Journal of cardiothoracic and vascular anesthesia
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Intramyocardial hematomas are a rare complication of myocardial infarctions. Normally restricted to the left ventricle, in certain scenarios, such as after a percutaneous coronary intervention, intramyocardial hematomas also can occur in the left atrium. ⋯ Ultimately, because of the patient's complex comorbid status, his case was managed conservatively. In this E-challenge, the reason for the conservative approach and the alternative approach of surgically draining the intramyocardial hematoma are discussed.
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J. Cardiothorac. Vasc. Anesth. · Oct 2020
Observational StudyFluid Therapy With Gelatin May Have Deleterious Effects on Kidney Function: An Observational Trial.
To explore the effects of fluid therapy with the synthetic colloids hydroxyethyl starch (HES) and gelatin (GEL) on the incidence of acute kidney injury (AKI) and need for renal replacement therapy (RRT) in patients undergoing cardiac surgery. ⋯ Taking into account the limitations of the small sample size and a low event rate, the nonconsideration of established renal risk factors such as inotropes and vasopressors, and potentially unmeasured confounders, these findings suggested that gelatin solutions may have deleterious effects on renal function in cardiac surgical patients. The adverse clinical effects of HES on kidney function observed in other studies may have been blunted by the restrictive use of this synthetic colloid.
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J. Cardiothorac. Vasc. Anesth. · Oct 2020
Left Atrial Dissection and Rupture Following Excision of Left Atrial Myxoma: Role of Transesophageal Echocardiography.
Left atrial mass after excision of a left atrial myxoma may occur due to residual or additional masses, such as biatrial or multicentric myxomas and inverted left atrial appendage. In this E-challenge, the authors present a case where intraoperative transesophageal echocardiography allowed visualization of a left atrial mass after excision of a left atrial myxoma. Detailed examination demonstrated that the mass was due to left atrial dissection that progressed to rupture, allowing its early detection and repair. A high index of suspicion, as well as coordination between the surgeon and the perioperative echocardiographer, played a crucial role in the detection and management of this complication.
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J. Cardiothorac. Vasc. Anesth. · Oct 2020
Fibrinolysis and the Influence of Tranexamic Acid Dosing in Cardiac Surgery.
The present study aimed to determine whether underlying disease, performed surgery, and dose of tranexamic acid influence fibrinolysis measured with D-dimer levels. ⋯ D-dimer testing allows for the assessment of individual fibrinolytic activity in cardiac surgery, which is influenced by disease type, surgery type, and dose of tranexamic acid. The assessment of the fibrinolytic status may have the potential to facilitate dose-adjusted antifibrinolytic therapy in the future.