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hemodynamic optimization

Antonio G Cabrera, Kathleen K Kibler, R Blaine Easley, Michelle Goldsworthy, Lara S Shekerdemian, Dean B Andropoulos, Jeffrey Heinle, Erin A Gottlieb, Eric Vu, Ken M Brady
BACKGROUND: Elevated arterial blood pressure (ABP) is common after superior bidirectional cavo-pulmonary anastomosis (BCPA). The effects of elevated ABP after BCPA on cerebrovascular hemodynamics are unknown. We sought to determine the relationship between elevated ABP and cerebrovascular autoregulation after BCPA. METHODS: Prospective, observational study on infants with single-ventricle physiology after BCPA surgery. Continuous recordings of mean ABP, mean cavo-pulmonary pressure (PAP), near-infrared spectroscopy measures of cerebral oximetry (rSO2), and relative cerebral blood volume index (BVI) were obtained from admission to extubation...
March 14, 2018: Pediatric Research
David M Tehrani, Daniel Rodgers, Sirtaz Adatya, Nitasha Sarswat, Jayant Raikhelkar, Gene H Kim, Gabriel Sayer, Nir Uriel
We aim to evaluate the echocardiographic/hemodynamic effects of left ventricular assist devices in African American (AA) versus non-AA patients undergoing ramp speed optimization and its subsequent effect on readmissions. In 65 patients (26 AA), no differences in baseline echocardiographic/hemodynamic parameters were noted. During ramp testing, there was a significantly greater increase in cardiac output (slope: 0.29 ± 0.24 vs. 0.15 ± 0.12, p < 0.01) with more rapid decrease in left ventricular end-diastolic diameter (slope: -0...
March 13, 2018: ASAIO Journal: a Peer-reviewed Journal of the American Society for Artificial Internal Organs
Ali Kordzadeh, Alan Askari, Yiannis Panayiotopoulos
OBJECTIVE: It has been hypothesized that a novel measurement technique of arteriovenous ratio (AVR) index obtained from inflow (radial artery diameter) to that of outflow (cephalic vein diameter) and its application through the Bernoulli effect has no impact on the primary functional maturation (FM) of autogenous radiocephalic arteriovenous fistula (RCAVF). METHODS: A prospective consecutive single-center cohort study with intention to treat of 324 patients undergoing RCAVF during a period of 4 years was conducted...
March 8, 2018: Journal of Vascular Surgery
Mohammad Abdelghani, Robbert J de Winter, Yosuke Miyazaki, Rodrigo Modolo, Hiroki Tateishi, Rafael Cavalcante, Rogério Sarmento-Leite, José A Mangione, Alexandre Abizaid, Osama I I Soliman, Yoshinobu Onuma, Pedro A Lemos, Patrick W Serruys, Fabio S de Brito
OBJECTIVES: To explore the rate, the determinants of success, and the hemodynamic impact of balloon postdilatation (BPD) of self-expanding transcatheter heart valves (SE-THVs) BACKGROUND: BPD is commonly used to optimize valve expansion and reduce paravalvular leakage (PVL) after transcatheter aortic valve implantation (TAVI) without clearly knowing its hemodynamic benefits. METHODS: Patients (n = 307) who received a SE-THV were stratified according to whether a BPD was performed or not...
March 9, 2018: Catheterization and Cardiovascular Interventions
Nianfang Lu, Li Jiang, Bo Zhu, Wenyong Han, Yingqi Zhao, Yuntao Shi, Fashuang Guo, Xiuming Xi
OBJECTIVE: To explore the accuracy of fluid responsiveness assessment by variability of peripheral arterial peak velocity and variability of inferior vena cava diameter (ΔIVC) in patients with septic shock. METHODS: A prospective study was conducted. The patients with septic shock undergoing mechanical ventilation (MV) admitted to intensive care unit (ICU) of Beijing Electric Power Hospital from January 2016 to December 2017 were enrolled. According to sepsis bundles of septic shock, volume expansion (VE) was conducted...
March 2018: Zhonghua Wei Zhong Bing Ji Jiu Yi Xue
Hong-Yu Kuang, Yu-Hao Wu, Qi-Jian Yi, Jie Tian, Chun Wu, We Nian Shou, Tie-Wei Lu
BACKGROUND: Oral bosentan has been widely applied in pulmonary arterial hypertension associated with congenital heart disease (PAH-CHD). A systemic review and meta-analysis was conducted for a therapeutic evaluation of oral bosentan in both adult and pediatric patients with PAH-CHD. The acute responses and a long-term effect were respectively assessed in a comparison with baseline characteristics, and the improvement of exercise tolerance was analyzed. METHODS: PubMed, Medline, Embase, and Cochrane Central Register of clinical controlled trails or observational studies have been searched for a recording of bosentan effects on the PAH-CHD participants...
March 2018: Medicine (Baltimore)
Roberto Bini, Osvaldo Chiara, Stefania Cimbanassi, Giorgio Olivero, Antonella Trombetta, Paolo Cotogni
Background: Hemorrhagic shock (HS) is a major threat to patients with trauma and spontaneous bleeding. The aim of the study was to investigate early effects of vasopressin on metabolic and hemodynamic parameters and endothelium permeability by measuring capillary leakage compared to those of other resuscitation strategies in a HS model. Methods: Forty-five Sprague-Dawley rats were randomized into five groups: S group ( n  = 5), sham-operated rats without shock or resuscitation; HS group ( n  = 10), HS and no resuscitation; RL group ( n  = 10), HS and resuscitation with Ringer's lactate (RL); RLB group ( n  = 10), HS and resuscitation with two-third shed blood plus RL; and vasopressin group ( n  = 10), HS and resuscitation with RL, followed by continuous infusion of 0...
2018: World Journal of Emergency Surgery: WJES
Samet Yılmaz, Uğur Canpolat, Kazım Başer, Sefa Ünal, Mevlüt Serdar Kuyumcu, Sinan Aydoğdu
OBJECTIVE: The aim of this study was to determine the relationship between the neutrophil-to-lymphocyte ratio (NLR) and the functional severity of coronary stenosis assessed according to the fractional flow reserve (FFR) in stable coronary artery disease (CAD). METHODS: The clinical and laboratory data of 420 patients who underwent index coronary angiography for stable angina pectoris were analyzed retrospectively. The functional severity of an intermediate lesion was determined by FFR...
March 2018: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
Hoda Hatoum, Jennifer Dollery, Scott M Lilly, Juan A Crestanello, Lakshmi Prasad Dasi
BACKGROUND: This study aims to evaluate the effect of transcatheter aortic valve (TAV) implantation depth and rotation on pressure gradient (PG), leakage fractions (LF), leaflet shear stress and sinus washout in an effort to understand factors that may dictate optimal positioning for valve-in-valve (ViV) procedures. Sinus flow stasis is often associated with prosthetic leaflet thrombosis. While recent ViV in-vitro studies highlighted transcatheter aortic valve (TAV) supra-annular implantation potential benefits to minimize pressure gradients, the relationship between TAV depth and other determinates of valve function remains unknown...
March 1, 2018: Annals of Thoracic Surgery
Naoki Edo, Takahiro Yamamoto, Satoshi Takahashi, Yamato Mashimo, Koji Morita, Koji Saito, Hiroshi Kondo, Yuko Sasajima, Fukuo Kondo, Hiroko Okinaga, Kazuhisa Tsukamoto, Toshio Ishikawa
Pheochromocytoma rupture is rare, and emergent adrenalectomy is associated with a high mortality. We herein report a patient with pheochromocytoma rupture who was stabilized by transcatheter arterial embolization (TAE) and subsequently underwent elective surgery. A 45-year-old man presented with the sudden onset of left lateral abdominal pain, headache, chest discomfort, high blood pressure, and adrenal hemorrhaging on enhanced abdominal computed tomography. TAE was performed under a provisional diagnosis of pheochromocytoma rupture...
February 28, 2018: Internal Medicine
Tarun Chakravarty, Justin Cox, Yigal Abramowitz, Sharjeel Israr, Abhimanyu Uberoi, Sunghan Yoon, Damini Dey, Paya Zadeh, Wen Cheng, Raj R Makkar
AIMS: Residual gradients >20mmHg after transcatheter valve-in-valve (ViV) are associated with worse survival. This study evaluated the feasibility of high-pressure post-dilation with a non-compliant balloon after transcatheter ViV in small surgical valves to optimize hemodynamics. METHODS AND RESULTS: Thirty patients underwent ViV implantation in surgical valves with internal dimension ≤ 19mm. High-pressure post-dilation to 16-20 atmospheres with a non-compliant balloon was performed in 12 patients and 18 patients underwent ViV without post-dilation...
February 27, 2018: EuroIntervention
Elisabetta Tedaldi, Chiara Montanari, Kenneth I Aycock, Francesco Sturla, Alberto Redaelli, Keefe B Manning
Inferior vena cava (IVC) filters have been used for over five decades as an alternative to anticoagulation therapy in the treatment of venous thromboembolic disease. However, complications associated with IVC filters remain common. Though many studies have investigated blood flow in the IVC, the effects of respiration-induced IVC collapse have not been evaluated. Our hypothesis is that IVC collapse may have an influence on IVC filter performance. Therefore, we herein investigate the hemodynamics in uncollapsed and collapsed IVC configurations using in vitro flow experiments and computational simulations...
February 24, 2018: Medical Engineering & Physics
Montaser Elsawy Abd Elaziz, Amr Mohammad Allama
Temporary pacemaker wires are usually inserted in patients after valve replacement and may be beneficial for optimizing myocardial function in patients that develop postoperative hemodynamically significant arrhythmias [Elmi 2002]. Indications for temporary cardiac pacing (TCP) are atrial, ventricular or atrioventricular pacing for bradyarrhythmias and for management of both atrial and ventricular tachyarrhythmias [De Belder 1990; Liebold 1998].Pacemaker wires have two ends - one end has a small needle, which is passed into the myocardial surface, then is cut off...
February 19, 2018: Heart Surgery Forum
Raluca Pascalau, Vlad Adrian Padurean, Dana BARTOș, Adrian BARTOș, Bianca Aurora Szabo
AIM: Anatomical variants of the circle of Willis are diverse and frequent and, although they are not a direct cause of cerebrovascular diseases, they are risk factors for impaired collateral perfusion and wall shear stress. This study aimed to correlate the anatomical variants with their effects on the hemodynamic and geometrical parameters responsible for the pathogenesis of neurological diseases. MATERIAL AND METHODS: The circle of Willis and the proximal segments of the main arteries were dissected and measured on ten formalin-fixed human brains...
February 7, 2018: Turkish Neurosurgery
Bernd Saugel, Karim Bendjelid, Lester A H Critchley, Thomas W L Scheeren
Hemodynamic monitoring provides the basis for the optimization of cardiovascular dynamics in intensive care medicine and anesthesiology. The Journal of Clinical Monitoring and Computing (JCMC) is an ideal platform to publish research related to hemodynamic monitoring technologies, cardiovascular (patho)physiology, and hemodynamic treatment strategies. In this review, we discuss selected papers published on cardiovascular and hemodynamic monitoring in the JCMC in 2017.
February 26, 2018: Journal of Clinical Monitoring and Computing
Thomas A Hooven, Tara M Randis, Richard A Polin
Asymptomatic term and late-preterm newborns with risk factors for early onset sepsis commonly undergo laboratory evaluation and receive empiric antibiotic therapy. Some have challenged the rationale for current "rule-out sepsis" practices, arguing that they lead to unnecessary overtreatment and healthcare costs. A series of recent clinical studies has explored scheduled serial observations as an alternative to laboratory testing and empiric antibiotics for asymptomatic newborns with historical risk factors for sepsis...
February 26, 2018: Journal of Perinatology: Official Journal of the California Perinatal Association
Dorthe Viemose Nielsen, Christian Torp-Pedersen, Regitze Kuhr Skals, Thomas A Gerds, Zidryne Karaliunaite, Carl-Johan Jakobsen
BACKGROUND: Several choices of inotropic therapy are available and used in relation to cardiac surgery. Comparisons are necessary to select optimal therapy. In Denmark, dobutamine and milrinone are the two inotropic agents most commonly used to treat post-bypass low cardiac output syndrome. This study compares all-cause mortality with these drugs. METHODS: In a retrospective observational study we investigated 10,700 consecutive patients undergoing cardiac surgery from 1 April 2006 to 31 December 2013 at Aarhus and Aalborg University Hospitals in the Central and Northern Denmark Region...
February 26, 2018: Critical Care: the Official Journal of the Critical Care Forum
Li-Jun Chen, Yu-Qi Zhang, Zhi-Rong Tong, Ai-Min Sun
Analysis of hemodynamics inside tricuspid atresia (TA) chamber is essential to the understanding of TA for optimal treatment. In this study, we introduced a combined computational fluid dynamics (CFD) to simulate blood flow in the left ventricle (LV) to study the diastolic flow changes in TA.Real-time 3-dimentional echocardiography loops (ECHO) were acquired in normal control group, in TA patients before surgery (pre-op group) and after surgery (post-op group). ECHO loops were reconstructed and simulated by CFD, the geometric, volumetric changes, and vortices in the LV were studies and compare among 3 groups...
January 2018: Medicine (Baltimore)
Talha Irfan Khan, Haris Sheh Zad, Ismail Lazoglu, Ozlem Yalcin
The aim of this work was to analyze a shrouded impeller pediatric ventricular assist device (SIP-VAD). This device has distinctive design characteristics and parameter optimizations for minimization of recirculation flow and reduction in high-stress regions that cause blood damage. Computational Fluid Dynamics (CFD) simulations were performed to analyze the optimized design. The bench-top prototype of SIP-VAD was manufactured with biocompatible stainless steel. A study on the hydrodynamic and hemodynamic performance of the SIP-VAD was conducted with predictions from CFD and actual experimentation values, and these results were compared...
February 24, 2018: Journal of Artificial Organs: the Official Journal of the Japanese Society for Artificial Organs
Sean Collins, Jennifer Martindale
PURPOSE OF REVIEW: In spite of advances in our understanding of acute heart failure (AHF) and its different phenotypic expressions, AHF management is still centered on volume removal with intravenous diuretics. This narrative review describes the pathophysiology underlying hypertensive AHF and appraises therapies targeting these mechanisms. RECENT FINDINGS: Vascular redistribution rather than volume overload may be the primary determinant of elevated cardiac filling pressures and subsequent pulmonary congestion in patients with hypertensive AHF; in these patients, vasodilators should be the predominant treatment...
February 24, 2018: Current Hypertension Reports
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