Interactive cardiovascular and thoracic surgery
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Interact Cardiovasc Thorac Surg · Jun 2011
Case ReportsPulseCath(R) as a right ventricular assist device.
The PulseCath(®) is a pulsatile pump that offers a circulatory support up to 3 l/min. The PulseCath(®) is indicated for patients who require a higher degree of support than that offered by the intra-aortic balloon pump. We describe the first two cases of the use of the PulseCath(®) as a temporary support for the right ventricle after insertion through the pulmonary artery trunk. ⋯ In the first patient an irreversible metabolic unbalance, already present prior to PulseCath(®) insertion, led to multi-organ failure and eventually to death. In the second case the early utilization of PulseCath(®) led to a complete recovery of the right ventricle and the patient was discharged in good clinical condition. Besides the technical feasibility, this report would suggest that a correct timing is the key to success for the PulseCath(®) as a right ventricular assist device.
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Interact Cardiovasc Thorac Surg · Jun 2011
Case ReportsA ruptured mature teratoma in which follow-up computed tomography observation at short intervals was useful for a definitive diagnosis.
Rupture of mature mediastinal teratomas occasionally occurs, necessitating prompt surgical treatment. However, the clinical presentation of a ruptured teratoma can resemble that of pneumonia and/or pleuritis. We report a case of mediastinal teratoma rupture, in which follow-up computed tomography (CT) a short-interval after the first CT was useful for definitive diagnosis. ⋯ Eighteen hours later, a repeat CT-revealed an increase in the soft tissue area of the chest wall adjacent to the tumor, which led to the definitive diagnosis of ruptured teratoma, and immediate resection was performed. The histological diagnosis was a mature teratoma, and rupture was confirmed by the high lipase level in the pleural fluid. The patient's postoperative course was uneventful.
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Interact Cardiovasc Thorac Surg · Jun 2011
Case ReportsFirst experience with the ultra compact mobile extracorporeal membrane oxygenation system Cardiohelp in interhospital transport.
In patients with severe cardiopulmonary failure extracorporeal assist devices are to support patients during resuscitation, for transportation, until organ recovery, and as bridge to further therapeutic modalities. We report on our first experience with the new Cardiohelp system for interhospital transfer of cardiopulmonarily compromised patients. The Cardiohelp system was used for transportation and in-house treatment in six male patients with a mean age of 41±17 years. ⋯ A 100% survival was achieved. The portable Cardiohelp system allows location-independent stabilization of cardiopulmonary compromised patients with consecutive interhospital transfer and in-house treatment. The integrated sensors, which register arterial and venous line pressure, blood temperature, hemoglobin as well as SvO(2), greatly alleviate its management and considerably increase safety.
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Interact Cardiovasc Thorac Surg · Jun 2011
Rescue extracorporeal membrane oxygenation in children with refractory cardiac arrest.
We describe our experience with extracorporeal cardiopulmonary resuscitation (CPR) using extracorporeal membrane oxygenation (ECMO) in children with refractory cardiac arrest, and determine predictors for mortality. ECMO support was instituted on 42 children, median age 0.7 years (1 day-17.8 years), median weight 7.05 (range 2.7-80) kg who suffered refractory cardiac arrest (1992-2008). Patients were postcardiotomy (n=27), or had uncorrected congenital heart diseases (n=3), cardiomyopathy (n=3), myocarditis (n=2), respiratory failure (n=3), or had trauma (n=4). ⋯ Age, weight, sex, anatomic diagnosis, etiology (surgical vs. medical) were not significant predictors of poor outcome. Prolonged CPR and high-dose inotropes are significant predictors of mortality. Rescue ECMO support in children with refractory cardiac arrest can achieve acceptable survival and neurological outcomes.