1/16. Preliminary experience with a percutaneous cardiopulmonary support system.Percutaneous cardiopulmonary bypass has been introduced to support circulation in critical patients. In our preliminary experience we resuscitated two patients who sustained a prolonged cardiac arrest (52 min. and 31 min.) after coronary angiography and elective cardiac surgery, respectively. Cannulation was achieved percutaneously within 10 min. in both cases. Pump flow ranged from 2 to 31/m. Total support lasted from 52 min. to 180 min.. Both patients were successfully weaned. Patient 1 was declared brain dead and expired 17 days later. Patient 2 was discharged from the hospital and is doing well. Cannulation was attempted in a third patient after 30 min. of cardiac arrest. Despite surgical cut down of the femoral vessels, it was impossible to advance the arterial cannula because of bilateral occlusive disease. We conclude that PCPS is a powerful technique in selected patients to recover a stable cardiac function after prolonged cardiac arrest.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/16. Clinical experience with cerebral oximetry in stroke and cardiac arrest.OBJECTIVE: To address the ability and reliability of the INVOS 3100A (Somanetics, Troy, MI) cerebral oximeter to detect cerebral desaturation in patients and the interpretation of cerebral oximetry measurements using the INVOS 3100A in stroke and cardiac arrest. DESIGN: case reports of two patients. SETTING: Neurologic intensive care Unit of a University Hospital. patients: Two patients suffering occlusive strokes of the middle cerebral artery. One later suffered a cardiac arrest. RESULTS: The first case, a patient who suffered cardiac arrest while undergoing continuous cerebral oximetry, clearly demonstrated the ability of the INVOS 3100A to detect rapid tissue vascular oxyhemoglobin desaturation in the brain during circulatory arrest. In the second case, oximetry readings were obtained in a patient with a right internal carotid artery occlusion and an infarct in the middle cerebral artery territory. The circulation of the anterior cerebral artery (ACA) territory was intact. Stable xenon-computed tomography of local cerebral blood flow showed no perfusion in the infarct, and oximetry readings were between 60 and 65. In the border zone between the middle cerebral artery and the ACA, readings of 35 to 40 were obtained, and over the ACA territory, the readings were in the 60s. CONCLUSIONS: oximetry by near infrared spectroscopy reflects the balance between regional oxygen supply and demand. In dead or infarcted nonmetabolizing brain, saturation may be near normal because of sequestered cerebral venous blood in capillaries and venous capacitance vessels and contribution from overlying tissue. In regionally or globally ischemic, but metabolizing brain, saturation decreases because oxygen supply is insufficient to meet metabolic demand. These observations are supported by previously reported "normal" readings in unperfused or dead brains.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
3/16. Hypotensive hemorrhagic necrosis in basal ganglia and brainstem.Hypotensive hemorrhagic necrosis of the basal ganglia and brainstem has only occasionally been described. Three such cases are reported. Cardiac arrest had occurred in all cases, and it took at least 1 hour to restore adequate circulation. The patients remained comatose for 2 days to 2 weeks until death. Persistent hypotension causing ischemia in the distribution of deep perforating arteries is considered to have been the key underlying mechanism. hemorrhage is thought to have been caused by extravasation of red blood cells through damaged blood vessels.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
4/16. Replacement of the entire thoracic aorta according to the reversed Elephant Trunk technique.The aim of this work is to present our modified Elephant Trunk technique to reduce circulatory arrest time and consequently mortality and morbidity rates. According to Borst's technique the ascending aorta and aortic arch are replaced first, under deep hypothermic circulatory arrest, while a graft segment is left in the descending thoracic aorta. In the second stage of the operation, the descending thoracic aorta is replaced through left thoracotomy using this graft segment. In our modified technique, after the flexion in the proximal segment of the graft, the descending thoracic aorta is replaced first through left thoracotomy in Bio-Pump protection, choosing the best aortic segment for proximal anastomosis. In the second stage we replace the ascending aorta and the aortic arch using the graft and applying Carrel patch anastamosis only to the epiaortic vessels, under deep hypothermic circulatory arrest. It is our opinion that the mortality incidence of this technique is similar to that obtained with Borst's technique, though certainly inferior to the one stage procedure , while the morbidity results are better than those obtained with the Borst Elephant Trunk technique and with the one stage procedure. In fact there are fewer stroke incidents thanks to the reduced times of deep hypothermic circulatory arrest, and fewer postoperative bleedings and respiratory failures thanks to the reduced times of the total cardiopulmonary bypass. At the beginning we used this technique to replace symptomatic aneurysms, covered ruptures, and hematomas of the wall of the descending thoracic aorta, which required replacement of the descending thoracic aorta first; we later extended the treatment to all types of thoracic aorta aneurysms.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
5/16. "Off-pump" repair of a postangioplasty coronary artery bleed.Following percutaneous multivessel coronary stent implantation with full anticoagulation, a 65-year-old man suffered tamponade and cardiac arrest. After successful resuscitation, he underwent repeat coronary angiography which demonstrated extravasation of contrast from a distal circumflex subbranch. Thereafter, he was transferred to the cardiothoracic surgery unit where the leaking vessel was oversewn using the Medtronic Octopus Retractor for stabilization. This report illustrates the growing wider use of "off-pump" techniques beyond coronary artery bypass grafting. In this case, the patient was exposed to a much shorter procedure with less morbidity than could have been expected had cardiopulmonary bypass been used.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
6/16. Cardiac arrest in a soccer player: a unique case of anomalous coronary origin detected by 16-row multislice computed tomography coronary angiography.Anomalous origin of the coronary arteries may be present in otherwise normal subjects without clinical significance, but can also be the cause of myocardial ischemia and sudden death in both adults and teenagers. In particular, the origin of the left main coronary artery or left anterior descending artery from the right sinus of valsalva or right coronary artery may result in compression of the vessel during or immediately after exercise. We present a unique case of coronary anomaly with four separate coronary ostia originating from the right coronary sinus in a soccer player with sudden cardiac arrest. Multislice contrast-enhanced computed tomography has emerged as a valid noninvasive method for the diagnosis of coronary artery anomaly.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
7/16. Thrombosed arch vessels after cardiac arrest because of pulmonary embolism.An unusual case of thrombus formation in the arch vessels after cardiac arrest because of pulmonary embolism is reported. A 67-year-old woman developed pulmonary embolism that soon led to cardiac arrest. Although percutaneous cardiopulmonary support was started, the blood pressure of her upper extremity was below 20 mm Hg and blood gas analysis showed marked metabolic and respiratory acidosis. Transesophageal echocardiography revealed thrombus in the right pulmonary artery, thrombus with floppy movement in the aortic arch, and 3 arch branch arteries filled with thrombus with little blood flow around it. After thrombolytic therapy, the thrombi gradually shrunk and perfusion in the upper extremities improved. The patient was successfully weaned from percutaneous cardiopulmonary support and was discharged alive. Thrombus formation can occur in the arch branch arteries after cardiac arrest, causing unusual laboratory data. Transesophageal echocardiography is useful for obtaining real-time information in the cardiovascular system at bedside in such a critically ill patient.- - - - - - - - - - ranking = 5keywords = vessel (Clic here for more details about this article) |
8/16. survival after spontaneous coronary artery dissection presenting with ventricular fibrillation arrest.Spontaneous coronary artery dissection (SCAD) is a rarely documented etiology of myocardial infarction and sudden cardiac death (SCD). We present a case of a 37-year-old non-pregnant female who presented with a left anterior descending artery (LAD) dissection complicated by ventricular fibrillation arrest. After early diagnostic catheterization and medical management, our patient experienced a complete recovery, returning to her pre-SCD status without limitation. This case is unique in that the SCAD did not occur in the context of previously described associations. Also, this is only the second reported case of a patient with SCAD who survived documented SCD. Our case suggests that medical management is a reasonable option in patients with single-vessel non-left main/proximal LAD artery SCAD.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
9/16. Intravasation of barium sulphate at barium enema examination.We report a case of venous intravasation of barium sulphate occurring during a routine barium enema examination for investigation of rectal bleeding. The patient suffered a cardiopulmonary arrest, but made a full recovery after organ support in intensive care. review of radiographs from the examination showed intravasated barium in pelvic vessels. We review the literature on this rare, but serious, complication of barium enema examination and suggest measures by which intravasation can be prevented.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
10/16. Acute hyperkalemia risks in recipients of kidney graft cooled with Collins' solution.The authors present the first case of cardiac arrest, occurring at the time of vessel clamps removal, of a kidney transplantation cooled prior to grafting with Collin's solution. Monitoring of cardiac (K) has demonstrated the role of Collin's solution (K = 141 mEq/l) in the genesis of this incident. The mean /- SD increase of the K concentration in the right atrium within the seconds following the removal of the graft vessels clamps was 2.6 /- 1.5 mEq. Acute electrocardiographic abnormalities primarily represented by sudden apparition of hyperkalemic T waves and extrasystols occurs in more than 50% of the cases. The effects of progressive blood release in the graft and other preventive manipulations are studied and discussed.- - - - - - - - - - ranking = 2keywords = vessel (Clic here for more details about this article) |
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