BACKGROUND: Most surgeons prefer delivering cardioplegia alternatively via the aortic root and coronary sinus in patients undergoing coronary artery bypass graft surgery (CABG). Recently, some surgeons have delivered cardioplegia via the grafted vessel to the obstructed right coronary artery in order to preserve right ventricular function whenever retrograde cardioplegia is delivered. Thus, we have compared the effect on right ventricular preservation between the aforementioned two methods after cardiopulmonary bypass in patients undergoing a right CABG. METHODS: Twenty-eight patients undergoing an elective CABG with significant right coronary artery obstructive disease were allocated into 2 groups. In the alternative cardioplegia delivery group (A-group), cold blood cardioplegia was delivered via the aortic root and coronary sinus alternatively. In the simultaneous cardioplegia delivery group (S-group), cold blood cardioplegia was delivered via the coronary sinus and grafted vessel to the obstructed right coronary artery simultaneously. Hemodynamic measurements were obtained pre-bypass, at pericardial closure and at sternal closure. Data recorded included right ventricular ejection fraction, right ventricular volume index and right and left ventricular hemodynamics. RESULTS: There was no significant difference in the right ventricular ejection fraction between the two groups at pre-bypass, pericardial closure and sternal closure. In both groups, the right ventricular ejection fraction and cardiac index were not decreased, and the left ventricular ejection fraction was higher at pericardial closure than pre-bypass. However, in both groups, there was a decrease in the right andleft ventricular stroke work index and right ventricular stroke volume index at sternal closure. CONCLUSIONS: We have concluded that simultaneous cardioplegia delivery via the coronary sinus and grafted vessel to the obstructed right coronary artery was not superior to the alternative cardioplegia delivery via the aortic root and coronary sinus for preservation of right ventricular function in patients undergoing a right CABG.
Cardiopulmonary Bypass ; Coronary Artery Bypass* ; Coronary Sinus ; Coronary Vessels* ; Heart Arrest, Induced* ; Hemodynamics ; Humans ; Stroke ; Stroke Volume ; Transplants ; Ventricular Function, Right

When pericardial tamponade occurs to the left ventricular assist device (LVAD) implanted patients, typical hemodynamic signs of tamponade such as tachycardia and pulsus paradoxus may be masked by LVAD action. For those with normal heart, anesthetic management during pericardial tamponade operation before drainage is to restrict fluid administration and maintain perfusion pressure with vasopressor are recommended. But the things to concern are different in cases of patient with LVAD. Here, we describe a case of performing anesthesia with LVAD implanted patient for pericardial tamponade operation. A 58-year-old male with HeartWare™ (Medtronic, Framingham, MA, USA) LVAD implant was referred for cardiac tamponade surgery. After the induction of general anesthesia, his mean arterial pressure (MAP) decreased to 38 mmHg with device flow 1.8 L/min and device power 2.4 Watts at pump speed 2,400 RPM. Norepinephrine and Epinephrine infusion were initiated. MAP recovered to 70mmHg with device flow 3.7 L/min and power 3.0 Watts after the drainage of 1,200 cc of pericardial fluid. Cardiac tamponade with LVAD implanted patient present with decreased peak flow, mean flow and decreased pulsatility. LVAD flow depends on pump rotation, preload and afterload. In order to maintain flow in these patients, prevention of preload reduction is important. Since LVAD implantation becoming more popular as Bridge to transplantation and destination therapy, it is important for anesthesiologist to understand the LVAD parameters and factors that affect.
Anesthesia ; Anesthesia, General ; Arterial Pressure ; Cardiac Tamponade ; Drainage ; Epinephrine ; Heart ; Heart-Assist Devices ; Hemodynamics ; Humans ; Male ; Masks ; Middle Aged ; Norepinephrine ; Perfusion ; Pericardial Fluid ; Tachycardia

When pericardial tamponade occurs to the left ventricular assist device (LVAD) implanted patients, typical hemodynamic signs of tamponade such as tachycardia and pulsus paradoxus may be masked by LVAD action. For those with normal heart, anesthetic management during pericardial tamponade operation before drainage is to restrict fluid administration and maintain perfusion pressure with vasopressor are recommended. But the things to concern are different in cases of patient with LVAD. Here, we describe a case of performing anesthesia with LVAD implanted patient for pericardial tamponade operation. A 58-year-old male with HeartWareâ„¢ (Medtronic, Framingham, MA, USA) LVAD implant was referred for cardiac tamponade surgery. After the induction of general anesthesia, his mean arterial pressure (MAP) decreased to 38 mmHg with device flow 1.8 L/min and device power 2.4 Watts at pump speed 2,400 RPM. Norepinephrine and Epinephrine infusion were initiated. MAP recovered to 70mmHg with device flow 3.7 L/min and power 3.0 Watts after the drainage of 1,200 cc of pericardial fluid. Cardiac tamponade with LVAD implanted patient present with decreased peak flow, mean flow and decreased pulsatility. LVAD flow depends on pump rotation, preload and afterload. In order to maintain flow in these patients, prevention of preload reduction is important. Since LVAD implantation becoming more popular as Bridge to transplantation and destination therapy, it is important for anesthesiologist to understand the LVAD parameters and factors that affect.

When pericardial tamponade occurs to the left ventricular assist device (LVAD) implanted patients, typical hemodynamic signs of tamponade such as tachycardia and pulsus paradoxus may be masked by LVAD action. For those with normal heart, anesthetic management during pericardial tamponade operation before drainage is to restrict fluid administration and maintain perfusion pressure with vasopressor are recommended. But the things to concern are different in cases of patient with LVAD. Here, we describe a case of performing anesthesia with LVAD implanted patient for pericardial tamponade operation. A 58-year-old male with HeartWareâ„¢ (Medtronic, Framingham, MA, USA) LVAD implant was referred for cardiac tamponade surgery. After the induction of general anesthesia, his mean arterial pressure (MAP) decreased to 38 mmHg with device flow 1.8 L/min and device power 2.4 Watts at pump speed 2,400 RPM. Norepinephrine and Epinephrine infusion were initiated. MAP recovered to 70mmHg with device flow 3.7 L/min and power 3.0 Watts after the drainage of 1,200 cc of pericardial fluid. Cardiac tamponade with LVAD implanted patient present with decreased peak flow, mean flow and decreased pulsatility. LVAD flow depends on pump rotation, preload and afterload. In order to maintain flow in these patients, prevention of preload reduction is important. Since LVAD implantation becoming more popular as Bridge to transplantation and destination therapy, it is important for anesthesiologist to understand the LVAD parameters and factors that affect.

OBJECTIVE: A dichotomous Thl and Th2 cytokine profile has been associated with reproductive failure and success, respectively. The purpose of our study was to determine the levels of Thl cytokine (IFN- y ) secreted by peripheral blood mononuclear cells (PBMCs) form women with unexplained recurrentabortion (URA) and fertile controls in response to trophoblast antigen. METHODS: PBMCs were isolated from 30 nonpregnant women with URA and from 10 nonpregnant fertile controls. Following 4 days of culture (1 * 10(6) cells/mL) with and without a protein extract derived from a trophoblast cell line (30 ug/mL, protein). None of the women had allergies, atopy or recent infection. Cytokines were measured in supernatants with enzyme-linked immunosorbent assay (ELISA) kits. IFN- r kit was obtained from BOISOURCE (lower limit of sensitivity, 15.6 pg/mL for IFN- r ). All values below the lowest limit of sensitivity as determined by test kit standards were considered negative. The cytokine stimulation test is considered positive if the IFN- r concentration increases by 200% or more with the trophoblast antigen stimulation. Datas are presented as mean+ SEM. Nonparametric testing (Mann-Whitney U) was used for analysis with P<0.05 considered statistically significant. RESULTS: The Thl-type cytokine (IFN- r ) was detected in 20(67%) of 30 supernatants from women with URA. In contrast, 2 (20%) of trophoblast-activated PBMC culture supernatants from the 10 parus women with normal reproductive histories was detected IFN- r and but were significantly lower than levels in women with URA who had secreted IFN- r upon trophoblast stimulation (99.80+ 18.17 pg/mL versus 166.47 + 36.96 pg/mL, p<0.05). Spontaneous secretion of IFN- r was significantly higher in culture supernatants from women with URA than in supernatants from women with successful reproductive histories (41.36.09+6.99 pg/mL versus 25.89+9.34 pg/mL, p<0.05). CONCLUSION: These data indicate that there are significant differences between women with URA and women with normal reproductive histories in their regulation of the Thl-cytokine (IFN- r) in response to trophoblast. Thl-type immunity to trophoblast is associated with URA and may play a role in reproductive failure.
Abortion, Spontaneous* ; Cell Line ; Cytokines ; Enzyme-Linked Immunosorbent Assay ; Female ; Humans ; Hypersensitivity ; Pregnancy ; Reproductive History ; Trophoblasts*

Aortic dissection in pregnant patients results in an inpatient mortality rate of 8.6%. Owing to the pronounced mortality rate and speed at which aortic dissections progress, efficient early detection methods are crucial. Here, we highlight the importance of early chest computed tomography (CT) for differentiating aortic dissection from pulmonary embolism in pregnant patients with dyspnea. We present the unique case of a 38-year-old pregnant woman with elevated D-dimer and N-terminal pro-brain natriuretic peptide (NT-proBNP) levels, initially suspected of having a pulmonary embolism. Initial transthoracic echocardiography did not indicate aortic dissection. Surprisingly, after an emergency cesarean section, a chest CT scan revealed a DeBakey type I aortic dissection, indicating a diagnostic error. Our findings emphasize the need for early chest CT in pregnant patients with dyspnea and elevated D-dimer and NT-proBNP levels. This case report highlights the critical importance of considering both aortic dissection and pulmonary embolism in the differential diagnosis of such cases, which will inform future clinical practice.

BACKGROUND: The mechanisms of pulmonary hypertension(PHT) are usually quite different in acquired disorders of the left side of the heart from those of congenital heart disease. Accordingly, this study was designed to compare pulmonary hemodynamics immediately after cardiopulmonary bypass(CPB) in patients with undergoing repair of atrial(ASD) or ventricular septal defect(VSD) and mitral valve replacement(MVR). METHODS: 49 patients with PHT defined as a resting systolic pulmonary arterial pressure(SPAP) greater than 35 mmHg were studied and were divided preoperatively into two groups; repair of ASD or VSD(Group I, n=18) and MVR(Group II, n=31). Measurements were made after sternotomy and prior to initiation of CPB and upon stabilization following discontinuation of CPB. RESULTS: In group I, SPAP, DPAP and MPAP decreased by 44%, 22% and 35% respectively and pulmonary vascular resistance index(PVRI) decreased by 47% after CPB. In group II, SPAP, DPAP and MPAP revealed 25%, 32% and 29% reduction respectively and PVRI decrease by 39% after CPB. SPAP decreased more significantly after CPB in group I(44% vs 25%, p<0.05). CI increased significantly in group II while decreased in group I. Intraoperative inotropes and vasodilators were used more in group II than in group I(24/31 vs 6/18). CONCLUSIONS: The successful replacement of the valve and patch repair of defect may reduce both PAP and PVRI moderately in patients with PHT.
Heart ; Heart Defects, Congenital ; Heart Septal Defects, Ventricular* ; Hemodynamics* ; Humans ; Hypertension, Pulmonary* ; Mitral Valve* ; Sternotomy ; Vascular Resistance ; Vasodilator Agents

BACKGROUND: Hemodynamic monitoring during aortic valve replacement in patients with aortic stenosis is controversial and there are little prospective data on which to base an enlightened clinical decision. The relationship between central venous pressure (CVP) and pulmonary capillary wedge pressure (PCWP) was examined in patients with aortic stenosis. METHODS: 30 patients with aortic stenosis who underwent aortic valve replacement were examined. For each patient, simultaneous measurements of CVP, pulmonary artery diastolic pressure (PADP) and PCWP were made at pre-and post-cardiopulmonary bypass. After cardiopulmonary bypass, measurement of left atrial pressure(LAP) was made. RESULTS: The PCWP correlated well with PADP(r=0.86 p<0.01, r=0.79 p<0.01) and LAP (r=0.89 p<0.01) at pre- and post-bypass. The CVP did not correlate with PADP(r=0.22 p>0.05, r=0.45 p>0.05), PCWP(r=0.39 p<0.01, r=0.53 p<0.01) and LAP(r=0.53 p<0.05) at pre- and post-bypass. The changes in CVP and PCWP also correlated poorly at pre- and post-bypass (r=0.16 p>0.05, r=0.51 p<0.05). CONCLUSIONS: This study confirmed the disparities between CVP and PCWP which were anticipated in aortic stenosis. This disparity seems due to marked differences between either compliance or function of the two ventricles. Therefore, CVP monitoring in aortic stenosis is limited value and may mislead in management.
Aortic Valve ; Aortic Valve Stenosis* ; Blood Pressure ; Cardiopulmonary Bypass ; Central Venous Pressure* ; Compliance ; Heart ; Hemodynamics ; Humans ; Pulmonary Artery ; Pulmonary Wedge Pressure*

BACKGROUND: It has been known that a reversal of usual relationship between aortic and radial artery pressures(RAP) can occur in adult patients following cardiopulmonary bypass(CPB). The phenomenon of a pressure gradient between RAP and femoral artery pressure(FAP) were evaluated in pediatric patients before and after CPB. METHODS: 141 perdiatric patients undergoing open heart surgery were allocated into 2 groups. Group 1(n=77): infant's body weight was below 10kg. Group 2(n=64): child's body weight was between 10 and 20kg. After induction of anesthesia RAP was measured through 22G(1 inch) or 24G(3/4 inch) catheters and FAP was measured through 20G(2 inch) or 22G(1 inch) catheters using calibrated transducers. Hematocrit, rectal and nasopharyngeal temperature and left atrial pressure(LAP) were recorded 10 min after induction, immediately, l5, 30 and 60 min after CPB. Values are expressed as mean+/-SD and analysed using paired and unpaired t-test; p<0.05 was considered significant. RESULT: Systolic femoral arterial pressure(SFAP) was higher than radial arterial pressure(SRAP) before CPB in both groups. After CPB, the pressure gradient persisted in group 2 but was reversed with statistical significance in group l. CONCLUSION: When hypotension occurs during cardiac surgery, a comparison is recommended between radial and femoral or aortic pressure before treatment for hypotension is contemplated.
Adult ; Anesthesia ; Arterial Pressure* ; Blood Pressure ; Body Weight ; Catheters ; Femoral Artery ; Heart* ; Hematocrit ; Humans ; Hypotension ; Radial Artery ; Thoracic Surgery* ; Transducers

BACKGROUND: Amrinone is a noncatecholamine, nonglycoside agent with both inotropic and vasodilatory properties and therefore seems suitable for therapy of right ventricular(RV) dysfunction. The effects of amrinone on systemic and pulmonary hemodynamics in patients with secondary pulmonary hypertension were evaluated. METHODS: With IRB(Institutional Review Board) approval, 21 patients with pulmonary hypertension whose mean pulmonary arterial pressure(mPAP) was greater than 30 mmHg consented to participate in this prospective study. After the sternotomy under the steady state of anesthesia with fentanyl and low concentration of isoflurane, hemodynamic variables including heart rate, systemic arterial pressure(SAP), PAP, cardiac output were measured as control values. Patients recieved an initial bolus dose(1.0 mg/kg) of amrinone followed by a continuous infusion(7.5 mcq/kg/min) for 30 minutes. Hemodynamic variables were measured at 10 minutes and 30 minutes after the start of the continuous infusion. RESULTS: Amrinone reduced SAP and PAP and vascular resistance without tarchycardia. There was no significant change of cardiac output. Ratio of mPAP to mean SAP was decreased after the administration of amrinone. CONCLUSIONS: In cases of chronic RV failure with pulmonary hypertension, amrinone is especially useful because it improve cardiac performance without tarchycardia and reduce RV afterload. Indeed in this study, the fact that amrinone decreased SAP and systemic vascular resistance but reduced PAP and pulmonary vascular resistsnce more significantly(p<0.01) was revealed.
Amrinone* ; Anesthesia ; Blood Pressure ; Cardiac Output ; Fentanyl ; Heart Rate ; Hemodynamics* ; Humans ; Hypertension ; Hypertension, Pulmonary* ; Isoflurane ; Prospective Studies ; Sternotomy ; Vascular Resistance