Automated Intra-abdominal Pressure Monitoring During Orthotopic Heart Transplant Leads to Early Diagnosis and Treatment of Intraoperative Abdominal Compartment Syndrome-A Case Report.

We describe a case of spontaneous retroperitoneal hematoma leading to abdominal compartment syndrome and organ failure during a complicated orthotopic heart transplantation in a patient previously on mechanical circulatory support. After the patient had been weaned of cardiopulmonary bypass, the patient suddenly became hemodynamically unstable despite good LV and RV function. While the patient was resuscitated, high intra-abdominal pressures were noted on a novel monitor measuring real-time intra-abdominal pressures and urinary output.

Successful Outcomes following Repair of a Type A Aortic Dissection during Pregnancy.

Type A aortic dissections during pregnancy are rare but lethal events, with reported mortalities as high as 60%. Unique changes in hemodynamics, hormone-related alterations in aortic tissue, and preexisting risk factors place patients at an elevated risk for dissection. We report a successful repair of a Type A aortic dissection at 32 weeks of gestation, with excellent outcomes in both mother and child.

Aortic Root Dilation and Testosterone Use: Are They Associated?

Aortic root dilation and thoracic aortic aneurysms are relatively rare in young and healthy patient populations. However, a number of observed incidental cases regarding young males and testosterone use raises suspicion of a potential risk factor for aortic root dilation. The authors' patient, a healthy 40-year-old man with a significant history of testosterone use who developed a massively dilated aortic root, is sufficiently alarming to report.

Role of Methadone in Extracorporeal Membrane Oxygenation: Two Case Reports.

Extracorporeal membrane oxygenation (ECMO) affects pharmacokinetics/dynamics of drugs in unpredictable ways. Anecdotally, ECMO patients require high doses of opioids and sedatives, leading to concerns of tolerance. Methadone is a long-acting synthetic opioid with antagonist properties at the n-methyl-d-aspartate (NMDA) receptor.

Hemodynamic Consequences of Laparoscopy for Patients on Mechanical Circulatory Support.

Background: Technologic advances and superior survival with mechanical circulatory support (MCS) have led to an expanding population that develops intraabdominal conditions requiring intervention. Whether laparoscopy can be performed without detrimental effects on hemodynamics and device function is not well described.

Materials And Methods: Effects of laparoscopy performed on MCS were retrospectively assessed.

Chylothorax and re-expansion pulmonary edema following myocardial re-vascularization: role of lymph vessel insufficiency.

Chylothorax is a rare complication following coronary artery bypass graft surgery. In the following case, we report a chylothorax complicating left internal mammary artery harvesting due to injury of the left anterior mediastinal lymph node chain (LAMLNC) at the level of the proximal pedicle of the mammary artery. Re-expansion pulmonary edema occurred during re-operation for chylothorax following suturing of this lymph node chain.

A rare inferior middle mediastinal tumor resection under extra-corporeal circulation.

An inferior middle mediastinal mass was observed in a 51-year-old woman initially presenting as pericardial effusion and mimicking lymph node disease. Thoracotomy demonstrated a tumor invading the posterior atrial wall. Complete resection was possible under the extracorporeal circulation.

Cryopreserved aortic viable homograft for active aortic endocarditis.

Background: To evaluate the short and long-term results of cryopreserved aortic viable homograft (CAVH) in the treatment of active aortic endocarditis.

Methods: From January 1992 to December 2002, 104 patients (23 females, 81 males) with a mean age 51 +/- 13 years (from 14 to 77) underwent CAVH replacement for active aortic valve endocarditis. Seventy-six patients (73%) had endocarditis of the native aortic valve, 28 (27%) had endocarditis of prosthetic aortic valve; among them, eight had a recurrent infection.

Fulminant myocarditis in adults and children: bi-ventricular assist device for recovery.

Objective: Fulminant myocarditis (FM) is uncommon and may be followed by a rapidly intractable cardiogenic shock. We report five consecutive patients with FM successfully bridged to recovery with a mechanical paracorporel biventricular assist device (BiVAD).

Methods: Five patients, four adults and one child (mean age 27+/-6 years, range, 5-36 years) underwent implantation from November 1999 to May 2003, for FM.

Cellular cardiomyoplasty: clinical application.

Myocardial regeneration can be induced with the implantation of a variety of myogenic and angiogenic cell types. More than 150 patients have been treated with cellular cardiomyoplasty worldwide, 18 patients have been treated by our group. Cellular cardiomyoplasty seems to reduce the size and fibrosis of infarct scars, limit postischemic remodelling, and restore regional myocardial contractility.

Right ventricular cardiomyoplasty: 10-year follow-up.

Background: Chronically depressed right ventricular (RV) function presents an unsolved therapeutic challenge in cardiac surgery. Despite recent advances in medical and surgical therapies, prognosis remains poor and patient's quality of life and mortality are frequently unacceptable. The aim of this study is to present the first clinical report and long-term results of RV dynamic cardiomyoplasty applied in patients with RV failure caused by isolated RV cardiomyopathies.

Robotic-assisted cardiac surgery: anesthetic and postoperative considerations.

Objective: To assess the feasibility of endoscopic telemanipulated cardiac surgery and describe the anesthetic, postoperative, and surgical implications of minimally invasive robotic-assisted cardiac surgery.

Design: Prospective study.

Setting: Cardiovascular and transplant center, university hospital.

Chylothorax complicating pulmonary resection.

Background: Chylothorax complicating pulmonary resection (CCPR) is infrequent and surgical treatment is for the most part avoided. The purpose of this study is to analyze the clinical and therapeutic characteristics of this complication.

Methods: From March 1981 to June 2001, 26 cases of CCPR (24 men and 2 women; mean age 57 years) were treated in two departments of thoracic surgery.

Cardiomyoplasty: ventricular reconstruction after tumor resection.

Objective: Although cardiac transplantation has been performed for complete removal of ventricular tumors, complete surgical resection with ventricular reconstruction is desirable. Thus patients with benign tumors would probably be cured, and those with malignant tumors would have a better prognosis. In this study extensive and complete surgical resection of ventricular tumors is followed by anatomic and functional ventricular reconstruction with a dynamic cardiomyoplasty procedure.

Prediction of arterial oxygen tension during one-lung ventilation: analysis of preoperative and intraoperative variables.

Objective: To determine whether currently available preoperative and intraoperative variables related to arterial oxygen tension (PaO(2)) can be used as predictors for low PaO(2) during one-lung ventilation (OLV).

Design: A prospective cohort study.

Setting: Primary university hospital.

Triple valve repair for young rheumatic patients.

Background: Facing young foreign polyvalvular rheumatic patients, for which long-term anticoagulation is not available, we have chosen to attempt triple valve repair procedures in order to avoid prosthetic implantation in this particular population suffering from triple valve disease.

Methods: Twenty-one young rheumatic patients (mean age:11+/-4 years) underwent triple valve repair procedures including cusp extension on the aortic valve aortic between September, 1992 and December, 2000. Valvular pathology characteristics according to Carpentier's classification included mitral insufficiency type III post+II ant (n=10), type III post (n=4), type II ant (n=2), mitral stenosis (n=5), type III aortic insufficiency (n=21), type I (n=13) and type III (n=8) tricuspid insufficiency.