Homemade Salvage Setup for a Catastrophic Heater/Cooler Failure on Cardiopulmonary Bypass.

Perfusion-related problems are still reported at incidence, varying from .72 to 2.86%, and add to the morbidity and mortality of cardiac surgery. Awareness of such problems and establishing protocols to avoid and manage them is a key factor in further improving patient outcomes. In this report, we describe a homemade setup which was used as a desperate salvage measure to rewarm a 1-year-old baby on cardiopulmonary bypass for intracardiac repair, who was inadvertently cooled to 24°C because of a malfunctioning heater/cooler machine.

Anomalous left pulmonary artery: rare case, uncertain embryology and off-pump approach.

Left pulmonary artery from descending aorta, left-sided arch and patent ductus arteriosus is a rare congenital anomaly. Only one such case has been reported before, which was repaired in the neonatal period and the authors suggested that current theories of embryology failed to explain such a combination. Early and often bilateral pulmonary vascular disease is common with such defects. We present an 8-month-old baby, with this anatomy, who was repaired using an off-pump approach, to minimize the risk of postoperative pulmonary hypertensive crisis and propose a "modified ontogenic theory" to explain the embryology.

The effect of distal pulmonary obstruction or elevated atrial pressures on pulmonary flow and pulmonary vascular disease: a mathematical flow circuit analogy model-based analysis.

BACKGROUND: Late presentation of large left to right shunts is a major problem in developing countries and evaluating the operability is a challenge during preoperative evaluation. The factors that determine the development and progression of the pulmonary vascular disease are still largely unknown, though there is evidence to show that increased pulmonary flow is the main contributing factor. We have found cases of operability despite late presentation of ventricular septal defect (VSD). In some of these cases, the reason for operability may lie in associations. We herein attempt to provide a mathematical explanation for their operability. AIMS AND OBJECTIVES: To assess the effect of different levels of obstruction and elevated ventricular end-diastolic pressure on pulmonary flow. MATERIALS AND METHODS: Mathematical flow analogy models were constructed and analysed based on Ohm's law and the laws governing flow in series and parallel flow circuits. RESULTS: Any narrowing in the pulmonary circulation produces a reduction in pulmonary blood flow and the pulmonary to systemic blood flow ratio, irrespective of its position. This increases the systemic flow and blood pressure if the ventricular performance remains constant. A rise in ventricular end-diastolic pressure reduces the total cardiac output, pulmonary flow and systemic blood flow with a preserved pulmonary to systemic flow ratio. The absolute reduction in pulmonary flow will exceed the absolute reduction in systemic flow, with its ratio being in proportion to the ratio of systemic to pulmonary vascular resistance. However, a higher pressure will be transmitted distally in these settings. These mechanisms of flow reduction may prevent irreversible pulmonary vascular disease. CONCLUSION: Distal pulmonary obstruction or elevated ventricular end-diastolic pressure can reduce pulmonary blood flow and may prevent irreversible pulmonary vascular disease. Clinical studies in this direction are recommended for validation.

Sinus Node Dysfunction After Extracardiac Conduit and Lateral Tunnel Fontan Operation: The Importance of the Type of Prior Superior Cavopulmonary Anastomosis.

This review summarizes the influence of the type of prior superior cavopulmonary anastomosis in the studies that report a difference in the occurrence of sinus node dysfunction among extracardiac conduit Fontan and lateral tunnel Fontan operations along with clinical implications.

Temporary clamping of branch pulmonary artery for pulmonary hemorrhage after endarterectomy.

A 49-year-old man underwent pulmonary thromboendarterectomy for chronic thromboembolic pulmonary hypertension. A massive pulmonary hemorrhage developed, which was identified to be from the right lower lobe, when weaning off cardiopulmonary bypass was attempted. He was managed by temporary overnight clamping of the right pulmonary artery, after the upper lobe branch. The next morning the clamp was removed, the bleeding had stopped completely, and his chest was closed. The patient was discharged on the 21st day. At 14 months' follow-up, he is in New York Heart Association functional class I. In suitable patients, temporary clamping of branch pulmonary artery can be a useful salvage measure, as in this patient.