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pulmonary hypertension preoperative management

Beth Dunlap, George Weyer
Pulmonary hypertension is a common, complex group of disorders that result from different pathophysiologic mechanisms but are all defined by a mean pulmonary arterial pressure of 25 mm Hg or greater. Patients often initially present to family physicians; however, because the symptoms are typically nonspecific or easily attributable to comorbid conditions, diagnosis can be challenging and requires a stepwise evaluation. There is limited evidence to support screening of asymptomatic individuals. Echocardiography is recommended as the initial step in the evaluation of patients with suspected pulmonary hypertension...
September 15, 2016: American Family Physician
William R Auger, Jess Mandel, Joanna Pepke-Zaba
Chronic thromboembolic pulmonary hypertension is a progressive and life-threatening condition that is believed to be related to inadequate dissolution of acute pulmonary thromboemboli, followed by fibrotic organization. Without appropriate treatment, progressive pulmonary hypertension, right ventricular failure, and death may occur. While the disorder was initially described nearly a century ago in autopsy studies, antemortem diagnosis became feasible with the advent of cardiac catheterization and angiography techniques in the 1940s, while surgical thromboendarterectomy was not attempted until the 1960s...
July 2016: Annals of the American Thoracic Society
Hee Young Kim, Seung-Hoon Baek, Ji Uk Yoon, Dong Hoon Lee, Gyeong-Jo Byeon, Ji Hye Ahn
We report cardiac arrest due to obstruction of the right ventricular outflow tract (RVOT) caused by an RVOT mass that was not identified preoperatively. A 62-year-old woman with renal cell carcinoma (RCC) experienced deteriorating hypotension and bradycardia during radical nephrectomy. Hemodynamic stability was maintained on extracorporeal membrane oxygenation, and after surgery, she was transferred to the intensive care unit. On postoperative day 3, transthoracic echocardiography showed an intracardiac mass obstructing the RVOT, which caused severe functional pulmonary stenosis and moderate resting pulmonary hypertension...
September 2016: Journal of Clinical Anesthesia
J C Galán Gutiérrez, F E Fernández Suárez, P Miranda García, L A Sopena Zubiria
Eisenmenger syndrome (ES) is a complex combination of cardiovascular abnormalities defined as pulmonary hypertension with investment or bidirectional flow through an intracardiac or aortopulmonary communication, usually secondary to a congenital heart disease not resolved promptly. It carries a significant risk of perioperative mortality, with an incidence close to 30% for non-cardiac surgery. We report the anaesthetic management in a ES patient undergoing breast surgery, which was successfully performed under general anaesthesia combined with thoracic analgesic blocks...
August 20, 2016: Revista Española de Anestesiología y Reanimación
David Faraoni, Daniel Vo, Viviane G Nasr, James A DiNardo
BACKGROUND: Children with major and severe congenital heart disease (CHD) undergoing noncardiac surgery are at increased risk of mortality. The objective of this study was to identify the predictors for in-hospital mortality, and to develop a risk stratification score that could be used to help decision making and the development of perioperative management guidelines. METHODS: We included all children with major (eg, tetralogy of Fallot with wide open pulmonary insufficiency, hypoplastic left heart syndrome including stage 1 repair) or severe CHD (eg, children with uncorrected CHD, children with documented pulmonary hypertension, children with ventricular dysfunction requiring medications, or children listed for heart transplant) recorded in the 2012 and 2013 American College of Surgeons National Surgical Quality Improvement Program Pediatric databases in a derivation cohort, and those recorded in the 2014 database in a validation cohort...
October 2016: Anesthesia and Analgesia
Sho Ohno, Yukitoshi Niiyama, Takeshi Murouchi, Michiaki Yamakage
Severe pulmonary arterial hypertension is a significant risk factor for anesthetic management in patients undergoing even non-cardiac surgery. A 64-year-old female patient with severe pulmonary arterial hypertension was scheduled to undergo inguinal hernioplasty. Preoperative systolic pulmonary arterial pressure was 115 mmHg. We selected monitored anesthesia care with 0.2-0.5 μg x kg(-1) x hr(-1) dexmedetomidine and ultrasound-guided iliohypogastric block. Thereafter, LiDCOrapid was used to acquire the hemodynamic responses during surgery...
May 2016: Masui. the Japanese Journal of Anesthesiology
Rogelio Castillo-Luna, Osvaldo Miranda-Araujo
BACKGROUND: Pulmonary hypertension is a disease of poor prognosis when is associated with pregnancy. A maternal mortality of 30-56% and a neonatal survival of approximately 85% is reported. Surveillance of patients with severe pulmonary hypertension during pregnancy must be multidisciplinary, to provide information and optimal treatment during and after gestation. Targeted therapy for pulmonary arterial hypertension during pregnancy significantly reduces mortality. The critical period with respect to mortality, is the first month after birth...
December 2015: Ginecología y Obstetricia de México
Christopher W Jensen, Andrew B Goldstone, Y Joseph Woo
This review will discuss the medical management of pulmonary hypertension in patients with left ventricular assist devices. Although much has been written on the management of primary pulmonary hypertension, also called pulmonary arterial hypertension, this review will instead focus on the treatment of pulmonary hypertension secondary to left heart disease. The relevant pharmacotherapy can be divided into medications for treating heart failure, such as diuretics and β-blockers, and medications for treating pulmonary hypertension...
June 2016: Current Heart Failure Reports
Rainer Kozlik-Feldmann, Georg Hansmann, Damien Bonnet, Dietmar Schranz, Christian Apitz, Ina Michel-Behnke
Pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD) is a complex disease that presents with a broad spectrum of morphological and haemodynamic findings of varying severity. Recently, the aspect of paediatric pulmonary hypertensive vascular disease (PPHVD) has been introduced to expand the understanding of the full spectrum of pulmonary hypertension and increased pulmonary vascular resistance. Evaluation and treatment of PAH-CHD/PPHVD-CHD can be divided into in different topics...
May 2016: Heart: Official Journal of the British Cardiac Society
Bo Yang, Christina DeBenedictus, Tessa Watt, Sean Farley, Alona Salita, Whitney Hornsby, Xiaoting Wu, Morley Herbert, Donald Likosky, Steven F Bolling
OBJECTIVES: To provide initial evidence on the management of mitral stenosis and pulmonary hypertension (PH) based on short-term and long-term outcomes following mitral valve surgery. METHODS: Consecutive patients with mitral stenosis (n = 317) who had undergone mitral valve surgery between 1992 and 2014 with recorded pulmonary artery pressure (PAP) data were reviewed. PH severity, based on systolic PAP, was categorized as mild (35 to 44 mm Hg), moderate (45 to 59 mm Hg), or severe (>60 mm Hg)...
August 2016: Journal of Thoracic and Cardiovascular Surgery
Matthias Heringlake, Julika Schön, Teresa Pliet, Nils Haake, Alexander Reinecke, Marit Habicher, Michael Sander, Andreas Markewitz, Daniel A Reuter, Heinrich Volker Groesdonk, Georg Trummer, Kevin Pilarzyk, Michael von der Brelie, Berthold Bein, Uwe Schirmer
Background Sparse data are available on the prevalence of right ventricular dysfunction and/or pulmonary arterial hypertension in patients scheduled for cardiac surgery in Germany as well as on the intensity and modalities used for diagnosis, perioperative monitoring, and treatment of these comorbidities. Methods A postal survey including questions on the prevalence of preoperative right ventricular dysfunction and/or pulmonary arterial hypertension in patients undergoing cardiac surgery in 2009 was sent to 81 German heart centers...
February 24, 2016: Thoracic and Cardiovascular Surgeon
Nancy E Epstein
BACKGROUND: More and more, no one seems to be in charge of taking care of patients with spinal disease both before and after spine surgery. Yet, as spine surgeons, we should not have to direct basic medical clearance prior to surgery, or direct basic medical postoperative care. METHODS: As we as spine surgeons did not complete medical residencies, why are we now being asked to take care of all postoperative issues in our patients undergoing spine surgery. As "captains of the ship," we are increasingly managing hypertension, diabetes, deep venous thrombosis/pulmonary embolism, and other basic medical issues...
2016: Surgical Neurology International
Lijian Cheng, Lihua Wang, Wei Lu, Guobing Cheng, Yunping Lan
OBJECTIVE: To compare cardiac adverse events, clinical outcomes and mid-and-long-term effects among massive and sub-massive pulmonary embolism (PE) patients under different periodswho received thrombus fragmentation by pigtail catheter. METHODS: Two groups of patients who receivedthrombusfragmentation bypigtail catheter in different periods were analyzed retrospectively. Group E: 38 cases received therapy from July 2004 to October 2009 with local anesthesia; Group P: 64 cases with general anesthesia from March 2010 to December 2014...
January 26, 2016: Zhonghua Yi Xue za Zhi [Chinese medical journal]
Daniel Dumitrescu, Felix Gerhardt, Thomas Viethen, Matthias Schmidt, Eckhard Mayer, Stephan Rosenkranz
BACKGROUND: Chronic thromboembolic pulmonary hypertension (CTEPH) is a progressive disease. For patients with operable CTEPH, there is a clear recommendation for surgical removal of persistent thrombi by pulmonary endarterectomy (PEA). However, without the presence of PH, therapeutic management of chronic thromboembolic disease (CTED) is challenging - especially in highly trained subjects exceeding predicted values of maximal exercise capacity. CASE PRESENTATION: A 43-year-old male athlete reported with progressive exercise limitation since 8 months...
2016: BMC Pulmonary Medicine
Gayatri Mishra, Amrutha Bindu Nagella, S Parthasarathy, Bangaru Vivek
Here, we report a rare case of a 23-year-old term parturient with Eisenmenger syndrome due to Taussig-Bing anomaly presenting with gestational hypertension, oligohydramnios, and intrauterine growth retardation posted for elective cesarean section. Preoperatively, echocardiography of the patient was suggestive of double-outlet right ventricle (DORV) with large sub-pulmonic ventricular septal defect (VSD), right ventricular hypertrophy, bidirectional shunt and severe pulmonary artery hypertension. The surgery was successfully performed under a graded segmental epidural anesthesia with 2% lignocaine...
September 2015: Anesthesia, Essays and Researches
Stanisław Ostrowski, Anna Marcinkiewicz, Anna Kośmider, Andrzej Walczak, Radosław Zwoliński, Ryszard Jaszewski
INTRODUCTION: Approximately 60 000 prosthetic valves are implanted annually in the USA. The risk of prosthesis dysfunction ranges from 0.1% to 4% per year. Prosthesis valve dysfunction is usually caused by a thrombus obstructing the prosthetic discs. However, 10% of prosthetic valves are dysfunctional due to pannus formation, and 12% of prostheses are damaged by both fibrinous and thrombotic components. The authors present two patients with dysfunctional aortic prostheses who were referred for cardiac surgery...
September 2015: Kardiochirurgia i Torakochirurgia Polska, Polish Journal of Cardio-Thoracic Surgery
Suparna Dutta, Steven L Cohn, Kurt J Pfeifer, Barbara A Slawski, Gerald W Smetana, Amir K Jaffer
BACKGROUND: As our surgical population becomes older and more medically complex, knowledge of the most recent perioperative literature is necessary to optimize perioperative care. We aim to summarize and critique literature published over the past year with the highest potential to impact the clinical practice of perioperative medicine. METHODS: We reviewed articles published between January 2014 and April 2015, identified via MEDLINE search. The final 10 articles selected were determined by consensus among all authors, with criteria for inclusion including scientific rigor and relevance to perioperative medicine practice...
March 2016: Journal of Hospital Medicine: An Official Publication of the Society of Hospital Medicine
Clayton C Petro, Siavash Raigani, Mojtaba Fayezizadeh, James R Rowbottom, John C Klick, Ajita S Prabhu, Yuri W Novitsky, Michael J Rosen
BACKGROUND: Repair of hernias with loss of domain can lead to elevated intraabdominal pressure. The authors aimed to characterize the effects of elective hernia repair on intraabdominal pressure, as well as its predictors and association with negative outcomes. METHODS: Patients undergoing elective hernia repair requiring myofascial release had intraabdominal and pulmonary plateau pressures measured preoperatively, postoperatively, and on the morning of the first postoperative day...
October 2015: Plastic and Reconstructive Surgery
Dakshesh H Parikh, Shree Vishna Rasiah
Antenatal diagnosis of lung lesion has become more accurate resulting in dilemma and controversies of its antenatal and postnatal management. Majority of antenatally diagnosed congenital lung lesions are asymptomatic in the neonatal age group. Large lung lesions cause respiratory compromise and inevitably require urgent investigations and surgery. The congenital lung lesion presenting with hydrops requires careful postnatal management of lung hypoplasia and persistent pulmonary hypertension. Preoperative stabilization with gentle ventilation with permissive hypercapnia and delayed surgery similar to congenital diaphragmatic hernia management has been shown to result in good outcome...
August 2015: Seminars in Pediatric Surgery
Cyndi U Chung, Jason D Wink, Jonas A Nelson, John P Fischer, Joseph M Serletti, Suhail K Kanchwala
BACKGROUND: Surgical site infections (SSIs) are a costly complication, resulting in lower patient satisfaction and higher health care expenditures. Incidence varies widely in the literature by surgery type, yet few studies focus exclusively on autologous breast reconstruction, an increasingly common surgery. The aim of this study is to identify risk factors for SSIs in free flap breast reconstruction using the National Surgical Quality Improvement Program Database (NSQIP). METHODS: Patients undergoing breast reconstruction with any flap type were identified by Current Procedural Terminology codes in the NSQIP database...
July 2015: Journal of Reconstructive Microsurgery
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