Annals of thoracic and cardiovascular surgery : official journal of the Association of Thoracic and Cardiovascular Surgeons of Asia
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Ann Thorac Cardiovasc Surg · Aug 2007
Case ReportsA case of aortoenteric fistula following abdominal aortic reconstruction.
We report the case of a 64-year-old male patient with graft-enteric fistula. This complication might have been induced by sigmoid colonic ischemia resulting from injury to the mesocolon during abdominal aortic reconstruction. ⋯ Two further emergent operations were required to obtain complete remission from this complication, comprising bilateral extra-anatomical axillofemoral bypass grafts and infected graft removal, followed by an operation for left common iliac artery stump disruption. Although the patient remained in good health for 3 years with no complications, he died of aortic stump disruption 43 months after the last operation.
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A rotary blood pump may be implanted as a bridge to cardiac transplantation. Also, mechanical, histological, and biochemical improvements have been described in cardiac function after the implantation of a left ventricular assists device (LVAD). Thus there is considerable enthusiasm that LVAD might be used as a bridge to the recovery of myocardial function. Unlike a pulsatile pump, however, we cannot stop the rotary blood pump to estimate cardiac function. If the rotary blood pump stops, back flow will occur. In this study, a new method was examined that can estimate cardiac function without stopping the pump. ⋯ This method is simple and useful for estimating the cardiac function without pump stoppage.
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Ann Thorac Cardiovasc Surg · Aug 2007
Case ReportsEarly initiation of polymyxin B-immobilized fiber therapy effective for septic shock after aortic replacement.
A 76-year-old female underwent ascending aorta and partial arch replacement. She developed septic shock on postoperative day 6. She was administered dopamine, 10 microg x kg(-1) x min(-1); dobutamine, 5 microg x kg(-1) x min(-1); and norepinephrine, 0.3 microg x kg(-1) x min(-1). ⋯ Direct hemoperfusion using polymyxin B-immobilized fiber (PMX-DHP) was started; 3 h later, the blood pressure increased to 118/54 mmHg. Norepinephrine was stopped, and dopamine and dobutamine doses were decreased to 5 microg x kg(-1) x min(-1) 3 and 12 h after completing PMX-DHP, respectively. In suspected septic shock, early PMX-DHP simultaneously with drug treatment facilitates hemodynamic improvement.