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Cardiac care

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https://www.readbyqxmd.com/read/28214967/increased-atrial-%C3%AE-adrenergic-receptors-and-grk-2-gene-expression-can-play-a-fundamental-role-in-heart-failure-after-repair-of-congenital-heart-disease-with-cardiopulmonary-bypass
#1
Marcela Silva Oliveira, Fabio Carmona, Walter V A Vicente, Paulo H Manso, Karina M Mata, Mara Rúbia Celes, Erica C Campos, Simone G Ramos
Surgeries to correct congenital heart diseases are increasing in Brazil and worldwide. However, even with the advances in surgical techniques and perfusion, some cases, especially the more complex ones, can develop heart failure and death. A retrospective study of patients who underwent surgery for correction of congenital heart diseases with cardiopulmonary bypass (CPB) in a university tertiary-care hospital that died, showed infarction in different stages of evolution and scattered microcalcifications in the myocardium, even without coronary obstruction...
February 18, 2017: Pediatric Cardiology
https://www.readbyqxmd.com/read/28213888/transfusion-in-critical-care-a-uk-regional-audit-of-current-practice
#2
J O M Plumb, M G Taylor, E Clissold, M P W Grocott, R Gill
A consistent message within critical care publications has been that a restrictive transfusion strategy is non-inferior, and possibly superior, to a liberal strategy for stable, non-bleeding critically ill patients. Translation into clinical practice has, however, been slow. Here, we describe the degree of adherence to UK best practice guidelines in a regional network of nine intensive care units within Wessex. All transfusions given during a 2-month period were included (n = 444). Those given for active bleeding or within 24 h of major surgery, trauma or gastrointestinal bleeding were excluded (n = 148)...
February 18, 2017: Anaesthesia
https://www.readbyqxmd.com/read/28213667/point-of-care-testing-for-coagulation-function-coaguchek-%C3%A2-xs-system-versus-standard-laboratory-testing-in-pediatric-patients-with-normal-and-abnormal-coagulation-function
#3
Hiromi Kako, Vidya T Raman, Dmitry Tumin, Julie Rice, Joseph D Tobias
PURPOSE: Intraoperative abnormalities of coagulation function may occur for various reasons. In most scenarios, treatment is directed by laboratory parameters. Unfortunately, standard laboratory testing may take 1-2 h. The purpose of the current study was to evaluate a point-of-care testing device (CoaguChek(®) XS System) in pediatric patients. METHODS: Patients ranging in age from 2 to 18 years, undergoing posterior spinal fusion (PSF) or cardiac surgery using cardiopulmonary bypass (CPB) were eligible for inclusion...
February 17, 2017: Journal of Anesthesia
https://www.readbyqxmd.com/read/28213587/emergency-extracorporeal-life-support-and-ongoing-resuscitation-a-retrospective-comparison-for-refractory-out-of-hospital-cardiac-arrest
#4
A Schober, F Sterz, H Herkner, C Wallmueller, C Weiser, P Hubner, C Testori
BACKGROUND: In refractory cardiac arrest, with cardiopulmonary resuscitation (CPR) for more than 30 min, chances of survival are small. Extracorporeal cardiopulmonary resuscitation (ECPR) is an option for certain patients with cardiac arrest. The aim of this study was to evaluate characteristics of patients selected for ECPR. METHODS: Anonymised data of adult patients suffering refractory cardiac arrest, transported with ongoing CPR to an ED of a tertiary care centre between 2002 and 2012 were analysed...
February 17, 2017: Emergency Medicine Journal: EMJ
https://www.readbyqxmd.com/read/28213377/interventional-treatment-of-pulmonary-embolism
#5
David M Dudzinski, Jay Giri, Kenneth Rosenfield
Pulmonary embolism (PE) is a serious and prevalent cause of vascular disease. Nevertheless, optimal treatment for many phenotypes of PE remains uncertain. Treating PE requires appropriate risk stratification as a first step. For the highest-risk PE, presenting as shock or arrest, emergent systemic thrombolysis or embolectomy is reasonable, while for low-risk PE, anticoagulation alone is often chosen. Normotensive patients with PE but with indicia of right heart dysfunction (by biomarkers or imaging) constitute an intermediate-risk group for whom there is controversy on therapeutic strategy...
February 2017: Circulation. Cardiovascular Interventions
https://www.readbyqxmd.com/read/28212182/what-s-new-in-obstetric-anesthesia-the-2016-gerard-w-ostheimer-lecture
#6
Philip E Hess
This special article presents potentially important trends and issues affecting the field of obstetric anesthesia drawn from publications in 2015. Both maternal mortality and morbidity in the United States have increased in recent years because, in part, of the changing demographics of the childbearing population. Pregnant women are older and have more pre-existing conditions and complex medical histories. Cardiovascular and noncardiovascular medical diseases now account for half of maternal deaths in the United States...
March 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28211974/whole-exome-sequencing-identified-1-base-pair-novel-deletion-in-bcl2-associated-athanogene-3-bag3-gene-associated-with-severe-dilated-cardiomyopathy-dcm-requiring-heart-transplant-in-multiple-family-members
#7
Muhammad Arshad Rafiq, Ayeshah Chaudhry, Melanie Care, Danna A Spears, Chantal F Morel, Robert M Hamilton
Dilated cardiomyopathy (DCM) is characterized by dilation and impaired contraction of the left ventricle or both ventricles. Among hereditary DCM, the genetic causes are heterogeneous, and include mutations encoding cytoskeletal, nucleoskeletal, mitochondrial, and calcium-handling proteins. We report three severely affected males, in a four-generation pedigree, with DCM phenotype who underwent cardiac transplant. Cardiomegaly with marked biventricular dilation and fibrosis were noticeable histopathological findings...
March 2017: American Journal of Medical Genetics. Part A
https://www.readbyqxmd.com/read/28211020/goal-directed-fluid-restriction-during-brain-surgery-a-prospective-randomized-controlled-trial
#8
Jinfeng Luo, Jing Xue, Jin Liu, Bin Liu, Li Liu, Guo Chen
BACKGROUND: The value of goal-directed fluid therapy in neurosurgical patients, where brain swelling is a major concern, is unknown. The aim of our study was to evaluate the effect of an intraoperative goal-directed fluid restriction (GDFR) strategy on the postoperative outcome of high-risk patients undergoing brain surgery. METHODS: High-risk patients undergoing brain surgery were randomly assigned to a usual care group (control group) or a GDFR group. In the GDFR group, (1) fluid maintenance was restricted to 3 ml/kg/h of a crystalloid solution and (2) colloid boluses were allowed only in case of hypotension associated with a low cardiac index and a high stroke volume variation...
December 2017: Annals of Intensive Care
https://www.readbyqxmd.com/read/28210523/complete-recovery-from-cardiac-arrest-caused-by-risperidone-induced-hypothermia
#9
Takahiko Nagamine
Hypothermia is a rare adverse effect of risperidone and is associated with ventricular arrhythmias, which may lead to intensive care unit admission and sometimes death. We describe a patient with schizophrenia who was taking risperidone and who, after falling into a hypothermic state, suffered cardiac arrest. Observations of the case and a brief literature review are provided.
November 2016: Innovations in Clinical Neuroscience
https://www.readbyqxmd.com/read/28209484/successful-provision-of-inter-hospital-extracorporeal-cardiopulmonary-resuscitation-for-acute-post-partum-pulmonary-embolism
#10
C McDonald, J Laurie, S Janssens, C Zazulak, P Kotze, K Shekar
Mortality during pregnancy in a well-resourced setting is rare, but acute pulmonary embolism is one of the leading causes. We present the successful use of extracorporeal cardiopulmonary resuscitation (eCPR) in a 22-year old woman who experienced cardiopulmonary collapse following urgent caesarean section in the setting of a sub-massive pulmonary embolus. Resources and personnel to perform eCPR were not available at the maternity hospital and were recruited from an adjacent pediatric hospital. Initial care used low blood flow extracorporeal membrane oxygenation (ECMO) with pediatric ECMO circuitry, which was optimized when the team from a nearby adult cardiac hospital arrived...
January 9, 2017: International Journal of Obstetric Anesthesia
https://www.readbyqxmd.com/read/28209460/pharmacologic-cardioversion-with-intravenous-amiodarone-is-likely-safe-in-neurocritically-ill-patients
#11
Michael Su, David Seki, Asma M Moheet
Neurological injury is often associated with cardiac abnormalities, including electrophysiological issues. Cardioversion of acute atrial fibrillation (<48h' duration) without anticoagulation carries about a 0.7% risk of thromboembolism. There is limited data on managing acute atrial fibrillation specifically in the neuroscience intensive care unit (NSICU) setting. We sought to determine the safety of using intravenous (IV) amiodarone for restoring sinus rhythm in patients with presumed new onset atrial or ventricular tachycardia after neurological injury...
February 13, 2017: Journal of Clinical Neuroscience: Official Journal of the Neurosurgical Society of Australasia
https://www.readbyqxmd.com/read/28208963/clinical-profile-of-cardiac-arrhythmias-in-children-attending-the-out-patient-department-of-a-tertiary-paediatric-care-centre-in-chennai
#12
Sarala Premkumar, Premkumar Sundararajan, Thangavelu Sangaralingam
INTRODUCTION: The presentation of symptoms of paediatric arrhythmias vary depending on the age and underlying heart disease. Physical examination of children with important arrhythmias may be entirely normal. AIM: Aim is to study the characteristics of cardiac arrhythmias in paediatric patients in a tertiary paediatric care centre in Chennai, India. MATERIALS AND METHODS: The participants (n=60) were from birth to 12 years of age. Patients with sinus arrhythmias, sinus tachycardia and sinus bradycardia were excluded...
December 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28208923/long-term-outcome-in-patients-with-esophageal-stenting-for-cancer-esophagus-our-experience-at-a-rural-hospital-of-punjab-india
#13
Parvinder Singh, Abhitesh Singh, Anantbir Singh, Ghansham Sharma, Parmod Kumar Bhatia, Amarjeet Singh Grover
INTRODUCTION: Cancer of the esophagus is among the leading cause of cancer deaths in Punjab, India. Patients generally present with dysphagia as their first symptom and more often they have advanced disease at the time of presentation to a tertiary care centre. Palliative procedures have important roles in this setting. Stenting is the best option to palliate the symptoms of dysphagia, from which patient is suffering the most. AIM: To know the success rate, early and long term complications and mortality in esophageal stenting, when it was done in malignant esophageal stricture patients...
December 2016: Journal of Clinical and Diagnostic Research: JCDR
https://www.readbyqxmd.com/read/28207570/international-survey-of-critically-ill-children-with-acute-neurologic-insults-the-prevalence-of-acute-critical-neurological-disease-in-children-a-global-epidemiological-assessment-study
#14
Ericka L Fink, Patrick M Kochanek, Robert C Tasker, John Beca, Michael J Bell, Robert S B Clark, Jamie Hutchison, Monica S Vavilala, Anthony Fabio, Derek C Angus, R Scott Watson
OBJECTIVE: The international scope of critical neurologic insults in children is unknown. Our objective was to assess the prevalence and outcomes of children admitted to PICUs with acute neurologic insults. DESIGN: Prospective study. SETTING: Multicenter (n = 107 PICUs) and multinational (23 countries, 79% in North America and Europe). PATIENTS: Children 7 days to 17 years old admitted to the ICU with new traumatic brain injury, stroke, cardiac arrest, CNS infection or inflammation, status epilepticus, spinal cord injury, hydrocephalus, or brain mass...
February 15, 2017: Pediatric Critical Care Medicine
https://www.readbyqxmd.com/read/28207446/why-anesthesiologists-must-incorporate-focused-cardiac-ultrasound-into-daily-practice
#15
Bradley J Coker, Josh M Zimmerman
The size, availability, cost, and quality of modern ultrasound devices have, for the first time in modern medicine, enabled point-of-care ultrasound by the noncardiologist physician. The appropriate application of focused cardiac ultrasound (FoCUS) by anesthesiologists has the potential to alter management and affect outcomes for a wide range of patients. In this article, the indications, benefits, and limitations of FoCUS are described. The training and equipment required to perform FoCUS are also discussed...
March 2017: Anesthesia and Analgesia
https://www.readbyqxmd.com/read/28207437/lack-of-association-between-preoperative-statin-use-and-respiratory-and-neurologic-complications-after-cardiac-surgery
#16
Ryu Komatsu, Huseyin Oguz Yilmaz, Jing You, C Allen Bashour, Shobana Rajan, Edward G Soltesz, Daniel I Sessler, Alparslan Turan
BACKGROUND: Statins may reduce the risk of pulmonary and neurologic complications after cardiac surgery. METHODS: The authors acquired data for adults who had coronary artery bypass graft, valve surgery, or combined procedures. The authors matched patients who took statins preoperatively to patients who did not. First, the authors assessed the association between preoperative statin use and the primary outcomes of prolonged ventilation (more than 24 h), pneumonia (positive cultures of sputum, transtracheal fluid, bronchial washings, and/or clinical findings consistent with the diagnosis of pneumonia), and in-hospital all-cause mortality, using logistic regressions...
February 16, 2017: Anesthesiology
https://www.readbyqxmd.com/read/28203541/anesthetic-considerations-in-robotic-mitral-valve-surgery
#17
Kent H Rehfeldt, J Valery Andre, Matthew J Ritter
The robotic approach to cardiac surgery offers patients numerous potential advantages compared with a traditional sternotomy approach including shorter hospital length of stay, reduced pain, fewer blood transfusions, and a quicker return to normal daily activities. At the same time, robotic cardiac surgery requires that the anesthesiologist employs several subspecialty skillsets in order to provide optimal care for these patients. Multiple different regional anesthesia techniques may be used to improve analgesia, reduce opioid dosages, and facilitate rapid extubation at the conclusion of the case...
January 2017: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28203537/robotic-cardiac-surgery-in-brazil
#18
Robinson Poffo, Alisson P Toschi, Renato B Pope, Paola K Montanhesi, Ricardo S Santos, Alexandre Teruya, Dina M Hatanaka, Gabriel F Rusca, Claudio H Fischer, Marcelo C Vieira, Marcia R Makdisse
BACKGROUND: Brazil, the largest country and economy in South America, is a major driving force behind the development of new medical technologies in the region. Robotic cardiac surgery (RCS) has been evolving rapidly since 2010, when the first surgery using the DaVinci(®) robotic system was performed in Latin America. The aim of this article is to evaluate short and mid-term results in patients undergoing robotic cardiac surgery in Brazil. METHODS: From March 2010 to December 2015, 39 consecutive patients underwent robotic cardiac surgery...
January 2017: Annals of Cardiothoracic Surgery
https://www.readbyqxmd.com/read/28203408/determinants-of-prolonged-intensive-care-unit-stay-in-patients-after-cardiac-surgery-a-prospective-observational-study
#19
Theodore Kapadohos, Epameinondas Angelopoulos, Ioannis Vasileiadis, Serafeim Nanas, Anastasia Kotanidou, Andreas Karabinis, Katerina Marathias, Christina Routsi
BACKGROUND: Prolonged intensive care unit (ICU) stay of patients after cardiac surgery has a major impact on overall cost and resource utilization. The aim of this study was to identify perioperative factors which prolong stay in ICU. METHODS: All adult patients from a single, specialized cardiac center who were admitted to the ICU after cardiac surgery during a 2-month period were included. Demographic and clinical characteristics, comorbidities, preoperative use of drugs, intraoperative variables, and postoperative course were recorded...
January 2017: Journal of Thoracic Disease
https://www.readbyqxmd.com/read/28203407/thoracoabdominal-aortic-replacement-for-crawford-extent-ii-aneurysm-after-thoracic-endovascular-aortic-repair
#20
Haiou Hu, Tie Zheng, Junming Zhu, Yongmin Liu, Ruidong Qi, Lizhong Sun
BACKGROUND: The surgical treatment of Crawford extent II aneurysms after thoracic endovascular aortic repair (TEVAR) remains challenging, because of the need to remove the failed endograft and the complexity of the aortic reconstruction. We retrospectively reviewed our experience with surgical management of Crawford extent II aneurysms after TEVAR using thoracoabdominal aortic replacement (TAAR). METHODS: Eleven patients (10 males, 1 female) with Crawford extent II aneurysm after TEVAR were treated with TAAR between August 2012 and May 2015...
January 2017: Journal of Thoracic Disease
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