultrafiltration was not used. Our results indicate that there is little difference in the rate of decay of antibiotic levels with or without the use of a haemoconcentrator. This implies that ultrafiltration procedures do not put the patient at any increased risk for infection and that additional measures beyond that which we would normally use at our institution need not be taken.
