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Asymptomatic heart failure anesthesia

Anna Ledakowicz-Polak, Jarosław Bartodziej, Agata Majos, Marzenna Zielińska
BACKGROUND: Stress- induced cardiomyopathy is acute, reversible left ventricle mainly apical dysfunction in patients with normal coronary angiography. Rarely it regards basal segments, therefore defined as "inverted stress- induced cardiomyopathy". While classic form mostly affects postmenopausal women, inverted variant occurs essentially in younger females, always triggered by stress. It can also develop after medical procedures and surgery. Herein we report such unique case of 36- year old woman after cesarean delivery...
April 29, 2016: BMC Cardiovascular Disorders
Sara Leite, Sara Rodrigues, Marta Tavares-Silva, José Oliveira-Pinto, Mohamed Alaa, Mahmoud Abdellatif, Dulce Fontoura, Inês Falcão-Pires, Thierry C Gillebert, Adelino F Leite-Moreira, André P Lourenço
Myocardial stiffness and upward-shifted end-diastolic pressure-volume (P-V) relationship (EDPVR) are the key to high filling pressures in heart failure with preserved ejection fraction (HFpEF). Nevertheless, many patients may remain asymptomatic unless hemodynamic stress is imposed on the myocardium. Whether delayed relaxation induced by pressure challenge may contribute to high end-diastolic pressure (EDP) remains unsettled. Our aim was to assess the effect of suddenly imposed isovolumic afterload on relaxation and EDP, exploiting a highly controlled P-V experimental evaluation setup in the ZSF1 obese rat (ZSF1 Ob) model of HFpEF...
November 15, 2015: American Journal of Physiology. Heart and Circulatory Physiology
Lan He, Fang Liu, Lin Wu, Chun-Hua Qi, Li-Feng Zhang, Guo-Ying Huang
BACKGROUND: Although balloon angioplasty (BA) has been performed for more than 20 years, its use as a treatment for native coarctation of the aorta (CoA) during childhood, especially in young infants, remains controversial. This study aimed to assess the effects and potential role of percutaneous transcatheter BA for native CoA as an alternative therapy to surgical repair in young infants. METHODS: The 37 patients aged from 6 days to 6 months with severe CoA in congestive heart failure or circulatory shock were admitted for BA...
April 20, 2015: Chinese Medical Journal
Pablo Moriña-Vázquez, Jessica Roa-Garrido, Juan M Fernández-Gómez, José Venegas-Gamero, Rafael B Pichardo, Manuel H Carranza
BACKGROUND: Biventricular pacing through the coronary sinus (CS) is effective for the treatment of patients with heart failure and left bundle-branch block. However, this approach is not always feasible. Although surgical epicardial lead implantation is an alternative, the technique may be deleterious in some patients. Thus, direct left ventricular (LV) endocardial pacing under local anesthesia may be an option. OBJECTIVE: We describe our technique and analyze the results of direct LV endocardial pacing...
June 2013: Pacing and Clinical Electrophysiology: PACE
Rainer Hoffmann, Helge Möllmann, Shahram Lotfi
Treatment options for re-stenotic aortic valve prosthesis implanted by transcatheter technique have not been evaluated systematically. We describe the case of a 75-year-old dialysis patient who was treated by transcatheter aortic valve implantation 3.5 years ago and now presented with severe stenosis of the percutaneous heart valve. The patient was initially treated with a trans-apical implantation of an Edwards Sapien 26 mm balloon expandable valve. The patient remained asymptomatic for 3 years when he presented with increasing shortness of breath and significant calcification of the valve prosthesis on transesophageal echocardiography...
December 1, 2013: Catheterization and Cardiovascular Interventions
E J Bakker, K M van de Luijtgaarden, F van Lier, T M Valentijn, S E Hoeks, M Klimek, H J M Verhagen, R J Stolker
OBJECTIVES: Endovascular aneurysm repair (EVAR) is associated with reduced cardiac stress compared with open repair and is an attractive therapeutic option, especially in cardiac fragile patients. General and locoregional anaesthesia differ regarding the stress response evoked by surgery. The aim of the study is to compare the incidence of cardiac events after EVAR under general or locoregional anaesthesia. METHODS: A total of 302 consecutive patients undergoing infrarenal EVAR between 2002 and 2011 were analysed in this retrospective cohort study...
August 2012: European Journal of Vascular and Endovascular Surgery
A L Hoefnagel, R Wissler
The vast majority of females affected by hemochromatosis are asymptomatic during childbearing years. We were able to provide effective obstetric anesthesia care to a 35-year-old woman with severe hemochromatosis. She had systolic heart failure with a left ventricular ejection fraction of 15%, severe pulmonary hypertension, mitral insufficiency, a history of ventricular tachycardia, cirrhosis, obstructive sleep apnea, gestational diabetes, and severe scoliosis. A multidisciplinary approach was used to stabilize her heart failure and prepare her for childbirth...
January 2012: International Journal of Obstetric Anesthesia
José M Hernández-García, Antonio J Muñoz-García, Juan H Alonso-Briales, Manuel F Jiménez-Navarro, Antonio J Domínguez-Franco, Isabel Rodríguez-Bailón, Eduardo Olalla-Mercadé, Eduardo de Teresa-Galván
Recently, percutaneous aortic valve replacement has emerged as a therapeutic option for patients with severe symptomatic aortic stenosis and a high surgical risk. We report our initial experience in four patients with percutaneous implantation of a CoreValve aortic prosthesis to treat aortic bioprosthesis dysfunction involving aortic stenosis or regurgitation. In-hospital and medium-term outcomes were analyzed. The procedure was performed under local anesthesia and guided by angiography. The prosthesis was implanted successfully in all patients, although a second prosthesis was required in one case because the first was positioned too high...
February 2011: Revista Española de Cardiología
Anna M Calleja, Subha Dommaraju, Rakesh Gaddam, Stephen Cha, Bijoy K Khandheria, Hari P Chaliki
Severe aortic stenosis (AS) is a known predictor of cardiac risk during noncardiac surgery. However, for patients with asymptomatic AS, it is unclear whether aortic valve surgery should precede noncardiac surgery. We studied 30 patients with asymptomatic, severe AS with a mean age of 78 + or - 9 years, an aortic valve area of 0.77 + or - 0.16 cm(2), a mean gradient of 50.1 + or - 9.5 mm Hg, and a peak gradient of 84 + or - 22 mm Hg. They were compared to 60 age-matched (within 2 years) and gender-matched (ratio of 1:2) patients with mild-to-moderate AS (controls)...
April 15, 2010: American Journal of Cardiology
Ali F Aburahma, Patrick A Stone, Stephen M Hass, L Scott Dean, Joseph Habib, Tammi Keiffer, Mary Emmett
BACKGROUND: The use of shunting in carotid endarterectomy (CEA) is controversial. This randomized trial compared the results of routine (RS) vs selective shunting (SS) based on stump pressure (SP). METHODS: Two-hundred CEA patients under general anesthesia were randomized into RS (98 patients) or SS (102 patients), where shunting was used only if systolic SP (SSP) was <40 mm Hg. Clinical and demographic characteristics were comparable in both groups. Patients underwent immediate and 30-day postoperative duplex ultrasound follow-up...
May 2010: Journal of Vascular Surgery
Vishnu Datt, Deepak K Tempe, Sanjula Virmani, Devesh Datta, Mukesh Garg, Amit Banerjee, Akhlesh S Tomar
Asymptomatic women with mild aortic stenosis (AS) and normal left ventricular functions can successfully carry pregnancy to term and have vaginal deliveries. However, severe AS (valve area <1.0 cm2) can result in rapid clinical deterioration and maternal and fetal mortality. So, these patients require treatment of AS before conception or during pregnancy preferably in the second trimester. In suitable patients percutaneous balloon aortic valvotomy appears to carry lower risk. It can also be used as a palliative procedure allowing deferral of aortic valve replacement until after delivery...
January 2010: Annals of Cardiac Anaesthesia
W Bai, S Kaushal, S Malviya, K Griffith, R G Ohye
Hemodynamic changes during pregnancy can result in cardiovascular decompensation in women with pre-existing cardiac diseases. Despite optimized medical treatment, some patients with severe structural cardiac abnormalities may need surgical intervention during pregnancy. We describe a woman who presented at 20 weeks of gestation with acute heart failure due to cor triatriatum, a rare form of congenital heart disease. This condition is characterized by a perforated fibromuscular membrane dividing the left atrium into two chambers...
January 2010: International Journal of Obstetric Anesthesia
Toshihiko Ishiguro, Yasuaki Gyouda, Akitaka Yoshizawa, Kazuo Arakawa
BACKGROUND: It is difficult to evaluate the tolerance to anesthesia of patients undergoing operations, who have risk factors of congestive heart failure, such as hypertension, old age or various cardiac diseases. BNP (B type natriuretic peptide) is a useful biomarker as a screening tool for LV dysfunction. Therefore we hypothesized that the measurement of BNP may be useful for perioperative management of these patients. METHODS: Subjects were 101 (58 male and 43 female) gastro-intestinal cancer patients, aged 30 to 91 years (mean 63...
May 2009: Masui. the Japanese Journal of Anesthesiology
J J Peña, J I Marqués, E Mateo, J Llagunes, F Aguar, J de Andrés
Congenital sinus of Valsalva aneurysms are extremely rare in Spain. The lesion consists of a defect that allows the aortic media to separate from the annulus fibrosus of the aortic valve, causing it to dilate with arterial pressure. The natural course of the aneurysm involves the risk of complication due to bacterial endocarditis, with conduction blocks or myocardial ischemia. Rupture of the aneurysm, usually into a right chamber, causes a left-right shunt that leads to heart failure and death if untreated...
March 2008: Revista Española de Anestesiología y Reanimación
T Dimski, J Heinen-Lauten, H Krep
A 71-year-old female patient developed acute myocardial failure immediately after cataract surgery under general anesthesia. Subsequently performed laevocardiography demonstrated a basal ballooning of the left ventricle characteristic of basal tako-tsubo cardiomyopathy. The basal tako-tsubo cardiomyopathy was induced by a previously asymptomatic pheochromocytoma. The left ventricular function recovered completely within 4 days without specific treatment.
February 2008: Der Anaesthesist
S Ausset, Y Auroy, E Lambert, P Vest, C Plotton, S Rigal, B Lenoir, D Benhamou
BACKGROUND AND OBJECTIVE: The aim of this study was to assess the incidence of perioperative myocardial damage detected by serial measurements of troponin I after hip surgery and its association with late cardiovascular outcome. METHODS: Troponin I was measured during the first three postoperative days in 88 consecutive patients undergoing hip surgery. Values above the 99th percentile (0.08 ng mL(-1)) were considered positive. Major cardiac events (cardiac death, myocardial infarction and cardiac failure) were recorded during hospital stay and 1 yr after surgery...
February 2008: European Journal of Anaesthesiology
Gordon E Pate, Abdul Al Zubaidi, Mann Chandavimol, Christopher R Thompson, Bradley I Munt, John G Webb
BACKGROUND: Paravalvular leaks (PVLs) are a well-recognized complication of prosthetic valve replacement. Most are asymptomatic and benign, but some may cause symptoms due to a large regurgitant volume or hemolysis. Medical therapy is palliative, while reoperation carries significant morbidity and mortality. Percutaneous transcatheter closure techniques, now routinely applied in the management of pathological cardiac and vascular communications, may be adaptable to PVL closure, potentially offer symptomatic relief...
October 2006: Catheterization and Cardiovascular Interventions
Zeev Friedman, Frances Chung, David T Wong
PURPOSE: An increasing number of patients with complex medical problems are now considered suitable for ambulatory surgery. The purpose of this study was to identify the current clinical practice of ambulatory surgical patient selection. METHODS: A standardized questionnaire specifying 30 clinical conditions was sent to all practicing anesthesiologists who are members of the Canadian Anesthesiologists' Society. Recipients were asked to indicate if they would provide ambulatory anesthesia (yes/no answers) for an adult patient with each of those isolated conditions...
May 2004: Canadian Journal of Anaesthesia, Journal Canadien D'anesthésie
J R Schneider, J S Droste, N Schindler, J F Golan
OBJECTIVES: Carotid endarterectomy has been shown to be of clear benefit to selected patients. However, recent trials of carotid endarterectomy versus best medical therapy have excluded octogenarians, and some authors have suggested that carotid endarterectomy would have an unfavorable cost-benefit relationship in octogenarians. We compared patients and results for carotid endarterectomy in octogenarians and younger patients. METHODS: We reviewed the results for 582 primary carotid endarterectomies (90 in octogenarians and 492 in younger patients) performed in 528 patients between February 1, 1985, and January 31, 1998 (all data were collected prospectively for the most recent 301 carotid endarterectomies)...
May 2000: Journal of Vascular Surgery
M P Smith, J E Tetzlaff, J J Brems
BACKGROUND AND OBJECTIVES: Interscalene block can be chosen for complete anesthesia for shoulder surgery. Phrenic nerve block occurs with almost all interscalene blocks, but is well tolerated in most patients. This may not be the case in selected geriatric patients. METHODS: The patient is a 90-year-old female with osteoarthritis of the left shoulder scheduled for total shoulder anthroplasty. Past medical history revealed hypertension, mild mitral valve insufficiency, and a remote episode of congestive heart failure...
March 1998: Regional Anesthesia and Pain Medicine
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