Successful Rescue from Cardiac Arrest in a Patient with Postinfarction Left Ventricular Blow-Out Rupture: "Extra-Pericardial Aortic Cannulation" for Establishment Total Cardiopulmonary Bypass

2014 ◽  
Vol 17 (4) ◽  
pp. 217
Author(s):  
Suguru Ohira ◽  
Hitoshi Yaku ◽  
Shunsuke Nakajima ◽  
Akihiko Takahashi
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Bypass ◽  
Artery Bypass ◽  
Median Sternotomy ◽  
Venous Drainage ◽  
Left Ventricular ◽  
Ascending Aorta ◽  
Right Atrial ◽  
Aortic Cannulation ◽  
The Right

We report a quick and simple technique to establish cardiopulmonary bypass (CPB) in a left ventricular (LV) blow-out rupture. A 74-year-old woman with a diagnosis of acute myocardial infarction suddenly collapsed and lost consciousness. A venous-arterial extracorporeal membrane oxygenation (ECMO) device was inserted by femoral cannulation. Emergent median sternotomy was performed. The pericardium was not opened first, and the thymus was divided to expose the ascending aorta just above the pericardial reflection. After placing two purse-string sutures on the distal ascending aorta, a 7-mm aortic cannula (Terumo, Tokyo, Japan) was inserted. The pericardium was then incised. A large volume of blood was expelled from the pericardial space, and CPB was initiated with suction drainage. A two-stage venous drainage cannula was then inserted from the right atrial appendage without hemodynamic collapse. After cardiac arrest, closure of ruptured LV wall and concomitant coronary artery bypass grafting were performed. The patient was weaned from CPB with an intra-aortic balloon pump (IABP) and the previously inserted venous-arterial ECMO. Extra-pericardial aortic cannulation is an effective and reproducible method to prepare for CPB in emergent cases of LV rupture.

scholarly journals EPICARDIAL PACING

2010 ◽  
Vol 17 (01) ◽  
pp. 55-58
Author(s):  
ZAHID PARVEZ ◽  
FARID AHMAD CHAUDHARY ◽  
AJMAL HASAN NAZQVI ◽  
Muniza Saeed
Keyword(s):  
Cardiac Surgery ◽  
Artery Bypass ◽  
Left Ventricular ◽  
Right Atrial ◽  
Routine Practice ◽  
Optimum Time ◽  
Pacing Threshold ◽  
Significant Difference ◽  
Group 2 ◽  
The Right

Placement of epicardial wires on the right atrial and right ventricle surfaces is a routine practice in cardiac surgery. These pacingelectrodes are used for invasive pacing of the myocardium for a variety of emergent and elective conditions postoperatively. There is uncertaintyin actual practice about the optimum time for their removal, and practice varies widely between different institutions. Objectives: To determine thetime related efficacy of these pacing electrodes after cardiac surgery, to find out the optimum time of their removal. Period: July 2008 toOctober 2008. Patients & Methods: 47 patients those underwent coronary artery bypass surgery were prospectively enrolled and evaluatedwith standard 12 lead ECG and ventricle pacing threshold immediately after surgery and on the 5t h postoperative day. The patients were dividedinto two subgroups according to their left ventricle ejection fraction ( > 40% verses < 40%). Results: There was significant difference in theeffective pacing threshold in groupl and 2 on immediate post operative period and on day 5. (P = 0.002 and P = 0.02 respectively) The sensingthreshold immediately after operation and on 5t h post operative day also differed significantly (P = 0.009 in group 1 and 0.02 in group 2) Theeffective VVI* pacing was lost in 17 patients (40.5%) on the 5t h post operative day and comparison of effective pacing threshold in the twogroups showed no significant difference during the same period of time (P = NS). "Ventrculo-ventrical inhibition. Conclusions: The epicardialpacing wires have little usefulness after the fifth postoperative day and should be removed by this time. In addition postoperative pacingthreshold was not affected by the decreased left ventricular function.

scholarly journals A Case Report of Iatrogenic Pulmonary Artery Injury due to Chest-Tube Insertion Repaired under Cardiopulmonary Bypass

2013 ◽  
Vol 2013 ◽  
pp. 1-2 ◽  
Author(s):  
Ciss Amadou Gabriel ◽  
Dieng Papa Adama ◽  
Ba Papa Salmane ◽  
Gaye Magaye ◽  
Diatta Souleymane ◽  
...  
Keyword(s):  
Case Report ◽  
Cardiopulmonary Bypass ◽  
Pulmonary Artery ◽  
Chest Tube ◽  
Main Pulmonary Artery ◽  
Median Sternotomy ◽  
Posterior Wall ◽  
Ascending Aorta ◽  
Artery Injury ◽  
The Right

The authors presented a case of a 50-year-old patient with multiple trauma who suffered from the inadvertent cannulation of the main pulmonary artery at the second attempt of left chest drainage. Pulmonary artery injury has been suspected because early chest tube production was 2300 mL of blood. CT scan showed injury of the trunk of the pulmonary artery, left hemothorax, and suspect damage of the right branch of the pulmonary artery. That chest tube touched the posterior wall of ascending aorta. Surgical approach was median sternotomy. Exploration showed a perforation of the trunk of pulmonary artery without lesion of the right pulmonary branch and the posterior wall of the ascending aorta. The lesion was repaired under normothermic partial cardiopulmonary bypass. Postoperative period was free of events. Review of the literatures for this rare case report has been done.

Sternotomy Sparing Thoratec Heartmate 3 Implantation via Bilateral Minithoracotomy

2018 ◽  
Vol 13 (1) ◽  
pp. 74-76 ◽  
Author(s):  
Julia Riebandt ◽  
Dominik Wiedemann ◽  
Guenther Laufer ◽  
Daniel Zimpfer
Keyword(s):  
Left Ventricular ◽  
Ascending Aorta ◽  
Intercostal Space ◽  
Implantation Technique ◽  
Thromboembolic Complications ◽  
Short Term ◽  
Short Term Mortality ◽  
Transplant Candidates ◽  
The Right ◽  
Outflow Graft

A novel sternotomy sparing implantation technique for the Thoratec HeartMate 3 is described. Cannulation of the left ventricular apex is performed via a minithoracotomy in the left fourth or fifth intercostal space. The outflow graft is advanced through the pericardium to a second minithoracotomy in the right second intercostal space and then anastomosed to the ascending aorta. This approach was performed in three patients so far with no need for conversion. We did not observe any perioperative adverse events, such as bleeding or thromboembolic complications, as well as no short-term mortality. This technique is especially appealing in multimorbid and frail patients, future transplant candidates, and patients with impaired right ventricular function.

Arterial pressure-flow relations in the awake standing dog

1975 ◽  
Vol 229 (5) ◽  
pp. 1261-1270 ◽  
Author(s):  
W Enrlich ◽  
FV Schrijen ◽  
TA Solomon ◽  
E Rodriguez-Lopez ◽  
RL Riley
Keyword(s):  
Heart Rate ◽  
Arterial Pressure ◽  
Rate Increase ◽  
Diastolic Pressure ◽  
Aortic Pressure ◽  
Left Ventricular ◽  
Right Atrial ◽  
Heart Rate Increase ◽  
Underlying Mechanisms ◽  
The Right

The transient circulatory changes following paced heart rate increase are reported from 133 trials with 6 unanesthetized dogs with chronically implanted monitoring devices for heart rate, cardiac output, aortic blood pressure, and mean right atrial pressure. In 62 trials with 2 of the dogs, pulmonary artery, and left ventricular end-diastolic pressure, as well as left ventricular dP/dt were also studied. The sequence of changes in pressures and flows is analyzed in terms of probable underlying mechanisms, particularly with respect to the nature of vascular resistances. The rise in aortic pressure and flow during the first 3 s of paced heart rate increase, before arterial stretch receptor reflexes become active, is more consistent with an effective downstream pressure of about 49 mmHg, presumably at the arteriolar level, than with an effective downstream pressure close to 0 mmHg at the right atrial level. In the pulmonary circulation where vascular reflex effects are less prominent, the pattern of pulmonary arterial pressure and flow for the entire 30 s of observation is consistent with an effective downstream pressure of 9 mmHg, presumably at the alveolar or pulmonary arteriolar level, rather than at the level of the left ventricular end-diastolic pressure.

scholarly journals Characteristics and long-term outcomes of aortico-left ventricular tunnel

2020 ◽  
Author(s):  
Jing Sun ◽  
Hongxia Qi ◽  
Hongyuan Lin ◽  
Wenying Kang ◽  
Shoujun Li ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Valve Replacement ◽  
Surgical Repair ◽  
Mechanical Valve ◽  
Left Ventricular ◽  
Ascending Aorta ◽  
Aortic Orifice ◽  
The Right

Abstract OBJECTIVES Aortico-left ventricular tunnel (ALVT) is an extremely rare, abnormal paravalvular communication between the aorta and the left ventricle. Few studies have identified the characteristics and long-term prognosis associated with ALVT. METHODS The data of 31 patients with ALVT from July 2002 to December 2019 were reviewed. Echocardiography was performed in all patients during the follow-up period. RESULTS The median age of the patients was 11.5 years. Bicuspid aortic valve and dilatation of the ascending aorta were found in 13 patients, respectively. The aortic orifice in 20 patients showed a close relation to the right sinus and the right–left commissure. Of the 31 patients, 26 were operated on. Mechanical valve replacement was performed in 4 patients and aortic valve repair, in 6 patients. Ascending aortoplasty was performed in 5 patients and aortic replacement was done in 2 patients. One patient died of ventricular fibrillation before the operation. Follow-up of the remaining 30 patients ranged from 1 to 210 months (median 64 months). There were 4 deaths during the follow-up period: 1 had mechanical valve replacement and 3 did not undergo surgical repair. In the 26 patients without aortic valve replacement, 6 had severe regurgitation and 2 had moderate regurgitation. In the 28 patients without replacement of the ascending aorta, 11 had continued dilatation of the ascending aorta, including those who had aortoplasty. CONCLUSIONS The aortic orifice of ALVT showed an association with the right sinus and the right–left commissure. For patients who did not have surgery, the long-term survival rate remained terrible. Surgical closure should be done as soon as possible after ALVT is diagnosed. The main long-term complications after surgical repair included aortic regurgitation and ascending aortic dilatation.

Comprehensive transthoracic cardiac imaging in mice using ultrasound biomicroscopy with anatomical confirmation by magnetic resonance imaging

2004 ◽  
Vol 18 (2) ◽  
pp. 232-244 ◽  
Author(s):  
Yu-Qing Zhou ◽  
F. Stuart Foster ◽  
Brian J. Nieman ◽  
Lorinda Davidson ◽  
X. Josette Chen ◽  
...  
Keyword(s):  
Cardiac Imaging ◽  
Superior Vena ◽  
Main Pulmonary Artery ◽  
Vena Cava ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Ascending Aorta ◽  
High Frequency Ultrasound ◽  
The Right

High-frequency ultrasound biomicroscopy (UBM) has recently emerged as a high-resolution means of phenotyping genetically altered mice and has great potential to evaluate the cardiac morphology and hemodynamics of mouse mutants. However, there is no standard procedure of in vivo transthoracic cardiac imaging using UBM to comprehensively phenotype the adult mice. In this paper, the characteristic mouse thoracic anatomy is elucidated using magnetic resonance (MR) imaging on fixed mice. Besides the left parasternal and apical windows commonly used for transthoracic ultrasound cardiac imaging, a very useful right parasternal window is found. We present strategies for optimal visualization using UBM of key cardiac structures including: 1) the right atrial inflow channels such as the right superior vena cava; 2) the right ventricular inflow tract via the tricuspid orifice; 3) the right ventricular outflow tract to the main pulmonary artery; 4) the left atrial inflow channel, e.g., pulmonary vein; 5) the left ventricular inflow tract via the mitral orifice; 6) the left ventricular outflow tract to the ascending aorta; 7) the left coronary artery; and 8) the aortic arch and associated branches. Two-dimensional ultrasound images of these cardiac regions are correlated to similar sections in the three-dimensional MR data set to verify anatomical details of the in vivo UBM imaging. Dimensions of the left ventricle and ascending aorta are measured by M-mode. Flow velocities are recorded using Doppler at six representative intracardiac locations: right superior vena cava, tricuspid orifice, main pulmonary artery, pulmonary vein, mitral orifice, and ascending aorta. The methodologies and baseline measurements of inbred mice provide a useful guide for investigators applying the high-frequency ultrasound imaging to mouse cardiac phenotyping.

scholarly journals Right atrial myxoma presenting as a pulmonary embolism in a 32-year-old female

2019 ◽  
Vol 8 ◽  
pp. 204800401881760 ◽  
Author(s):  
Amitabh C Pandey ◽  
John J Carey ◽  
Jess L Thompson
Keyword(s):  
Pulmonary Embolism ◽  
Median Sternotomy ◽  
Atrial Myxoma ◽  
Atrial Septum ◽  
Right Atrial ◽  
Cardiac Tumors ◽  
Right Atrial Mass ◽  
Sternal Border ◽  
Right Atrial Myxoma ◽  
The Right

Primary cardiac tumors are typically benign, with myxomas being most common. We present a 32-year-old female with a chief complaint of dyspnea and a constant non-radiating chest pressure along the left sternal border. She was found to have a pulmonary embolism that was ultimately caused by embolization of a right atrial myxoma with remnants of a large, highly mobile mass attached to the right inter-atrial septum prolapsing through the tricuspid valve. The patient underwent a median sternotomy, right atrial mass resection, pulmonary embolectomy, and inter-atrial septum reconstruction using the patient’s pericardium. The importance of finding the etiology of initial diagnoses is stressed with long-term outcomes for patients.

scholarly journals Percutaneous or Side-Arm Graft Right Subclavian Artery Cannulation via Median Sternotomy

Aorta ◽  
2019 ◽  
Vol 07 (05) ◽  
pp. 150-153
Author(s):  
Corrado Cavozza ◽  
Antonio Campanella ◽  
Pellegrino Pasquale ◽  
Andrea Audo
Keyword(s):  
Cardiopulmonary Bypass ◽  
Subclavian Artery ◽  
Circulatory Arrest ◽  
Median Sternotomy ◽  
Innominate Artery ◽  
Bypass Flow ◽  
Surgical Incision ◽  
Artery Cannulation ◽  
The Right ◽  
Antegrade Cerebral Perfusion

AbstractSeveral cannulation sites alternative to the ascending aorta, such as femoral, right axillary, carotid, innominate artery, and, less commonly, apical sites, have been proposed. Cannulation of the right subclavian artery, through sternotomy, is one possible means of establishing cardiopulmonary bypass, hence avoiding a second surgical incision. In our experience, cardiopulmonary bypass flow was adequate and circulatory arrest with antegrade cerebral perfusion was successfully performed in all cases. There was no in-hospital mortality.

Cardiac and Pericardial Echinococcosis: Report of 15 Cases

2007 ◽  
Vol 15 (4) ◽  
pp. 278-279 ◽  
Author(s):  
Vakeli Murat ◽  
Zhongxi Qian ◽  
Shuiyuan Guo ◽  
Jun Qiao
Keyword(s):  
Heart Failure ◽  
Developing Countries ◽  
Cardiopulmonary Bypass ◽  
Right Heart Failure ◽  
Right Atrial ◽  
Serologic Test ◽  
Right Heart ◽  
Late Death ◽  
The Right

Between 1978 and 2002, 15 patients (mean age, 23.0 ± 8.5 years) with cardiac and pericardial echinococcosis were treated surgically. The cysts were located in the right atrium in 3 patients, on the anterior myocardium in 7, and pericardially in 5. The 3 patients with right atrial cysts were operated on using cardiopulmonary bypass. There were 4 recurrences requiring re-operation after a mean of 12 months. All other patients received mebendazole treatment and exhibited no recurrence during follow-up. One late death due to chronic right heart failure occurred after 10 months of follow-up. The serologic test is an effective method of diagnosis in undeveloped and developing countries.

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