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Catena E.,Cardiovascular Anaesthesia and Intensive Care Unit | Tasca G.,Cardiac Surgery
Best Practice and Research: Clinical Anaesthesiology | Year: 2012

Ventricular assist devices are electromechanical pumps used for circulatory support of patients with severe heart failure. Current ventricular assist device therapy provides a broad spectrum of support systems ranging from short-term to long-term devices. Echocardiography is an ideal modality to monitor patients undergoing mechanical circulatory support because it is less invasive, widely available and can be performed at the bedside. Both long-term and short-term devices require a careful echocardiographic management before implant, during surgical procedure and during postoperative course. Perioperative echocardiographic examination is performed to assess cardiac abnormalities that could lead to postoperative complications, to evaluate the surgical result and to determine reasons of postoperative haemodynamic compromises. Cannulae visualisation, patent forame ovale (PFO), air in cardiac chambers, aortic and or mitral regurgitation, right-ventricular function, left-ventricular unloading and filling, tamponade and pump failure are the most important issues discussed in this review. © 2012 Elsevier Ltd. All rights reserved.

Oreglia J.A.,Niguarda Hospital | Bruschi G.,Cardiac Surgery | Klugmann S.,Niguarda Hospital
Catheterization and Cardiovascular Interventions | Year: 2010

Iatrogenic coronary fistula is a rare condition whose treatment strategy is not well established. We report the case of a 70-year-old patient who came to our attention with echocardiographic and scintigraphic signs of myocardial ischemia and who had undergone heart transplantation 10 years earlier. The coronary angiogram showed a coronary fistula connecting the left-anterior descending artery to the right ventricle via an enlarged septal branch. Because of the presence of myocardial ischemia, the patient was scheduled for percutaneous coronary intervention. The fistula was sealed with implant of two polytetrafluoroethylene (PTFE)-covered stents that excluded the septal branch. One-year follow-up showed persistence of the good result in terms of angiographic and clinical outcome. © 2010 Wiley-Liss, Inc.

Billings F.T.,Vanderbilt University | Byrne J.G.,Cardiac Surgery | Petracek M.R.,Cardiac Surgery | Pretorius M.,Vanderbilt University
CardioRenal Medicine | Year: 2014

Background: Intraoperative hemolysis and inflammation are associated with acute kidney injury (AKI) following cardiac surgery. Plasma-free hemoglobin induces heme oxygenase-1 (HO-1) expression. HO-1 degrades heme but increases in experimental models of AKI. This study tested the hypothesis that plasma HO-1 concentrations are associated with intraoperative hemolysis and are increased in patients that develop AKI following cardiac surgery. Methods: We measured plasma HO-1, free hemoglobin, and inflammatory markers in 74 patients undergoing cardiopulmonary bypass (CPB). AKI was defined as an increase in serum creatinine concentration of 50% or 0.3 mg/dl within 72 h of surgery. Results: Twenty-eight percent of patients developed AKI. HO-1 concentrations increased from 4.2 ± 0.2 ng/ml at baseline to 6.6 ± 0.5 ng/ml on postoperative day (POD) 1 (p < 0.001). POD1 HO-1 concentrations were 3.1 ng/ml higher (95% CI 1.1-5.1) in AKI patients, as was the change in HO-1 from baseline to POD1 (4.4 ± 1.3 ng/ml in AKI patients vs. 1.5 ± 0.3 ng/ml in no-AKI patients, p = 0.006). HO-1 concentrations remained elevated in AKI patients even after controlling for AKI risk factors and preoperative drug therapy. Peak-free hemoglobin concentrations correlated with peak HO-1 concentrations on POD1 in patients that developed AKI (p = 0.02). Duration of CPB and post-CPB IL-6 and IL-10 concentrations were also associated with increased HO-1 on POD1. Conclusion: Plasma HO-1 is increased in patients that develop AKI, and CPB duration, hemolysis, and inflammation are associated with increased HO-1 concentrations following cardiac surgery. Strategies that alter hemolysis and HO-1 expression during cardiac surgery may affect risk for AKI. © 2014 S. Karger AG, Basel.

D'Armini A.M.,University of Pavia | Morsolini M.,University of Pavia | Mattiucci G.,University of Pavia | Grazioli V.,University of Pavia | And 5 more authors.
Journal of Thoracic and Cardiovascular Surgery | Year: 2014

Objectives Chronic thromboembolic pulmonary hypertension can be cured by pulmonary endarterectomy. Operability assessment remains a major concern, because there are no well-defined criteria to discriminate proximal from distal obstructions, and surgical candidacy depends mostly on the surgeon's experience. The intraoperative classification of chronic thromboembolic pulmonary hypertension describes 4 types of lesions, based on anatomy and location. We describe our recent experience with the more distal (type 3) disease. Methods More than 500 pulmonary endarterectomies were performed at Foundation I.R.C.C.S. Policlinico San Matteo (Pavia, Italy). Because of recent changes in the patient population, 331 endarterectomies performed from January 2008 to December 2013 were analyzed. Two groups of patients were identified according to the intraoperative classification: proximal (type 1 and type 2 lesions, 221 patients) and distal (type 3 lesions, 110 patients). Results The number of endarterectomies for distal chronic thromboembolic pulmonary hypertension increased significantly over time (currently ∼37%). Deep venous thrombosis was confirmed as a risk factor for proximal disease, whereas patients with distal obstruction had a higher prevalence of indwelling intravascular devices. Overall hospital mortality was 6.9%, with no difference in the 2 groups. Postoperative survival was excellent. In all patients, surgery was followed by a significant and sustained improvement in hemodynamic, echocardiographic, and functional parameters, with no difference between proximal and distal cases. Conclusions Although distal chronic thromboembolic pulmonary hypertension represents the most challenging situation, the postoperative outcomes of both proximal and distal cases are excellent. The diagnosis of inoperable chronic thromboembolic pulmonary hypertension should be achieved only in experienced centers, because many patients who have been deemed inoperable might benefit from favorable surgical outcomes. © 2014 by The American Association for Thoracic Surgery.

Martin-Rojas T.,Hospital Nacional de Paraplejicos HNP | Gil-Dones F.,Hospital Nacional de Paraplejicos HNP | Lopez-Almodovar L.F.,Cardiac Surgery | Padial L.R.,Hospital Virgen de la Salud | And 3 more authors.
Journal of Proteome Research | Year: 2012

Degenerative aortic stenosis is the most common worldwide cause of valve replacement. While it shares certain risk factors with coronary artery disease, it is not delayed or reversed by reducing exposure to risk factors (e.g., therapies that lower lipids). Therefore, it is necessary to better understand its pathophysiology for preventive measures to be taken. In this work, aortic valve samples were collected from 20 patients that underwent aortic valve replacement (55% males, mean age of 74 years) and 20 normal control valves were obtained from necropsies (40% males, mean age of 69 years). The proteome of the samples was analyzed by quantitative differential electrophoresis (2D-DIGE) and mass spectrometry, and 35 protein species were clearly increased in aortic valves, including apolipoprotein AI, alpha-1-antitrypsin, serum albumin, lumican, alfa-1-glycoprotein, vimentin, superoxide dismutase Cu-Zn, serum amyloid P-component, glutathione S-transferase-P, fatty acid-binding protein, transthyretin, and fibrinogen gamma. By contrast, 8 protein species were decreased (transgelin, haptoglobin, glutathione peroxidase 3, HSP27, and calreticulin). All of the proteins identified play a significant role in cardiovascular processes, such as fibrosis, homeostasis, and coagulation. The significant changes observed in the abundance of key cardiovascular proteins strongly suggest that they can be involved in the pathogenesis of degenerative aortic stenosis. Further studies are warranted to better understand this process before we can attempt to modulate it. © 2012 American Chemical Society.

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