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Left heart vent

Seok In Lee, So Young Lee, Chang Hyu Choi, Kook Yang Park, Chul-Hyun Park
Acute myocardial infarction (AMI) can progress to cardiogenic shock and mechanical complications. When extracorporeal membrane oxygenation (ECMO) is applied to a patient with AMI with cardiogenic shock and mechanical complications, left ventricular (LV) decompression is an important recovery factor because LV dilation increases myocardial wall stress and oxygen consumption. The authors present the case of a 72-year-old man with AMI and LV dilation who developed cardiogenic shock and papillary muscle rupture and who was treated successfully by ECMO with a left atrial venting...
January 1, 2017: Journal of Intensive Care Medicine
Won Ho Kim, Tae Hee Hong, Joung Hun Byun, Jong Woo Kim, Sung Hwan Kim, Sung Ho Moon, Hyun Oh Park, Jun Young Choi, Jun Ho Yang, In Seok Jang, Chung Eun Lee, Jeong Hee Yun
In refractory cardiogenic shock, veno-arterial extracorporeal membrane oxygenation (ECMO) can be initiated. Although left heart decompression can be accomplished by insertion of a left atrial (LA) or LV cannula using a percutaneous pigtail catheter, the venting flow rate according to catheter size and ECMO flow rate is unknown. We developed an artificial ECMO circuit. 1L saline bag with its pressure set to 20 mmHg was connected to ECMO to mimic LV failure. A pigtail catheter was inserted into the 1 L saline bag to simulate LV unloading...
January 26, 2017: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Ender Gedik, Aydın Ulaş, Özgür Ersoy, Funda Atar, Aynur Camkıran Fırat, Arash Pirat
Heart transplant is the only definitive treatment of end-stage heart failure. Venoarterial extracorporeal membrane oxygenation may be used as a bridge to heart transplant. Among 31 patients who underwent heart transplant between January 2014 and June 2016, we present our experiences with 3 patients who received venoarterial extracorporeal support as a bridge to heart transplant. The first patient was a 51-year-old male with ischemic dilated cardiomyopathy. Transplant was performed after 6 days of extracorporeal support, and the patient was discharged and alive at follow-up...
2016: Experimental and Clinical Transplantation
Bahadır Gültekin, Özgür Ersoy, İlknur Akkaya, Çağrı Kayıpmaz, Araş Pirat, Atilla Sezgin
OBJECTIVES: Left ventricular distention can be recognized during the use of venoarterial extracorporeal membrane oxygenation as a key complication. Left ventricular decompression may decrease pulmonary pressure, minimize ventricular distention, and allow myocardial recovery. MATERIALS AND METHODS: We applied venoarterial extracorporeal membrane oxygenation to 4 patients while on a wait list for cardiac transplant. RESULTS: Two patients with severe heart failure developed high end-diastolic pressures leading to left ventricular distention...
2016: Experimental and Clinical Transplantation
Kan Nawata, Minoru Ono
Cardiac surgeries have become complicated, although the procedures have been sophisticated as well as anesthetic management and postoperative care. Cardiac surgery team's main concerns include how to preserve cardiac function after aortic cross-clamp and chemical cardiac arrest, which cause myocardial edema and reperfusion injury. These days beating-heart surgery for mitral valve diseases is reported. Patients of mitral disease with low cardiac function due to ischemic cardiomyopathy or dilated cardiomyopathy as well as patients of mitral disease with functional coronary bypass graft might be good candidates for beating-heart mitral valve surgery, via either median sternotomy or right thoracotomy approach...
July 2016: Kyobu Geka. the Japanese Journal of Thoracic Surgery
Ha Eun Kim, Jo Won Jung, Yu Rim Shin, Han Ki Park, Young Hwan Park, Hong Ju Shin
Patients with venoarterial extracorporeal membrane oxygenation (ECMO) frequently suffer from pulmonary edema due to left ventricular dysfunction that accompanies left heart dilatation, which is caused by left atrial hypertension. The problem can be resolved by left atrium (LA) decompression. We performed a successful percutaneous LA decompression with an atrial septostomy and placement of an LA venting cannula in a 38-month-old child treated with venoarterial ECMO for acute myocarditis.
June 2016: Korean Journal of Thoracic and Cardiovascular Surgery
Se Yong Jung, Hong Ju Shin, Jo Won Jung, Han Ki Park, Yu Rim Shin, Young Hwan Park, Nam Kyun Kim, Jae Young Choi
OBJECTIVES: The clinical outcome of children with severe acute myocarditis who require mechanical circulatory support is not well known. Therefore, we studied the survival and clinical courses of patients with acute fulminant myocarditis supported by extracorporeal life support (ECLS). METHODS: We performed a retrospective chart review of 13 consecutive children with acute fulminant myocarditis who were treated with ECLS between April 2013 and April 2015. Demographics, initial symptoms, laboratory results, management, clinical courses and last follow-up status were investigated...
August 2016: Interactive Cardiovascular and Thoracic Surgery
Klaus K Witte, Rowena Byrom, John Gierula, Maria F Paton, Haqeel A Jamil, Judith E Lowry, Richard G Gillott, Sally A Barnes, Hemant Chumun, Lorraine C Kearney, John P Greenwood, Sven Plein, Graham R Law, Sue Pavitt, Julian H Barth, Richard M Cubbon, Mark T Kearney
BACKGROUND: Patients with chronic heart failure (HF) secondary to left ventricular systolic dysfunction (LVSD) are frequently deficient in vitamin D. Low vitamin D levels are associated with a worse prognosis. OBJECTIVES: The VINDICATE (VitamIN D treatIng patients with Chronic heArT failurE) study was undertaken to establish safety and efficacy of high-dose 25 (OH) vitamin D3 (cholecalciferol) supplementation in patients with chronic HF due to LVSD. METHODS: We enrolled 229 patients (179 men) with chronic HF due to LVSD and vitamin D deficiency (cholecalciferol <50 nmol/l [<20 ng/ml])...
June 7, 2016: Journal of the American College of Cardiology
Tae Hee Hong, Joung Hun Byun, Hee Moon Lee, Yong Hwan Kim, Gu-Hyun Kang, Ju Hyeon Oh, Sang Won Hwang, Han Yong Kim, Jae Hong Park, Jae Jun Jung
Extracorporeal membrane oxygenation (ECMO) has become one of the often applied mechanical support for acute cardiogenic shock. During venoarterial (VA) ECMO support, left heart decompression should be considered when left ventricular (LV) distension develops with pulmonary edema and LV dysfunction. The aim of this study was to report the results of transaortic catheter venting (TACV), as an alternative venting method, performed during VA-ECMO in patients with acute cardiogenic shock. We retrospectively reviewed the records of seven patients who underwent both ECMO and TACV between February 2013 and February 2014...
March 2016: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Caroline Gavin, John Coblentz, Jeffrey R Acsell, Anthony G Shackelford, Joseph J Sistino
Vent vacuum relief valves (VRVs) are used to limit the negative pressure at the ventricular vent catheter tip as well as prevent reversal of blood flow and prevention of air embolism. The purpose of this study was to evaluate the performance of three commercially available ventricular vent valves. The negative pressure at which the vent valve opened was measured at the valve inlet using high-fidelity pressure transducers. Also, the flow rate at which air entrainment occurred due to valve opening was recorded...
March 2015: Journal of Extra-corporeal Technology
Tae Hee Hong, Joung Hun Byun, Byung Ha Yoo, Sang Won Hwang, Han Yong Kim, Jae Hong Park
Venoarterial extracorporeal membrane oxygenation (VA ECMO) is widely used in patients with cardiogenic shock. Insufficient decompression of the left ventricle (LV) is considered a major factor preventing adequate LV recovery. A 40-year-old male was diagnosed with acute myocardial infarction, and revascularization was performed using percutaneous stenting. However, cardiogenic shock occurred, and VA ECMO was initiated. Severe LV failure developed, and percutaneous transaortic catheter venting (TACV) was incorporated into the venous circuit of VA ECMO under transthoracic echocardiography guidance...
June 2015: Korean Journal of Thoracic and Cardiovascular Surgery
Christof Stamm, Miralem Pasic, Semih Buz, Roland Hetzer
A patient required emergency mitral valve replacement and extracorporeal membrane oxygenation (ECMO) support for acute biventricular failure. The left ventricular (LV) vent inserted via the left upper pulmonary vein induced thrombotic immobilization of a prosthetic valve leaflet, with significant intra-prosthesis regurgitation after ECMO explantation. Therefore, the left atrium was opened on the beating heart during conventional extracorporeal circulation, all prosthesis leaflets were excised and a 29-mm expandable Edwards Sapien prosthesis was inserted within the scaffold of the original prosthesis under direct vision...
September 2015: Interactive Cardiovascular and Thoracic Surgery
Fabio Sangalli, Gianluca Greco, Lucia Galbiati, Francesco Formica, Serena Calcinati, Leonello Avalli
We present the case of a woman assisted with veno-arterial extracorporeal membrane oxygenation (v-a ECMO) for postischemic cardiogenic shock, who developed left ventricular thrombosis despite systemic anticoagulation and left ventricular apical venting. We successfully achieved local thrombolysis with tenecteplase administered through the venting cannula to obtain local thrombolysis while reducing systemic effects to a minimum. The procedure was effective with mild systemic bleeding and the patient was successfully weaned off the extracorporeal support a few days thereafter...
June 2015: Journal of Cardiac Surgery
Douglas F Hacking, Derek Best, Yves d'Udekem, Christian P Brizard, Igor E Konstantinov, Johnny Millar, Warwick Butt
We aimed to determine the effect of elective left heart decompression at the time of initiation of central venoarterial extracorporeal membrane oxygenation (VA ECMO) on VA ECMO duration and clinical outcomes in children in a single tertiary ECMO referral center with a large pediatric population from a national referral center for pediatric cardiac surgery. We studied 51 episodes of VA ECMO in a historical cohort of 49 pediatric patients treated between the years 1990 and 2013 in the Paediatric Intensive Care Unit (PICU) of the Royal Children's Hospital, Melbourne...
April 2015: Artificial Organs
Lucas J Eastaugh, Ravi R Thiagarajan, Jeffrey R Darst, Doff B McElhinney, James E Lock, Audrey C Marshall
OBJECTIVES: Left atrial decompression using cardiac catheterization techniques has been described at centers with extracorporeal membrane oxygenation programs. Left atrial decompression can decrease cardiogenic edema, minimize ventricular distension, and allow myocardial recovery. We describe Boston Children's Hospital's experience with percutaneous left atrial decompression techniques, acute outcomes, and clinical impact of left atrial decompression in extracorporeal membrane oxygenation patients...
January 2015: Pediatric Critical Care Medicine
Lars B van Middendorp, Jos G Maessen, Peyman Sardari Nia
We describe the case of a 59-year old male patient undergoing combined coronary artery bypass grafting and aortic valve replacement. Manipulation of the heart during cardiopulmonary bypass significantly decreased venous return. Several measures were necessary to improve venous return to a level at which continuation of the procedure was safe. Based on the initial troubles with venous return, we decided to selectively cross-clamp the aorta. This resulted in a large amount of backflow of oxygenated blood from the left ventricle, necessitating additional vents in the pulmonary artery and directly in the left ventricle...
December 2014: Interactive Cardiovascular and Thoracic Surgery
Taiju Watanabe, Hirokuni Arai
Mitral valve repair is the preferred surgical treatment for mitral regurgitation. Cardiac surgeons must increasingly pursue high-quality mitral valve repair, which ensures excellent long-term outcomes. Intraoperative assessment of a competency of the repaired mitral valve before closure of the atrium is an important step in accomplishing successful mitral valve repair. Saline test is the most simple and popular method to evaluate the repaired valve. In addition, an "Ink test" can provide confirmation of the surface of coaptation, which is often insufficient in the assessment of saline test...
November 2014: General Thoracic and Cardiovascular Surgery
Ismihan S Onan, Sertac Haydin, Mehmet Yeniterzi
Inverted left atrial appendage is an unusual complication associated with congenital cardiac surgery. Inversion of the left atrial appendage may occur during the surgical procedure or afterwards. The left atrial appendage may invert iatrogenically or as a result of the negative pressure during placement or removal of the left atrial vent or during deairing manoeuvres. This event can be life-threatening because of the mass effect of the atrial appendage within the left atrial cavity.
March 2015: Cardiology in the Young
Alexander Weymann, Bastian Schmack, Anton Sabashnikov, Christopher T Bowles, Philipp Raake, Rawa Arif, Markus Verch, Ursula Tochtermann, Jens Roggenbach, Aron Frederik Popov, Andre Ruediger Simon, Matthias Karck, Arjang Ruhparwar
BACKGROUND: The purpose of this prospective study was to evaluate the effects and functional outcome of central extracorporeal life support (ECLS) with left ventricular decompression for the treatment of refractory cardiogenic shock and lung failure. METHODS: Between August 2010 and August 2013, 12 consecutive patients (2 female) with a mean age of 31.6 ± 15.1 years received central ECLS with left ventricular decompression for the treatment of refractory cardiogenic shock and lung failure...
2014: Journal of Cardiothoracic Surgery
Sachin Talwar, Palleti Rajashekhar, Aandrei Jivendra Jha, Balram Airan
We report an unusual cause of failure of successful delivery of antegrade cardioplegia through the aortic root that was caused by the accidental passage of the left ventricular vent catheter across the aortic valve producing acute aortic regurgitation. This problem is best prevented.
January 1, 2014: World Journal for Pediatric & Congenital Heart Surgery
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