Journal of cardiac surgery
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Aortic arch surgery is impossible without the temporary interruption of brain perfusion and therefore is associated with high incidence of neurologic injury. The deep hypothermic circulatory arrest (HCA), in combination with antegrade or retrograde cerebral perfusion (RCP), is a well-established method of brain protection in aortic arch surgery. In this retrospective study, we compare the two methods of brain perfusion. ⋯ The antegrade perfusion seems to be related with significantly lower incidence of temporary neurological complications, earlier extubation, shorter ICU-stay, and hospitalization, and hence lower total cost.
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Acute fulminant myocarditis can cause left ventricular dysfunction that predisposes the patients to critical condition. Left ventricular assist device (LVAD) is a useful option for the patient whose condition is resistant to medical therapy. However, when right ventricular dysfunction with hypoxia is complicated with left ventricular dysfunction, it can be difficult to make a prompt decision in order to achieve better outcome. We present our case in which the support on LVAD and extracorporeal membrane oxygenation (ECMO) was effective to treat critically ill patients.
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Case Reports
Right ventricular failure following heart transplantation--recovery after extended mechanical support.
Early graft failure, particularly right ventricular dysfunction, remains a significant determinant of early morbidity and mortality in heart transplant recipients. If conservative medical management fails to help recover cardiac allograft function, mechanical circulatory support either bridging to recovery or retransplantation remains the last option. We report on a 16-year-old patient with hypertropic nonobstructive cardiomyopathy who was weaned successfully from a right ventricular assist device (RVAD) after extended right ventricular mechanical support for three months following heart transplantation.
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Real-time readings of the regional oxygen saturation (rSO(2)) using near-infrared spectroscopy (NIRS) during the aortic arch surgery can provide an early detection of perfusion or oxygenation abnormalities. ⋯ Continuous monitorization of the cerebral O(2) saturation during aortic arch surgery in adults and infants is a feasible technique to control an adequate cannula positioning and to optimize clinical outcomes avoiding neurological complications related to cerebral malperfusion.