The Precision of Pulmonary Artery Catheter Bolus Thermodilution Cardiac Output Measurements Varies With the Clinical Situation.

Objective: To investigate the effects of ventilatory mode, injectate temperature, and clinical situation on the precision of cardiac output measurements.

Design: Randomized, prospective observational study.

Setting: Single university hospital.

[Non-cardiac surgery in patients with cardiac disease].

Background: Patients with cardiac disease have a higher incidence of cardiovascular events after non-cardiac surgery than those without such disease. This paper provides an overview of perioperative examinations and treatment.

Material And Methods: Own experience and systematic literature search through work with European guidelines constitute the basis for recommendations given in this article.

[A young woman with cardiac arrest].

A 20-year-old woman presented with dyspnoea in the Emergency department and subsequently suffered a cardiac arrest. The initial rhythm was PEA (pulseless electrical activity). She had intermittent return of spontaneous circulation.

Transcutaneous aortic valve implantation: recent advances and future.

Purpose Of Review: To present recent experiences and studies on transcutaneous aortic valves implantation for severe aortic stenosis in elderly patients with high-risk profile.

Recent Findings: The surgical implantation of aortic valves is a highly efficient and safe procedure but some patients with a high-risk profile are denied surgery. Transcutaneous implantation of aortic valves has evolved as an alternative.

Prophylactic treatment with levosimendan: a retrospective matched-control study of patients with reduced left ventricular function.

Objective: Levosimendan is a calcium-sensitising inotropic agent and a vasodilator used in the treatment of heart failure. Post-cardiotomy cardiac failure is more common in patients with a low preoperative left ventricular ejection fraction (LVEF). We aim at investigating how prophylactic treatment with levosimendan before weaning from cardiopulmonary bypass (CPB) affects postoperative haemodynamics and outcome in patients with low preoperative LVEF.

[A 76-year-old man with a murmur after myocardial infarction].

A 76-year-old, previously healthy man who presented with acute onset of central chest pain is described. An ECG taken in the ambulance showed ST-elevation in chest leads V1 to V4, whereupon thrombolysis was initiated before hospitalization. A new ECG taken on admission at the local hospital showed reduced ST-elevation.

Early mobilization after aortic valve surgery.

In recent years, the focus in peri-operative care of cardiac patients has shifted from trying to create a stress-free environment to hasten the recovery of patients by providing early extubation, early mobilization, and enteral nutrition. Fast-track cardiac surgery has therefore made a paradigm shift in postoperative care. However, evidence on the safety of early postoperative mobilization in high-risk groups like aortic valve replacement surgery is lacking.

The marked reduction in mixed venous oxygen saturation during early mobilization after cardiac surgery: the effect of posture or exercise?

Early mobilization after cardiac surgery induces a marked reduction in mixed venous oxygen saturation (Svo2). Using pulmonary artery catheters and indirect calorimetry, we investigated the effects of exercise and postural change on cardiac index (CI) and Svo2 before and on the first morning after coronary artery bypass surgery. Sixteen patients with an ejection fraction >0.

Post-operative myocardial dysfunction does not affect the physiological response to early mobilization after coronary artery bypass grafting.

Background: An acute increase in oxygen demand can be compensated for either by increased cardiac index (CI) or increased oxygen extraction, resulting in reduced mixed venous oxygen saturation (SvO2). We tested the hypothesis that post-operative cardiac dysfunction may explain why oxygen extraction alone is increased during early mobilization after cardiac surgery.

Methods: Twenty patients with a pre-operative ejection fraction > 50% were included in an open prospective observational study comparing the changes in SvO2 and hemodynamics during mobilizations immediately prior to surgery and on the first post-operative morning.

Mixed venous oxygen desaturation during early mobilization after coronary artery bypass surgery.

Background: Early postoperative mobilization induces a marked reduction in mixed venous oxygen saturation (S(v)O(2)) after aortic valve replacement. We investigated whether a similar desaturation occurs among coronary artery bypass grafting (CABG) patients, and if the desaturation was related to the preoperative ejection fraction (EF).

Methods: Thirty-one CABG patients with a wide range in EF were included in an open observational study.

Marked mixed venous desaturation during early mobilization after aortic valve surgery.

Unlabelled: We investigated the physiological reaction to mobilization the first and second day after aortic valve replacement in an open, prospective study. Hemodynamic and oxygenation variables were recorded in 15 patients using a pulmonary artery oximetry catheter and bench oximetry. Serious intraoperative events occurred in 3 patients, but all patients began mobilization on the first postoperative day and mobilization was accomplished without clinical problems.

Markers for endothelial activation during open heart surgery.

Background: Reliable markers for endothelial activation are needed when studying biocompatibility of cardiopulmonary bypass.

Methods: Blood samples from 21 patients undergoing combined valve and coronary artery bypass surgery were collected before anesthesia (T1), after re-transfusion of blood from the heart-lung machine (T2), and on the first postoperative morning (T3). Concentrations of soluble markers were determined using sandwich enzyme-linked immunoadsorbent assay for sICAM-1, sVCAM-1, and sE-selectin.

Guiding surgical cannulation of the inferior vena cava with transesophageal echocardiography.

Unlabelled: We studied 150 adult cardiac surgery patients to assess visualization of the venous cannula and the venous system by intraoperative transesophageal echocardiography and to register the incidence of cannulation of hepatic veins. The quality of images, the dimensions of the venous system, the position of the venous cannula, and the adequacy of venous return were registered. Acceptable image quality of the inferior vena cava and the right hepatic vein (RHV) was obtained in 95% and 87% of cases, respectively.

Inflammatory response after open heart surgery: release of heat-shock protein 70 and signaling through toll-like receptor-4.

Background: Coronary artery bypass grafting with the use of cardiopulmonary bypass is known to mediate an inflammatory response. The stress-inducible heat-shock protein (HSP) 70 has been detected in myocardial cells after CABG, and toll-like receptors (TLRs) are suggested as putative signaling receptors for the HSPs, mediating synthesis of inflammatory cytokines. The main aims of our study were to explore the release of HSP70 and the regulation of monocyte TLR-2 and TLR-4 expression after CABG.

Beta-adrenergic signalling and threshold adrenaline concentration for induction of fibrillation in the perfused heart pretreated with antihypertensive drugs.

Recent investigations have shown that antihypertensive drug treatment leads to enhanced myocardial beta-adrenoceptor sensitivity. This study was therefore conducted to establish whether or not such hypersensitivity might trigger myocardial arrhythmia subsequent to adrenaline exposure. Adult male Wistar rats (n = 6 per group) were treated with either placebo (vehicle), metoprolol (2.

Is atrial fibrillation caused by extracorporeal circulation?

Background: Atrial fibrillation is the most common rhythm disturbance encountered after open heart operations, with a reported incidence up to 40%. Despite its high incidence and clinical relevance its etiology remains obscure. It has been hypothesized that atrial fibrillation might be related to extracorporeal circulation.