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Successful treatment of complete traumatic transection of the suprahepatic inferior vena cava with veno-venous and cardiopulmonary bypass with hypothermic circulatory arrest

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Hepatobiliary & Pancreatic Diseases International 2021年第6期20卷 601-610页

作者： Paulo N.Martins Julianna E.Buchwald Babak Movahedi Ulises Torres Timothy Emhoff Jennifer Walker Michael G.DeBusk Adel Bozorgzadeh Department of Surgery Division of TransplantationUniversity of MassachusettsWorcesterMA 01655USA Department of Surgery Division of TraumaUniversity of MassachusettsWorcesterMA 01655USA Department of Surgery Division of Cardiac SurgeryUniversity of MassachusettsWorcesterMA 01655USA

To the Editor:Complete traumatic transection of the suprahepatic inferior vena cava(IVC)has almost invariably a fatal *** are very few cases in the literature of patients that survived this type of *** we presented a case that was approached multidisciplinary(trauma surgeon,liver transplant surgeon,perfusionist,anesthesiologist,and cardiac surgeon)with a successful outcome including early recovery of all body functions and quality of life.

关键词： traumatic hepatic bypass

What is the real practice of exercise echocardiographic testing in asymptomatic patients with severe aortic stenosis？

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Chinese Medical Journal 2013年第24期126卷 4649-4654页

作者： Eun Jeong Cho Sung-Ji Park Jung-Eun Song Seol-Hwa Kim Yung-Joo Lee Ji-Hye Gakt Sung-A Chang Sang-Chol Lee Seung Woo Park division of Cardiology Department of Internal MedicineCardiovascular Imaging Center Cardiac and Vascular CenterSamsung Medical Center Sungkyunkwan University School ofMedicine Seoul Republic of Korea

Background Although exercise testing has been suggested to help predict clinical outcome, limited data are available to guide how exercise Doppler echocardiography （ECG） can be used clinically in asymptomatic patients with aortic stenosis （AS）. The aim of this study was to assess the clinical value of exercise echocardiographic testing in asymptomatic patients with severe AS. Methods Symptom-limited treadmill exercise testing using the modified Bruce protocol was performed in 31 asymptomatic patients （mean age （62＋11） years） with severe AS （aortic valve area 〈1 cm2, peak aortic velocity （AV Vmax）〉4 m/sec, or a mean transaortic pressure gradient （AV mean PG）〉40 mmHg （1 mmHg=0.133 kPa）） with normal left ventricular （LV） systolic function （LV ejection fraction （EF）〉50%）. Clinical symptoms, vital signs, ECG, and Doppler hemodynamics were obtained during and/or immediately after exercise. Results Aortic valve replacement （AVR） was performed in 18 patients during follow-up. The patients who had AVR exhibited higher baseline AV mean PG （51 （35-84） vs. 44 （25.2-57.0） mmHg; P=0.031）. There were no significant differences between the AVR group and non-AVR group including exercise duration （7.47 （2.32-11.59） vs. 7.25 （4.06- 10.52） minutes, P=0.917）, exercise capacity （10.1 （4.6-12.8） vs. 10.1 （7.0-12.8） metabolic equivalents, P=0.675）, and an increment in AV mean PG by exercise （18.5 （3.2-48.0） vs. 12.6 （4.4-32.1） mmHg, P=0.366）. Univariate regression analysis revealed that independent determinant of AVR was the baseline AV mean PG （P=-0.031）. Conclusions Although additional value of exercise ECG was demonstrated, baseline transaortic mean pressure gradient is the major determinant of AVR. Further large-scale prospective studies are required to determine whether surgery should be recommended in the presence of an abnormal exercise ECG in asymptomatic severe AS.

关键词： aortic stenosis exercise echocardiography asymptomatic, aortic valve replacement

Diagnostic challenges from conflicting results of tests and imaging

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World Journal of Clinical Cases 2024年第24期12卷 5448-5451页

作者： Run Yu division of Endocrinology Diabetesand MetabolismUCLA David Geffen School of MedicineLos AngelesCA 90095United States

Accurate diagnosis is the foundation of clinical care but accurate diagnosis is not easily reached in some *** rare instances,even a sophisticated multidisciplinary team at an academic medical center cannot reliably reach an accurate diagnosis after extensive testing and imaging,and has to wait until histological diagnosis or even autopsy results are *** underlying reason of challenging diagnoses is mostly conflicting data from history,tests,and imaging that point to different *** this issue of World Journal of Clinical Cases,Huffaker et al reported such a challenging case of a tricuspid mass in a patient with Li-Fraumeni *** case by Huffaker et al powerfully illustrates the occasional diagnostic challenges inherent in our current diagnostic approach and the current *** should realize that in rare situations,agnosticism in diagnosis is unavoidable but a treatment has to be initiated so long as the principle of primum non nocere is upheld.

关键词： Li-Fraumeni syndrome cardiac mass Thrombus Challenging diagnosis Histological diagnosis False positive results

Health behavior outcomes in stroke survivors prescribed wearables for atrial fibrillation detection stratified by age

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Journal of Geriatric Cardiology 2024年第3期21卷 323-330页

作者： Joanne Mathew Jordy Mehawej Ziyue Wang Taylor Orwig Eric Ding Andreas Filippaios Syed Naeem Edith Mensah Otabil Alex Hamel Kamran Noorishirazi IrinaRadu Jane Saczynski David D.McManus Khanh-Van Tran division of Cardiovascular Medicine Department of MedicineUniversity of Massachusetts Chan Medical SchoolLake Avenue NorthWorcesterUSA Department of Internal Medicine Central Michigan UniversityMount PleasantUSA Department of Pharmacy and Health Systems Sciences School of PharmacyNortheastern UniversityBostonUSA Department of Population and Quantitative Health Sciences University of Massachusetts Chan Medical SchoolLake Avenue NorthWorcesterUSA

BACKGROUND Smartwatches have become readily accessible tools for detecting atrial fibrillation(AF).There remains limited data on how they affect psychosocial outcomes and engagement in older *** examine the health behavior outcomes of stroke survivors prescribed smartwatches for AF detection stratified by *** We analyzed data from the Pulsewatch study,a randomized controlled trial that enrolled patients(≥50 years)with a history of stroke or transient ischemic attack and CHA2DS2-VASc≥*** participants were equipped with a cardiac patch monitor and a smartwatch-app dyad,while control participants wore the cardiac patch monitor for up to 44 *** evaluated health behavior parameters using standardized tools,including the Consumer Health Activation Index,the Generalized Anxiety Disorder questionnaire,the 12-Item Short Form Health Survey,and wear time of participants categorized into three age groups:Group 1(ages 50-60),Group 2(ages 61-69),and Group 3(ages 70-87).We performed statistical analysis using a mixedeffects repeated measures linear regression model to examine differences amongst age *** Comparative analysis between Groups 1,2 and 3 revealed no significant differences in anxiety,patient activation,perception of physical health and wear *** use of smartwatch technology was associated with a decrease in perception of mental health for Group 2 compared to Group 1(β=-3.29,P=0.046).CONCLUSION Stroke survivors demonstrated a willingness to use smartwatches for AF ***,among these study participants,the majority did not experience negative health behavior outcomes or decreased engagement as age increased.

关键词： prescribed stratified wear

Efficacy of High Dose Tranexamic Acid in Decreasing Bleeding after cardiac Surgery for Cyanotic Congenital Heart Disease in Children Less than Ten Kilo Body Weight

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World Journal of Cardiovascular Surgery 2018年第5期8卷 93-102页

作者： Saranya Vishnumathy Sampathkumar Vijayakumar Raju Soundaravalli Balakrishnan Saigopalakrishnan Mandhira Moorthy Anandhi Arul Kalyana Sundaram Muthuswamy Muralidharan Srinivasan division of cardiac anesthesia G. Kuppusamy Naidu Memorial Hospital Coimbatore India Pediatric cardiac Surgery G. Kuppusamy Naidu Memorial Hospital Coimbatore India Pediatric Cardiology G. Kuppusamy Naidu Memorial Hospital Coimbatore India

Background: To determine the effect of high dose tranexamic acid in decreasing immediate postoperative bleeding in children less than ten kilo body weight after complex cardiac surgery and also to evaluate the safety of high dose in small children. Methods: Between January-December 2015, 25 children weighing less than ten kilogram body weight underwent complex cardiac surgery for cyanotic congenital heart disease. All children were given dose of 100 mg/kg tranexamic acid at the time of anaesthetic induction and also 100 mg/kg into the CPB prime. The Median age and weight was 80 days (3 - 365) and 4.69 kg (2.4 - 7.8) respectively. The Median preoperative Hb was 10 g/dl (9.6 - 19.5 g/dl). cardiac surgery included total intracardiac repair for TOF in 10 pts (40%), TAPVC repair in 6 (24%), arterial switch operation in 6 pts (24%), BD glenn in 1, repair of DORV with VSD in 1 and VSD closure with scimitar vein reimplantation in 1 pt. Median CPB time was 127 minutes (97 - 343) and cross clamp time was 99 (67 - 200) minutes. Moderate to deep hypothermia was maintained in all with median temperature of 24°C (18 - 32). Three children (12%) had elective open chest in view of anticipated bleeding. Results: The Median postoperative drainage was 127 ml, (range 10 - 1250 ml). The median postoperative use of whole blood was 95 ml (range 10 - 275), packed cell was 187 ml (range 50 - 400 ml), frozen plasma was 88 ml (range 30 - 170), platelet concentrate was 57 ml, (range 10 - 100 ml) and cryoprecipitate was median 47.5 ml, (range 30 - 80 ml). No neurological dysfunction and renal dysfunction has been observed in any of the pts. Out of 4 mortalities (16%), only one was attributed to bleeding (4%) due to usage of ECMO. No late neurological or renal dysfunction has been observed in remaining 21 pts on follow up. Conclusion: High dose Tranexamic acid can be safely used in small children during complex cardiac surgery with significant reduction in postoperative bleeding and blood product

关键词： Pediatric cardiac Surgery Bleeding Antifibrinolytics Tranexamic Acid Renal Dysfunction Neurological Dysfunction

Secondary cardiovascular prevention in older adults： an evidence based review

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Journal of Geriatric Cardiology 2015年第5期12卷 459-464页

作者： Abdulla A Damluji Archana Ramlreddy Lynda Otalvaro Daniel E Forman Cardiovascular division and Elaine and Sydney Sussman cardiac Catheterization Laboratory University of Miami Miller School of Medicine MiamL FL USA Geriatric Cardiology Section University of Pittsburgh Medical Center Pittsburgh PA USA

1 BackgroundIn the United States, life expectancy is rising, particularly among the older population （〉 65 years）, with projected estimates approaching 20% by year 2050. Despite improved survival estimates, cardiovascular diseases remain the leading cause of morbidity and mortality resulting in substantial increase in health care cost. For younger adults, the evidence for secondary cardiovascular prevention is well established and corroborated by robust data. However, the application of risk reduction strategies in older populations remains an area of active debate. Many assume that vulnerability to chronic cardiovascular diseases is an inexorable part of aging such that the risks attributable to prevention outweigh potential benefits.

关键词： Cardiovascular disease Cardiovascular prevention Dyslipidemia Diabetes mellitus The elderly

Past and present of cardiocirculatory assist devices: a comprehensive critical review

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Journal of Geriatric Cardiology 2012年第4期9卷 389-400页

作者： Gianluca Rigatelli Francesco Santini Giuseppe Faggian Section of Adult Congenital Heart Disease Cardiovascular Diagnosis and Endoluminal Interventions Rovigo General Hospital Viale Tre Martiri 45100 Rovigo Italy division of cardiac Surgery University of Verona Medical School Verona Italy

During the last 20 years, the management of heart failure has significantly improved by means of new pharmacotherapies, more timely invasive treatments and device assisted therapies. Indeed, advances in mechanical support, namely with the development of more efficient left ventricular assist devices (LVADs), and the total artificial heart have reduced mortality and morbidity in patients awaiting transplantation, so much so, that LVADs are now approved of as a strategy for destination therapy. In this review, the authors describe in detail the current basic indications, functioning modalities, main limitations of surgical LAVDs, total artificial heart development, and percutaneous assist devices, trying to clarify this complex, but fascinating topic.

关键词： cardiac surgery Cardiocirculatory support Devices Heart failure Heart transplant

Percutaneous coronary intervention in the elderly:a growing need for a growing population

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老年心脏病学杂志：英文版 2005年第1期2卷 3-9页

作者： Samuel J.Shubrooks cardiac Catheterization Laboratory Cardiovascular division Beth Israel Deaconess Medical CenterBoston 02215USA Jr.

Persons aged 80 and above are the fastest growing age group in the United States population, having increased 50% since 1990 and predicted to grow another 25% by 2020.

关键词： PCI Percutaneous coronary intervention in the elderly CABG than

Atrial fibrillation:Is ablation the way of the future?

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Journal of Geriatric Cardiology 2004年第1期1卷 8-11页

作者： Brian Olshansky division of cardiac Electrophysiology University of Iowa Hospital200 Hawkins DriveIowa CityIA 52242USA

This issue of the Journal of Geriatric Cardiology features a manuscript entitled "A three-pulmonary vein isolation approach to treat paroxysmal atrial fibrillation".Dr. Lexin Wang addresses an important issue, and is ... 详细信息

关键词： Atrial fibrillation 田月