Texas Heart Institute journal
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Extensive aortic disease, such as atherosclerosis with aneurysms or dissections that involve the ascending aorta, can complicate the choice of a cannulation site for cardiopulmonary bypass. To date, the standard peripheral arterial cannulation site has been the common femoral artery; however, this approach carries the risk of atheroembolism due to retrograde aortic perfusion, or it is undesirable because of severe iliofemoral disease. Arterial perfusion through the axillary artery provides sufficient antegrade aortic flow, is more likely to perfuse the true lumen in the event of dissection, and is associated with fewer atheroembolic complications. ⋯ Axillary artery cannulation was successful in all patients; it provided sufficient arterial flow, and there were no intraoperative problems with perfusion. In the presence of extensive aortic or iliofemoral disease, arterial perfusion through the axillary artery is a safe and effective means of providing sufficient arterial inflow during cardiopulmonary bypass. In this regard, it is an excellent alternative to standard femoral artery cannulation.
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Case Reports
Transcatheter closure of a patent foramen ovale in an adult with hypoxemia after cardiac transplantation.
We describe a case of refractory hypoxemia secondary to a patent foramen ovale immediately after orthotopic heart transplantation in a 60-year-old woman. The patent foramen ovale was successfully closed with a septal occlusion device, with resolution of the hypoxemia. To our knowledge, transcatheter closure of a patent foramen ovale in an adult patient with refractory hypoxemia during the immediate post-transplant period has not previously been reported.
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Case Reports
Vasoplegic syndrome after off-pump coronary artery bypass surgery: an unusual complication.
We report the case of a 65-year-old man who developed norepinephrine-resistant vasoplegic syndrome after elective off-pump coronary artery bypass surgery (OPCAB). The failure of norepinephrine to improve the patient's hemodynamics prompted us to start treatment with vasopressin; within 30 minutes, the hemodynamics began to improve. ⋯ To our knowledge, ours is the 1st report of vasopressin use for vasodilatory shock after OPCAB in the English-language medical literature. Herein, we discuss the pathophysiology and management of vasoplegic syndrome--which is controversial--with special emphasis on the use of vasopressin in this situation.