No abstract available.
Circulatory Arrest, Deep Hypothermia Induced ; Thoracic Surgery

No abstract available.
Aneurysm* ; Arteries* ; Cardiopulmonary Bypass* ; Circulatory Arrest, Deep Hypothermia Induced*

To present a case of a patient who will undergo pulmonary embolectomy under deep hypothermic circulatory arrest, to discuss the use of deep hypothermic circulatory arrest, and to elaborate on the various techniques utilized to provide optimum neuroprotection.
Human ; Female ; Middle Aged ; HYPOTHERMIA ; NEUROPROTECTIVE AGENTS ; CIRCULATORY ARREST, DEEP HYPOTHERMIA INDUCED ; HEART ARREST, INDUCED

Transcranial cerebral oximetry has been successfully used in a variety of neurosurgical conditions, primarily those associated with disturbed cerebral circulation. It has been also used in intraoperative monitoring of aortic dissection and surgical procedures performed under deep hypothermia and circulatory arrest. During disending aortic arch exposure, sudden cerebral oxygen saturation change from 63% to 48% was detected. After therapeutic bypass, cerebral oxygen saturation was increased to 65%. During aortic arch repair, deep hypothermic circulatory arrest with retrograde cerebral perfusion was applied for 130 min and cerebral oxygen saturation slowly decreased from 65% to 52%. Patient was discharged from hospital without neurologic complication and cognitive funtion disturbance.
Aorta, Thoracic ; Circulatory Arrest, Deep Hypothermia Induced ; Humans ; Hypothermia ; Monitoring, Intraoperative ; Oximetry ; Oxygen* ; Perfusion

Advances in anesthetic and surgical management, such as deep hypothermic circulatory arrest and temporary clipping, have improved outcomes for intracranial aneurysm patients. However, these techniques are associated with significant risks. We report on two cases in which adenosine administration was used to induce transient periods of cardiac asystole during intracranial aneurysm surgery. This asystole resulted in profound hypotension and collapse of the aneurysm, which facilitated its safe clipping.
Adenosine ; Aneurysm ; Circulatory Arrest, Deep Hypothermia Induced ; Heart Arrest ; Humans ; Hypotension ; Intracranial Aneurysm

Adult ; Circulatory Arrest, Deep Hypothermia Induced ; adverse effects ; Humans ; Male ; Rhabdomyolysis ; diagnosis ; etiology

Giant and complex aneurysm of the posterior circulation can pose several technical challenges with high operative morbidity. Recent advances in cardiac surgery have raised interest in the technique of deep hypothermic circulatory arrest for the management of giant and complex intracranial aneurysms of posterior circulation. The criteria for selecting patients for this procedure can be based on a preoperative analysis of available studies that suggests high risk with standard intervention. Using the technique of deep hypothermic circulatory arrest, we have successfully operated on a case of complex basilar tip aneurysm with MoyaMoya disease resulting in no significant neurological complications. We therefore suggest that patients with giant and complex intracranial aneurysms of posterior circulation might benefit from the use of deep hypothermic circulatory arrest technique.
Aneurysm* ; Cardiopulmonary Bypass ; Circulatory Arrest, Deep Hypothermia Induced* ; Humans ; Intracranial Aneurysm ; Moyamoya Disease* ; Thoracic Surgery

BACKGROUND: Thoracoabdominal aortic replacement is an extensive operation that opens both the pleural cavity and abdominal cavity, which has high mortality and morbidity rate. The authors have reported 9 cases of the thoracoabdominal aortic replacement in 2001. Since 2003 we have applied the deep hypothermic circulatory arrest to the Crawford type I and II thoracoabdominal aortic replacement. Therefore, we analysed the effect of the changes in operative techniques. MATERIAL AND METHOD: Between 1996 and 2005, we have performed 20 cases of thoracoabdominal aortic replacement. The underlying diseases were 8 cases of atherosclerotic aneurysm with 4 cases of ruptured aneurysm and 12 cases of aortic dissection with 10 cases of a previous operations. According to Crawford classification, there were 2 cases of type I, 7 cases of type II, 1 case of type III, 7 cases of type IV, and 3 cases of type V. We compaired the results of the patients who underwent thoracoabdmoninal replacement before 2001 which already has been reported and after then. RESULT: Before 2001 we have performed 9 cases of thoracoabdominal replacement and 5 patients were died of the operation. All three patients with type I and II were died. There was no case of thoracoabdominal replacement between 2001 and 2002, but after 2003 we have performed 11 cases of thoracoabdominal replacement which involved 1 case of type I, 5 cases of type II, 1 case of type III, 2 cases of type IV and 2 cases of type V. There was no mortality and no fetal complications. CONCLUSION: The deep hypothermic circulatory arrest is a safe method of extended thoracoabdominal aortic replacement.
Abdominal Cavity ; Aneurysm ; Aneurysm, Ruptured ; Circulatory Arrest, Deep Hypothermia Induced* ; Classification ; Humans ; Mortality ; Pleural Cavity

BACKGROUNDAntegrade selective cerebral perfusion (ASCP) is regarded to perform cerebral protection during the thoracic aorta surgery as an adjunctive technique to deep hypothermic circulatory arrest (DHCA). However, brain metabolism profile after ASCP has not been systematically investigated by metabolomics technology.

METHODSTo clarify the metabolomics profiling of ASCP, 12 New Zealand white rabbits were randomly assigned into 60 min DHCA with (DHCA+ASCP [DA] group, n = 6) and without ( DHCA [D] group, n = 6) ASCP according to the random number table. ASCP was conducted by cannulation on the right subclavian artery and cross-clamping of the innominate artery. Rabbits were sacrificed 60 min after weaning off cardiopulmonary bypass. The metabolic features of the cerebral cortex were analyzed by a nontargeted metabolic profiling strategy based on gas chromatography-mass spectrometry. Variable importance projection values exceeding 1.0 were selected as potentially changed metabolites, and then Student's t-test was applied to test for statistical significance between the two groups.

RESULTSMetabolic profiling of brain was distinctive significantly between the two groups (Q 2 Y = 0.88 for partial least squares-DA model). In comparing to group D, 62 definable metabolites were varied significantly after ASCP, which were mainly related to amino acid metabolism, carbohydrate metabolism, and lipid metabolism. Kyoto Encyclopedia of Genes and Genomes analysis revealed that metabolic pathways after DHCA with ASCP were mainly involved in the activated glycolytic pathway, subdued anaerobic metabolism, and oxidative stress. In addition, L-kynurenine (P = 0.0019), 5-methoxyindole-3-acetic acid (P = 0.0499), and 5-hydroxyindole-3-acetic acid (P = 0.0495) in tryptophan metabolism pathways were decreased, and citrulline (P = 0.0158) in urea cycle was increased in group DA comparing to group D.

CONCLUSIONSThe present study applied metabolomics analysis to identify the cerebral metabolic profiling in rabbits with ASCP, and the results may shed new lights that cerebral metabolism is better preserved by ASCP compared with DHCA alone.

Giant aneurysms and some basilar aneurysms can cause some problems due to their size and clot formation within them. Recently, profound hypothermia and barbiturate cerebral protection were used for successful surgical treatment of these complex intracranial vascular lesions. We experienced a female patient with a giant anterior aneurysm. After femoral arterial and venous cannulation, cardiopulmonary bypass was performed and the aneurysm was clipped under a state of deep hypothermic circulatory arrest. However, she developed postoperative brain swelling and coma and died due to respiratory failure in ICU.
Aneurysm* ; Brain Edema ; Cardiopulmonary Bypass ; Catheterization ; Cerebral Arteries* ; Circulatory Arrest, Deep Hypothermia Induced ; Coma* ; Female ; Humans ; Hypothermia* ; Respiratory Insufficiency