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https://www.readbyqxmd.com/read/29040402/is-postspinal-hypotension-a-sign-of-impaired-cardiac-performance-in-the-elderly-an-observational-mechanistic-study
#1
J Jakobsson, S H Kalman, M Lindeberg-Lindvet, E Bartha
Background: We have previously reported that stroke volume is reduced in a majority of elderly patients undergoing surgical repair of hip fracture before and after intrathecal injection of anaesthetic. We aimed to investigate these observations further in a prospective study of elderly patients undergoing elective hip or knee arthroplasty under spinal anaesthesia. Methods: Patients ≥65 yr undergoing elective arthroplasty were monitored with LiDCOplus™ preoperatively (baseline), before and continuously for 45 min after spinal anaesthesia...
October 10, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29036801/misinterpretation-of-the-sublingual-microcirculation-during-therapy-with-levosimendan
#2
Michael Hessler, Philip-Helge Arnemann, Sebastian Rehberg, Christian Ertmer
There is increasing evidence in the literature that preoperative treatment with levosimendan optimizes cardiopulmonary haemodynamics in patients scheduled for the implantation of a Left Ventricular Assist Device (LVAD). The present case report describes changes in sublingual microcirculation using incident dark field video microscopy in a patient, who received a continuous infusion of 0.5 mg/h levosimendan 12 h before LVAD implantation. Despite no evident macrohaemodynamic or metabolic changes, there was a dramatic reduction in total vessel density and perfused vessel density suggesting a deterioration of microcirculation according to the consensus conference criteria in vessels smaller than 20 μm in diameter...
October 7, 2017: Clinical Hemorheology and Microcirculation
https://www.readbyqxmd.com/read/29036615/monitoring-of-cerebral-oximetry-during-head-up-tilt-test-in-adults-with-history-of-syncope-and-orthostatic-intolerance
#3
E Bachus, H Holm, V Hamrefors, O Melander, R Sutton, M Magnusson, A Fedorowski
Aims: We applied near-infrared-spectroscopy (NIRS) to measure absolute frontal cerebral tissue oxygen saturation (SctO2) during head-up tilt test (HUT) in patients investigated for unexplained syncope. Methods and results: Synchronized non-invasive beat-to-beat haemodynamic monitoring, ECG, SctO2 (NIRS; normal range: 60-80%), and peripheral oxygen saturation (left hand, SpO2) were applied during HUT in a random sample of patients with unexplained syncope. Tracings of 54 patients (mean-age: 55 ± 19 years, 39% male) with negative HUT, vasovagal syncope (VVS), or orthostatic hypotension (OH) were analysed...
September 28, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/29036370/estimation-of-the-effects-of-multipoint-pacing-on-battery-longevity-in-routine-clinical-practice
#4
Finn Akerström, Irene Narváez, Alberto Puchol, Marta Pachón, Cristina Martín-Sierra, Moisés Rodríguez-Mañero, Luis Rodríguez-Padial, Miguel A Arias
Aims: Multipoint pacing (MPP) permits simultaneous multisite pacing of the left ventricle (LV); initial studies suggest haemodynamic and clinical benefits over conventional (single LV site) cardiac resynchronization therapy (CRT). The aim of this study was to estimate the impact of MPP activation on battery longevity in routine clinical practice. Methods and results: Patient (n = 46) and device data were collected from two centres at least 3 months after MPP-CRT device implantation...
September 23, 2017: Europace: European Pacing, Arrhythmias, and Cardiac Electrophysiology
https://www.readbyqxmd.com/read/29033504/procedural-characteristics-and-outcomes-of-transcatheter-aortic-valve-implantation-a-single-center-experience-of-the-first-100-inoperable-or-high-surgical-risk-patients-with-severe-aortic-stenosis
#5
Ying-Hwa Chen, Hsiao-Huang Chang, Po-Lin Chen, Zen-Chung Weng, I-Ming Chen, Hsin-Bang Leu, Chun-Yang Huang, Su-Man Lin, Mei-Han Wu
BACKGROUND: This is the first study of a Taiwanese population reporting transcatheter aortic valve implantation (TAVI) outcomes of the first 100 cases from a single center offering two different transcatheter heart valve technologies via six types of approaches. We herein report the 30-day and one-year outcomes in our first 100 TAVI patients at Taipei Veterans General Hospital. METHODS: From May 2010 to April 2016, 100 consecutive patients with severe aortic stenosis (AS) who were considered unsuitable or at high risk for surgical aortic valve replacement underwent TAVI...
July 2017: Acta Cardiologica Sinica
https://www.readbyqxmd.com/read/29032800/haemodynamic-effects-of-incomplete-stent-apposition-in-curved-coronary-arteries
#6
Winson X Chen, Eric K W Poon, Vikas Thondapu, Nicholas Hutchins, Peter Barlis, Andrew Ooi
Incomplete stent apposition (ISA, also known as malapposition) is a complication that affects day-to-day coronary stenting procedures. ISA is more prominent in complex arterial geometries, such as curvature, asa result of the limited conformability of coronary stents. These malapposed struts disturb the otherwise near-wall laminar blood flow and form a micro-recirculation environment. The micro-recirculation environment is often associated with low wall shear stress (WSS) and upsets the delicate balance of vascular biology, providing possible nidus for thrombosis and restenosis...
September 27, 2017: Journal of Biomechanics
https://www.readbyqxmd.com/read/29029934/ability-of-pulse-wave-transit-time-to-detect-changes-in-stroke-volume-and-to-estimate-cardiac-output-compared-to-thermodilution-technique-in-isoflurane-anaesthetised-dogs
#7
H Sano, J P Chambers
OBJECTIVE: To evaluate the ability of pulse wave transit time (PWTT) to detect changes in stroke volume (SV) and to estimate cardiac output (CO) compared with the thermodilution technique in isoflurane-anaesthetized dogs. STUDY DESIGN: Prospective, experimental study. ANIMALS: Eight adult laboratory dogs. METHODS: The dogs were anaesthetized with isoflurane and mechanically ventilated. Reference CO (TDCO) was measured via a pulmonary artery catheter using the thermodilution technique and reference SV (TDSV) was calculated...
April 26, 2017: Veterinary Anaesthesia and Analgesia
https://www.readbyqxmd.com/read/29029134/the-natural-history-and-surgical-outcome-of-patients-with-scimitar-syndrome-a-multi-centre-european-study
#8
Vladimiro L Vida, Alvise Guariento, Ornella Milanesi, Dario Gregori, Giovanni Stellin
Aims: Treatment decisions in patients with scimitar syndrome (SS) are often challenging, especially in patients with isolated SS who are often asymptomatic and who might be diagnosed accidentally. We queried a large multi-institutional registry of SS patients to evaluate the natural history of this condition and to determine the efficacy of surgical treatment in terms of survival and clinical status. Methods and results: We collected data on 485 SS patients from 51 institutions; 279 (57%) patients were treated surgically (STPs) and 206 (43%) were clinically monitored (CMPs)...
October 3, 2017: European Heart Journal
https://www.readbyqxmd.com/read/29029105/comparative-performance-of-transcatheter-aortic-valve-in-valve-implantation-versus-conventional-surgical-redo-aortic-valve-replacement-in-patients-with-degenerated-aortic-valve-bioprostheses-systematic-review-and-meta-analysis
#9
Miroslaw Gozdek, Giuseppe Maria Raffa, Piotr Suwalski, Michalina Kolodziejczak, Lech Anisimowicz, Jacek Kubica, Eliano Pio Navarese, Mariusz Kowalewski
The objective of this report was to directly compare, by means of a systematic review and meta-analysis, redo surgical aortic valve replacement (re-sAVR) with valve-in-valve transcatheter aortic valve implantation (ViV TAVI) for patients with failed degenerated aortic bioprostheses. Multiple databases were screened for all available reports comparing ViV TAVI with re-sAVR in patients with failing degenerated aortic bioprostheses. The primary outcome was all-cause mortality determined from the longest available survival data...
September 8, 2017: European Journal of Cardio-thoracic Surgery
https://www.readbyqxmd.com/read/29029023/comprehensive-evaluation-of-the-effectiveness-and-safety-of-balloon-pulmonary-angioplasty-for-inoperable-chronic-thrombo-embolic-pulmonary-hypertension-long-term-effects-and-procedure-related-complications
#10
Tatsuo Aoki, Koichiro Sugimura, Shunsuke Tatebe, Masanobu Miura, Saori Yamamoto, Nobuhiro Yaoita, Hideaki Suzuki, Haruka Sato, Katsuya Kozu, Ryo Konno, Satoshi Miyata, Kotaro Nochioka, Kimio Satoh, Hiroaki Shimokawa
Aims: Although balloon pulmonary angioplasty (BPA) improves haemodynamics and short-term prognosis in patients with inoperable chronic thrombo-embolic pulmonary hypertension (CTEPH), the long-term effects of BPA, and procedure-related complications remain to be fully elucidated. Methods and results: From July 2009 to October 2016, we performed a total of 424 BPA sessions in 84 consecutive patients with inoperable CTEPH. We used 3D reconstructed computed tomography to determine target lesions of pulmonary arteries and optical computed tomography to select balloon size, if needed...
September 23, 2017: European Heart Journal
https://www.readbyqxmd.com/read/29028985/impact-of-coronary-lumen-reconstruction-on-the-estimation-of-endothelial-shear-stress-in-vivo-comparison-of-three-dimensional-quantitative-coronary-angiography-and-three-dimensional-fusion-combining-optical-coherent-tomography
#11
Jihoon Kweon, Soo-Jin Kang, Young-Hak Kim, June-Goo Lee, Seungbong Han, Hojin Ha, Dong Hyun Yang, Joon-Won Kang, Tae-Hwan Lim, Osung Kwon, Jung-Min Ahn, Pil Hyung Lee, Duk-Woo Park, Seung-Whan Lee, Cheol Whan Lee, Seong-Wook Park, Seung-Jung Park
Aims: It is not clearly elucidated how the fusion technique improves the accuracy of endothelial shear stress (ESS) prediction, in comparison with that of three-dimensional (3D) quantitative coronary angiography (QCA) alone. We aimed to evaluate the difference in geometric measurements and haemodynamic estimation between 3D QCA and a 3D fusion model combining 3D QCA and optical coherence tomography (OCT). Methods and results: Computational fluid dynamics was assessed in the coronary models of 20 patients...
September 25, 2017: European Heart Journal Cardiovascular Imaging
https://www.readbyqxmd.com/read/29028925/influence-of-bayesian-optimization-on-the-performance-of-propofol-target-controlled-infusion
#12
J P van den Berg, D J Eleveld, T De Smet, A V M van den Heerik, K van Amsterdam, B J Lichtenbelt, T W L Scheeren, A R Absalom, M M R F Struys
Background: Target controlled infusion (TCI) systems use population-based pharmacokinetic (PK) models that do not take into account inter-individual residual variation. This study compares the bias and inaccuracy of a population-based vs a personalized TCI propofol titration using Bayesian adaptation. Haemodynamic and hypnotic stability, and the prediction probability of alternative PK models, was studied. Methods: A double-blinded, prospective randomized controlled trial of 120 subjects undergoing cardiac surgery was conducted...
October 3, 2017: British Journal of Anaesthesia
https://www.readbyqxmd.com/read/29028737/resting-pd-pa-and-haemodynamic-relevance-of-coronary-stenosis-as-evaluated-by-fractional-flow-reserve
#13
Giuseppe De Luca, Monica Verdoia, Lucia Barbieri, Paolo Marino, Harry Suryapranata
BACKGROUND: Fractional flow reserve (FFR) currently represents the gold standard in the evaluation of the haemodynamic relevance of coronary stenoses. However, both intracoronary and intravenous adenosine may be tolerated poorly by some patients. Therefore, considerable interest had been focused in the last few years on new adenosine-free indexes to define the haemodynamic relevance of coronary stenoses. So far, few data have been reported on resting Pd/Pa and its correlation with FFR as evaluated with high-dose intracoronary adenosine administration, which is the aim of the current study...
October 12, 2017: Coronary Artery Disease
https://www.readbyqxmd.com/read/29027653/comparison-of-dexmedetomidine-and-fentanyl-to-prevent-haemodynamic-response-to-skull-pin-application-in-neurosurgery-double-blind-randomized-controlled-trial
#14
Cattleya Thongrong, Pannawat Sirikannarat, Pornthep Kasemsiri, Pichayen Duangthongphon
BACKGROUND: Skull pin application during craniotomy is a highly noxious stimulus. Therefore, the attenuated effect between dexmedetomidine and fentanyl was investigated. METHOD: A randomized, double-blind controlled trial included sixty patients, randomly allocated into groups A and B. After patients entered the operative room, blood pressure and heart rate were measured (T1). At 5 minutes after propofol induction (T2), group A received dexmedetomidine 1 µg kg⁻¹ whereas group B received normal saline...
October 13, 2017: Anaesthesiology Intensive Therapy
https://www.readbyqxmd.com/read/29026516/ascending-cholangitis-rare-presentation-of-a-ruptured-right-sided-renal-angiomyolipoma
#15
Stefanie M Croghan, Orla McCormack, Anna L Walsh, Ted McDermott
We report the case of a 46-year-old female who presented to the Emergency Department with acute, painful obstructive jaundice, with evidence of secondary ascending cholangitis. Surprisingly, imaging revealed the clinical picture to be caused not by hepatobiliary pathology, but by external compression of the biliary tree from a ruptured renal angiomyolipoma (AML) of the right kidney. The patient remained haemodynamically stable and conservative management saw resolution of biliary obstruction. We believe this to be the first report of a renal AML presenting in this way...
October 2017: Journal of Surgical Case Reports
https://www.readbyqxmd.com/read/29026385/a-randomized-controlled-trial-to-assess-the-effect-of-a-ketamine-infusion-on-tourniquet-hypertension-during-general-anaesthesia-in-patients-undergoing-upper-and-lower-limb-surgery
#16
Joyce Ongaya, Vitalis Mung'ayi, Thikra Sharif, Jimmie Kabugi
BACKGROUND: Tourniquet hypertension arising from tourniquet inflation remains a primary concern to the anaesthetist. One drug commonly used to manage tourniquet hypertension is ketamine. No studies have examined the effect of ketamine on tourniquet hypertension for a period of more than one hour or an infusion of the same. OBJECTIVE: To compare the effect of an intravenous infusion of ketamine versus placebo on tourniquet induced hypertension in patients undergoing upper and lower limb surgery under general anaesthesia...
March 2017: African Health Sciences
https://www.readbyqxmd.com/read/29026001/understanding-a-role-for-hypoxia-in-lesion-formation-and-location-in-the-deep-and-periventricular-white-matter-in-small-vessel-disease-and-multiple-sclerosis
#17
REVIEW
Santiago Martinez Sosa, Kenneth J Smith
The deep and periventricular white matter is preferentially affected in several neurological disorders, including cerebral small vessel disease (SVD) and multiple sclerosis (MS), suggesting that common pathogenic mechanisms may be involved in this injury. Here we consider the potential pathogenic role of tissue hypoxia in lesion development, arising partly from the vascular anatomy of the affected white matter. Specifically, these regions are supplied by a sparse vasculature fed by long, narrow end arteries/arterioles that are vulnerable to oxygen desaturation if perfusion is reduced (as in SVD, MS and diabetes) or if the surrounding tissue is hypoxic (as in MS, at least)...
October 15, 2017: Clinical Science (1979-)
https://www.readbyqxmd.com/read/29025783/syncope-from-radiation-induced-baroreceptor-failure
#18
Scott E Janus, Taishi Hirai, Verghese Mathew, Mark Rabbat
Orthostatic hypotension has a vast differential that has been previously described throughout the literature. However, baroreceptor failure as a sequela of head and neck radiation is not often recognised as an important cause of dramatic haemodynamic variability. As a result, individuals suffering from baroreceptor failure likely have been undertreated. Herein, we report a case of a patient with a history of radiation to the neck for squamous cell carcinoma of the tongue and resultant baroreceptor failure resulting in syncope...
October 11, 2017: BMJ Case Reports
https://www.readbyqxmd.com/read/29024227/impact-of-atrial-fibrillation-on-rest-and-exercise-haemodynamics-in-heart-failure-with-mid-range-and-preserved-ejection-fraction
#19
David M Kaye, Frank E Silvestry, Finn Gustafsson, John G Cleland, Dirk J van Veldhuisen, Piotr Ponikowski, Jan Komtebedde, Shane Nanayakkara, Dan Burkhoff, Sanjiv J Shah
AIMS: Heart failure with preserved (HFpEF) and mid-range ejection fraction (HFmrEF) are becoming the most prevalent forms of heart failure. Patients with HFpEF/HFmrEF in atrial fibrillation (AF) have poorer survival and quality of life, but the mechanism underpinning this is unknown. We sought to investigate the influence of AF on the haemodynamic profile of HFpEF/HFmrEF patients at rest and during exercise. METHODS AND RESULTS: We invasively measured central haemodynamics at rest and during symptom-limited supine bicycle exercise in HFpEF/HFmrEF patients, 35 in sinus rhythm and 20 in AF with matched left ventricular ejection fraction...
October 11, 2017: European Journal of Heart Failure
https://www.readbyqxmd.com/read/29023881/review-article-the-role-of-the-microcirculation-in-liver-cirrhosis
#20
REVIEW
T Davies, S Wythe, J O'Beirne, D Martin, E Gilbert-Kawai
BACKGROUND: Intrahepatic microvascular derangements and microcirculatory dysfunction are key in the development of liver cirrhosis and its associated complications. While much has been documented relating to cirrhosis and the dysfunction of the microcirculation in the liver parenchyma, far less is known about the state of the extrahepatic microcirculation and the role this may have in the pathogenesis of multiple organ failure in end stage liver cirrhosis. AIM: To provide an update on the role of the microcirculation in the pathophysiology of cirrhosis and its associated complications and briefly discuss some of the imaging techniques which may be used to directly investigate the microcirculation...
November 2017: Alimentary Pharmacology & Therapeutics
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