28 research outputs found
Re-Entry to the Mediastinum when the Ascending Aorta is Adherent to the Sternum: A Two Stage Sternotomy Approach
No full textRe-entry to the mediastinum, when the ascending aorta aneurysm is adherent to the sternum is characterized by high risk of aneurysm rupture during sternum opening. In such cases, often cardiopulmonary bypass via peripheral vessels is institute and re-entry will be done in deep hypothermia and circulatory arrest. However, long CPB time and adhesion dissection when performed while the patient is heparinized, is demanding and notably time consuming. Also, post operative recovery might be complicated, including, prolonged intubation, kidney dysfunctionand numerous blood transfusions. In order to reduce both risks of aneurysm rupture during resternotomy and those related to prolonged CPB time, we present a surgical approach consisting of a two-stage sternotomy to avoid the risky zone, and extra-anatomic epiaortic vessels anastomoses. This technique presents several advantages: adhesion dissection and access to the heart before the heparin is administrated, simplifying surgical field preparation shorter CPB time, and circulatory arrest
LVAD driveline infection: Pump cable relocation in two stage surgical strategy and preventive partial driveline replacement
No full textMechanical left ventricular assist device implantation (LVAD) has become a well-established option for the treatment of patients with severe congestive heart failure. Infection of the driveline is considered the Achilles’ heel of this procedure and the reported surgical approach, by mean of topic and or driveline relocation, is characterized by a high recurrence rate. An alternative approach consisting in a two-stage surgical procedure with the use of antiseptic bath to eradicate the bacteria from the driveline is proposed. Also, a preventive early driveline replacement is suggested with an original technical solution here described
Perioperative Management for Surgical Repair of Ebstein's Anomaly.
No full textBackground: Ebstein's anomaly is a rare and complex heart defect that affects the tricuspid valve and is accountable for around 1% of congenital cardiac abnormalities. It is one of the most common congenital causes of tricuspid valve regurgitation. Ebstein's anomaly often is diagnosed prenatally, due to its severe cardiomegaly. Some individuals with this anomaly do not experience complications until adulthood and even then, they have mostly minor complaints like exercise intolerance. An atrial septal defect is most commonly (70-90%) associated with Ebstein's anomaly. However, ventricular septal defect (VSD) can be associated with 2-6% of the cases.
Case presentation: This report presents a case of surgical intervention for a 38-year-old female with Ebstein's anomaly symptomatic with moderate-severe pulmonary regurgitation and foramen ovale apertum.
Conclusions: Ebstein anomaly is a complicated form of congenital heart disease with variable clinical presentations. The anesthetic plan must also focus on maintenance of RV function and avoidance of increase in PVR. Reversible causes of increased PVR, such as acidemia, hypoxemia, and hypercarbia must be avoided. Agents that lower PVR, such as nitrates, and nitric oxide may be beneficial in patients with severe pulmonary hypertension.
With a sound knowledge of the cardiac anatomy, accurate scheming of surgical outcomes, routine follow-ups, multidisciplinary team approach, and better management, an experienced center can ultimately improve the prognosis of such patients
Anesthesia in Patient with Left Ventricular Assist Device LVAD support. A Case Report
No full textBackground; Left ventricular assist device (LVAD) implantation is not only a bridge-to-transplantation option for patients awaiting a donor's heart, but is often used as bridge-to-destination therapy in patients unsuitable for transplantation for various reasons. Device infection remains a threatening complication, which may lead to prolonged hospitalization, need to devise exchange, urgent transplantation, and even death of the patient. Infections with multidrug-resistant (MDR) organisms pose major difficulties for eradication therapy. Especially patients who are subject to continuous hospital treatments risk contamination or change of resistances spectrum. Gold standard therapy of certain organisms often fails to eradicate surface-associated colonization of implanted devices such as cardiovascular implants, while failed eradication leads to numerous complications and an increased mortality rate among the affected patients. Device infections through multidrug-resistant bacteria, such as MRSA, are often resistant even to first-line antibiotics, due to extended resistance spectrum and reduce tissue penetration in scar tissue after multiple surgical procedures. In addition, a solid biofilm on devices is often impenetrable even for suitable antibiotics because of the isolating nature of biofilms
The Benefits of early Extubation in OR and ICU after Cardiac Surgery
No full textObjective: operating room (or) extubation after adult cardiac surgery with cardiopulmonary bypass cPB is rare. We examined the outcome, factors and benefits of OR extubation.Methods: We operated 60 patients in german Hospital tirana, from January 2019 to September 2020, who had undergone caBg cardiac operations: 52 patients, mitral valve repair 5 patients, aortic stenosis 1patient, Bentall procedure 1 patient, left atrial myxoma 1 patient. the patients age was from 46-82 years old, there were 24 female patients and 36 male patients, 24 diabetic patients, 36 non-diabetic patients, in all cases we did not apply epidural anesthesia. Anesthesia was used with low doses of fentanyl. in combination with propofol, sevoflurane. In all cases neostigmine was used for decurarisation.the quality and depth of anesthesia was assessed with obvious signs such as tachycardia, hypertension, sweating. endogenous stress was also assessed by monitoring glycemia during the intervention.as extubation criteria were assessed the patient’s consciousness, respiratory mechanics, hemodynamic stability, diuresis, bleeding from drains.Results: 16 patients were extubated in the or and 44 patients were extubated 15-20 minutes after the intervention in icU. there was no reintubation. 2 patients were transferred immediately from or to the repart. 35 patients were transferred to the ward 3-4 hours after extubation. 23 patients were transferred to the ward the next morning. Patients left the hospital after 5-7 days.Conclusions:extubation in the or in the early postoperative period has now become a routine in all specialized clinics. the time spent in the ICU is very low and the day spent in the ward was 5-7 days. The benefit is in the best and fastest activation of patients in the early postoperative period as well as in reduced intervention costs
Postoperative Analgesia with Remifentanil vs Morphine-Metamizole Following Cardiac Surgery
No full textBackground: Pain management after cardiac surgery has been based on parenteral long-acting opioids such as morphine. The other alternative is remifentanil. We compared the efficacity of remifentanil vs morphine -metamizole for post cardiac surgery pain relief.
Methods; Twenty patients undergoing on-pump coronary artery bypass surgery, receiving standardized propofol–fentanyl and propofol based anesthesia, remifentanil group (Group R, n = 10) and fentanyl (Group F, n = 10). Postoperative analgesia was provided in R group initially with remifentanil and later with morphine-metamizole and in F group immediately after operation. Pain was controlled by visual observation, questioning, in rest and during coughing, with a score (0-3).
Results; There is no difference in time of extubation between groups but, pain score was much higher in F (3-9) group in first hour compared with R group (0-4). Morphine requirements was higher in (R) after remifentanil was stopped, in a first hour, but was lower after 24 hours compared with F group. Conclusion: Use of remifentanil is associated with lower scale of pain in postoperative period and lower morphine requirement after 24 hours, when analgesia treatment was changed
Management of COVID-19 Patient in Cardiac Surgery with Cardiopulmonary Bypass
No full textIntroduction: The diagnosis of COVID-19 is quite challenging due to the inconsistent correlation between laboratory findings, radiological imaging, and the clinical picture and contact history of the patient. the patients who underwent cardiac surgery with cardiopulmonary bypass (CPB) face double risk because CBP triggers an intense inflammatory response and the leading cause of mortality in COVID-19 patients is “cytokine storm”. In our institution 15 confirmed cases operated on with open-heart surgery. 9 cases isolated caBg, 4 cases valvular combined with caBg, and 1 valvular disease. Materials and method: all patients undergoing elective or urgent cardiac surgery at “Mother theresa” ’s Hospital from 11 March to 30 november 2020 were included in this study. Patients diagnosed with coViD-19 infection via positive throat swab taken due to clinical suspicion postoperatively were reviewed. Patients characteristics, type of intervention, date of coViD-19 diagnosis.Results: 9 patients (72%) normal recovery, no respiratory failure, only 3-5 days of fever (max 39,4). 3 of them a moderate respiratory failure. 3 patients with severe respiratory failure. only 3 deaths (26,6%).Recommendation: it’s important to a preoperative screening for coViD-19 patients. the outcome of cardiac surgical patients who contracted coViD-19 infection perioperatively is extremely poor. aggressive respiratory assistance (early intubation), high doses of corticosteroids, and anticoagulation, better result
Prosthetic Subclavian-Aortic Bypass as a Safe Surgical Technique for the Coarctation of the Aorta in Adults
No full textBACKGROUND: Coarctation represents 5-8% of congenital heart disease. Residual hypertension remains the main problem after late correction. Surgical treatment in the adult remains a challenge for the surgeon. Our prefered method used in this category is the Subclavian-aortic bypass.MATERIAL AND METHODS: We have reviewed our registry for the period of 12 years (1998- 2010) and we found a group of 18 adult patients being operated for coarctation of the aorta. The mean age of this group of patients was 24.7 ± 8.43 years (range 16-42 years). 13 were males and 5 females. RESULTS: Sugical technique: Most of the patients (13 pts, 72%) which were obviously treated with subclavian-aortic bypass with a Dacron prostheses. Mean preoperative and postoperative pressure gradients measured by echocardiography were 77.7 ± 20.16 mmHg and 22.3 ± 9.14 mmHg respectively. No mortality was observed in this series of patients. Chylothorax was the only complication observed in one patient in the early postoperative period.CONCLUSION: Coarctation of the aorta in adults is treated with optimal early results at our surgical centre. Subclavian-aortic bypass grafting requires less aortic dissection, can be performed with a partially occluding clamp, and does not compromise the spinal cord vascularization
Aortic Annular Enlargement during Aortic Valve Replacement
No full textIn the surgery of aortic valve replacement is always attempted, as much as possible, to implant the larger prosthesis with the mains goals to enhance the potential benefits, to minimise transvalvular gradient, decrease left ventricular size and avoid the phenomenon of patient-prosthesis mismatch. Implantation of an ideal prosthesis often it is not possible, due to a small aortic annulus. A variety of aortic annulus enlargement techniques is reported to avoid patient-prosthesis mismatch. We present the case that has submitted four three times open heart surgery. We used Manouguian technique to enlarge aortic anulus with excellent results during the fourth time of surgery
A Very Rare Case of Cor Triatriatum with Severe Mitral Regurgitation
No full textBACKGROUND: Cor triatriatum sinister is rare congenital heart disease. It is mainly presented in childhood and often accompanied with other congenital anomalies. The cases with cor triatriatum treated surgically in adults and accompanied with severe mitral regurgitation are very rare.CASE REPORT: We present a case with diagnosed cor triatriatum and severe mitral regurgitation. The diagnose was made by echocardiography. She was a female 25 years that was hospitalised with signs of heart failure NYHA II-III.CONCLUSION: We performed the resection of the membrane in the left atrium and repair of a mitral valve according to Alfieri. The patient did very well after the surgery
