The heart surgery forum
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The heart surgery forum · Apr 2016
Case ReportsRenal Artery Occlusion Due to Aortic Dissection Caused by Blunt Trauma.
In this report, our aim is to present a case of renal artery occlusion due to type-3 acute aortic dissection following blunt trauma. A twenty-four-year-old male patient was admitted to the emergency department of our hospital with pain in his abdomen and on his back 3 hours after a blunt abdominal trauma due to an industrial injury. After consultation with the urology department, the patient was taken to operation to be evaluated for an intervention for aortic dissection and nephrectomy.
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The heart surgery forum · Dec 2015
Case ReportsPinball-Like Free-Floating Left Atrial Ball Thrombus Presenting with Hemiplegia: A Challenging Treatment Decision.
We describe a case of a patient with a history of chronic atrial fibrillation who presented with sudden onset of left hemiplegia. Nine months earlier the longstanding warfarin therapy had been suspended due to a hemorrhagic stroke. ⋯ Due to the potential risk of an embolic event or a hemodynamic collapse, a decision to carry out an emergency operation was made irrespective of the neurological condition of the patient. Unfortunately, the patient died on the 18th postoperative day after a freshly occurring hemorrhagic stroke.
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The heart surgery forum · Jun 2015
Oxygen fraction adjustment according to body surface area during extracorporeal circulation.
The inspiratory oxygen fraction (FiO2) is usually set between 60% and 100% during conventional extracorporeal circulation (ECC). However, this strategy causes partial oxygen pressure (PaO2) to reach hyperoxemic levels (>180 mmHg). During anesthetic management of cardiothoracic surgery it is important to keep PaO2 levels between 80-180 mmHg. The aim of this study was to assess whether adjusting FiO2 levels in accordance with body temperature and body surface area (BSA) during ECC is an effective method for maintaining normoxemic PaO2 during cardiac surgery. ⋯ Adjustment of FiO2 according to BSA rather than keeping it at a constant level is more appropriate for keeping PaO2 between safe level limits. However, since oxygen consumption of cells vary with body temperature, it would be appropriate to set FiO2 levels in concordance with the body temperature in the rewarming period.
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The heart surgery forum · Apr 2015
Review Meta AnalysisRIPC Remains a Promising Technique for Protection of the Myocardium during Open Cardiac Surgery: A Meta-Analysis and Systematic Review.
Remote ischemic preconditioning (RIPC) is the process of inducing brief ischemia in a tissue to prevent ischemic damage in another. This preconditioning can be induced simply by inflating a blood pressure cuff on a limb. Previous randomized controlled trials (RCT) have suggested that RIPC may infer myocardial protection during open cardiac surgery. One method of assessing the degree of myocardial damage incurred in these studies is to assay troponin concentration. Troponin is a cardiac enzyme released by damaged myocardiocytes. With the recent publication of several large RCTs in this area, a meta-analysis of the evidence was undertaken. ⋯ The reduction in troponin concentration suggests that RIPC reduces myocardial damage during open cardiac surgery, however, the degree of bias in the studies assessed may have had a significant impact on this result.