Direct thrombin inhibitors directly bind to active sites on thrombin and exert their anticoagulant effect. Bivalirudin is used an alternative in cases of heparin-induced thrombocytopenia, heparin resistance, anaphylactic reaction to UFH, or anti-thrombin III deficiency. Here, we report a case of a 31-year-old female patient, diagnosed with recurrent chronic thromboembolic pulmonary hypertension posted for redo pulmonary thromboendarterectomy. Monitoring anticoagulation during bivalirudin therapy is sometimes confounding and challenging. Prolongation of CT on INTEM and HEPTEM has shown moderate to strong correlation with traditional laboratory tests like aPTT and HPTT (aPTT with Hepzyme). ROTEM can be a way forward for monitoring bivalirudin therapy.
{"title":"ROTEM and Bivalirudin: The Confounding Challenges Ahead","authors":"O. Mujahid, P. Kapoor","doi":"10.25259/mm_jccc_299","DOIUrl":"https://doi.org/10.25259/mm_jccc_299","url":null,"abstract":"Direct thrombin inhibitors directly bind to active sites on thrombin and exert their anticoagulant effect. Bivalirudin is used an alternative in cases of heparin-induced thrombocytopenia, heparin resistance, anaphylactic reaction to UFH, or anti-thrombin III deficiency. Here, we report a case of a 31-year-old female patient, diagnosed with recurrent chronic thromboembolic pulmonary hypertension posted for redo pulmonary thromboendarterectomy. Monitoring anticoagulation during bivalirudin therapy is sometimes confounding and challenging. Prolongation of CT on INTEM and HEPTEM has shown moderate to strong correlation with traditional laboratory tests like aPTT and HPTT (aPTT with Hepzyme). ROTEM can be a way forward for monitoring bivalirudin therapy.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"189 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72664403","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
suPAR is a promising biomarker of cardiovascular diseases, as it reflects “low-grade inflammation” and is associated with lifestyle factors such as smoking, alcohol, and an inactive lifestyle. suPAR is expressed in various cells involved in the development of atherosclerosis, including macrophages, endothelial cells, and smooth muscle cells, and an accumulation of suPAR in the atheroma has also been found. suPAR plays a role in the coagulation cascade during plasminogen activation and fibrinolysis. This abstract provides description of three case series showing the utility of suPAR as a risk prediction biomarker on VA extracorporeal membrane oxygenation (ECMO). We used SUPAR in 15 patients undergoing cardiac surgery of which three went on VA ECMO. Herein, we describe in detail three such patients and discuss each with good review of the literature.
{"title":"suPAR as a risk Prediction Biomarker in Extracorporeal Membrane Oxygenation","authors":"P. Kapoor, M. Prakash, O. Mujahid","doi":"10.25259/jccc_5_2023","DOIUrl":"https://doi.org/10.25259/jccc_5_2023","url":null,"abstract":"suPAR is a promising biomarker of cardiovascular diseases, as it reflects “low-grade inflammation” and is associated with lifestyle factors such as smoking, alcohol, and an inactive lifestyle. suPAR is expressed in various cells involved in the development of atherosclerosis, including macrophages, endothelial cells, and smooth muscle cells, and an accumulation of suPAR in the atheroma has also been found. suPAR plays a role in the coagulation cascade during plasminogen activation and fibrinolysis. This abstract provides description of three case series showing the utility of suPAR as a risk prediction biomarker on VA extracorporeal membrane oxygenation (ECMO). We used SUPAR in 15 patients undergoing cardiac surgery of which three went on VA ECMO. Herein, we describe in detail three such patients and discuss each with good review of the literature.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"5 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88587397","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"A New Journey Begins","authors":"P. Kapoor","doi":"10.25259/jccc_1_2023","DOIUrl":"https://doi.org/10.25259/jccc_1_2023","url":null,"abstract":"","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"85530022","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"ECMO: Past, Present, and Future","authors":"S. Conrad","doi":"10.25259/jccc_8_2023","DOIUrl":"https://doi.org/10.25259/jccc_8_2023","url":null,"abstract":"","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"37 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76497550","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Depending on the choice of cannulation techniques, ECMO can deliver purely respiratory support, respiratory support with right ventricular support, and full cardiopulmonary support. Today, with careful patient selection, ECMO is used as a rescue therapy to allow for recovery or bridge to transplant for hypoxic respiratory failure and severe refractory cardiogenic shock. The adverse effects of deep sedation and paralysis including bradycardia, ICU-acquired paresis, and ventilator-associated pneumonia pose valid concerns with reduction in lung volumes and capacities. One of the most frequently prescribed airway clearance therapy (ACT) options for patients with chronic lung conditions or decreased lung volumes is positive expiratory pressure therapy (PEP) device (Acapella) which causes reduction in hyperinflation and many other positive facts described in this review.
{"title":"Positive Expiratory Pressure Therapy Device, the Acapella in Post-ECMO Rehabilitation","authors":"T. B. Sheware, Ruchika, P. Kapoor","doi":"10.25259/mm_jccc_301","DOIUrl":"https://doi.org/10.25259/mm_jccc_301","url":null,"abstract":"Depending on the choice of cannulation techniques, ECMO can deliver purely respiratory support, respiratory support with right ventricular support, and full cardiopulmonary support. Today, with careful patient selection, ECMO is used as a rescue therapy to allow for recovery or bridge to transplant for hypoxic respiratory failure and severe refractory cardiogenic shock. The adverse effects of deep sedation and paralysis including bradycardia, ICU-acquired paresis, and ventilator-associated pneumonia pose valid concerns with reduction in lung volumes and capacities. One of the most frequently prescribed airway clearance therapy (ACT) options for patients with chronic lung conditions or decreased lung volumes is positive expiratory pressure therapy (PEP) device (Acapella) which causes reduction in hyperinflation and many other positive facts described in this review.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"53 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77242509","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Extracorporeal cardiopulmonary resuscitation (ECPR) is the implantation of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in a patient who experienced a sudden and unexpected pulseless condition attributable to cessation of cardiac mechanical activity. The aim of ECPR is to provide adequate perfusion to the end organs when the potentially “reversible” conditions were managed. ECPRs are mostly done in tertiary care center in India. There is little scope for out of hospital arrest as poor quality of CPR and response time exists with lack of awareness about ECPR, which hinders its wider usage even in IHCA. Emergency department doctors need to be involved to counsel, recognize candidates activate, and initiate ECPR.
{"title":"Role of ECMO in E-CPR","authors":"J. Haji, P. Kapoor","doi":"10.25259/jccc_3_2023","DOIUrl":"https://doi.org/10.25259/jccc_3_2023","url":null,"abstract":"Extracorporeal cardiopulmonary resuscitation (ECPR) is the implantation of venoarterial extracorporeal membrane oxygenation (VA-ECMO) in a patient who experienced a sudden and unexpected pulseless condition attributable to cessation of cardiac mechanical activity. The aim of ECPR is to provide adequate perfusion to the end organs when the potentially “reversible” conditions were managed. ECPRs are mostly done in tertiary care center in India. There is little scope for out of hospital arrest as poor quality of CPR and response time exists with lack of awareness about ECPR, which hinders its wider usage even in IHCA. Emergency department doctors need to be involved to counsel, recognize candidates activate, and initiate ECPR.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75994888","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
P. Kapoor, Pranay Oza, V. Goyal, Y. Mehta, M. Kanchi
Protective lung ventilation is the mainstay ventilation strategy for patients on extracorporeal membrane oxygenation (ECMO), as prolonged mechanical ventilation increases morbidity and mortality; the technicalities of ventilation with ECMO have evolved in the last decade. ECMO on the other end of the spectrum is a complete or total extracorporeal support, which supplies complete physiological blood gas exchanges, normally performed by the native lungs and thus is capable of delivering oxygen (O2) and removing CO equal to the metabolic needs of the patient, it requires higher flows, is more complex, and uses bigger cannulas, higher dose of heparin and higher blood volume for priming. This review describes in detail carbon dioxide removal on ECMO.
{"title":"Extracorporeal Membrane Oxygenation Carbon Dioxide Removal","authors":"P. Kapoor, Pranay Oza, V. Goyal, Y. Mehta, M. Kanchi","doi":"10.25259/mm_jccc_304","DOIUrl":"https://doi.org/10.25259/mm_jccc_304","url":null,"abstract":"Protective lung ventilation is the mainstay ventilation strategy for patients on extracorporeal membrane oxygenation (ECMO), as prolonged mechanical ventilation increases morbidity and mortality; the technicalities of ventilation with ECMO have evolved in the last decade. ECMO on the other end of the spectrum is a complete or total extracorporeal support, which supplies complete physiological blood gas exchanges, normally performed by the native lungs and thus is capable of delivering oxygen (O2) and removing CO equal to the metabolic needs of the patient, it requires higher flows, is more complex, and uses bigger cannulas, higher dose of heparin and higher blood volume for priming. This review describes in detail carbon dioxide removal on ECMO.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"17 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-01-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84036798","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
A 23-year-old male was admitted to our hospital with complaints of shortness of breath, grade-III, chest pain, and palpitation for the last 3 months. He had one episode of hemoptysis 3 months back. He was a known case of primary antiphospholipid antibody syndrome (APS) with bilateral chronic pulmonary thromboembolism with chronic thromboembolic pulmonary hypertension (CTEPH) with the presence of anticardiolipin antibody. The patient had no history of joint pain, hematuria, and photosensitivity. He was on domiciliary oxygen therapy at 1 L/min to maintain an oxygen saturation of 93%, riociguat, ecosprin, hydroxychlor-oquine, and enoxaparin. The patient was referred to our hospital for pulmonary thromboendarterectomy (PTE). On investigation, his two-dimensional (2D) echocardio-gram showed global left ventricular hypokinesia with an ejection fraction of 25%, severe right ventricular systolic dysfunction, dilated right atrium and ventricle, dilated tricuspid valve annulus with severe tricuspid regurgitation, mild pulmonary regurgitation, high normal inferior vena cava with an absence of respiratory collapse, and pulmonary artery systolic pressure of 37mm Hg.
{"title":"Pulmonary Thromboendarterectomy in a Known Case of Antiphospholipid Syndrome","authors":"C. Nanda, Y. Mehta, D. Kumar, V. Kohli, N. Trehan","doi":"10.1055/s-0042-1753495","DOIUrl":"https://doi.org/10.1055/s-0042-1753495","url":null,"abstract":"A 23-year-old male was admitted to our hospital with complaints of shortness of breath, grade-III, chest pain, and palpitation for the last 3 months. He had one episode of hemoptysis 3 months back. He was a known case of primary antiphospholipid antibody syndrome (APS) with bilateral chronic pulmonary thromboembolism with chronic thromboembolic pulmonary hypertension (CTEPH) with the presence of anticardiolipin antibody. The patient had no history of joint pain, hematuria, and photosensitivity. He was on domiciliary oxygen therapy at 1 L/min to maintain an oxygen saturation of 93%, riociguat, ecosprin, hydroxychlor-oquine, and enoxaparin. The patient was referred to our hospital for pulmonary thromboendarterectomy (PTE). On investigation, his two-dimensional (2D) echocardio-gram showed global left ventricular hypokinesia with an ejection fraction of 25%, severe right ventricular systolic dysfunction, dilated right atrium and ventricle, dilated tricuspid valve annulus with severe tricuspid regurgitation, mild pulmonary regurgitation, high normal inferior vena cava with an absence of respiratory collapse, and pulmonary artery systolic pressure of 37mm Hg.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"21 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72486695","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
U. Chowdhury, Niwin George, S. B., Balaji Chandhirasekar, S. Goja, Nagasai Manjusha, N. Pandey, P. Kapoor
Abstract A 10-year-old female patient diagnosed with isolated type I aortopulmonary window and severe pulmonary arterial hypertension who underwent repair of the aortopulmonary window via Johansson's transwindow approach using a unidirectional, fenestrated, valved, aorticopulmonary patch. The preoperative pulmonary vascular resistance was 9.0 Woods units/m 2 that reduced to 4.0 Woods units/m 2 after oxygen (100%) and nitric oxide (80 ppm) administration. The postoperative recovery was uneventful.
{"title":"Technical Details of Transwindow Fenestrated, Unidirectional, Valved, Aorticopulmonary Fabric Patch Closure of Aortopulmonary Window (UKC's Modification): A Video Presentation","authors":"U. Chowdhury, Niwin George, S. B., Balaji Chandhirasekar, S. Goja, Nagasai Manjusha, N. Pandey, P. Kapoor","doi":"10.1055/s-0042-1759805","DOIUrl":"https://doi.org/10.1055/s-0042-1759805","url":null,"abstract":"Abstract A 10-year-old female patient diagnosed with isolated type I aortopulmonary window and severe pulmonary arterial hypertension who underwent repair of the aortopulmonary window via Johansson's transwindow approach using a unidirectional, fenestrated, valved, aorticopulmonary patch. The preoperative pulmonary vascular resistance was 9.0 Woods units/m 2 that reduced to 4.0 Woods units/m 2 after oxygen (100%) and nitric oxide (80 ppm) administration. The postoperative recovery was uneventful.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"21 1","pages":"216 - 218"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87319173","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Abstract The incidence of idiopathic ventricular tachycardia is scarce; however, it is the most common type of ventricular tachycardia in previously normal children. Left posterior fascicular ventricular tachycardia is one of them, and many times it is mismanaged as paroxysmal supraventricular tachycardia. The characteristic features of this arrhythmia are a monomorphic tachycardia, right bundle branch block, and superior axis. This type of arrhythmia is highly sensitive to verapamil, even in infancy, but refractory to adenosine or amiodarone. As nonrecognition of this condition can be fatal, it should be identified early.
{"title":"Idiopathic Left Posterior Fascicular Ventricular Tachycardia in Children: A Case Report","authors":"Abhijit Ari, Manjeet Singh","doi":"10.1055/s-0042-1759814","DOIUrl":"https://doi.org/10.1055/s-0042-1759814","url":null,"abstract":"Abstract The incidence of idiopathic ventricular tachycardia is scarce; however, it is the most common type of ventricular tachycardia in previously normal children. Left posterior fascicular ventricular tachycardia is one of them, and many times it is mismanaged as paroxysmal supraventricular tachycardia. The characteristic features of this arrhythmia are a monomorphic tachycardia, right bundle branch block, and superior axis. This type of arrhythmia is highly sensitive to verapamil, even in infancy, but refractory to adenosine or amiodarone. As nonrecognition of this condition can be fatal, it should be identified early.","PeriodicalId":34567,"journal":{"name":"Journal of Cardiac Critical Care TSS","volume":"39 1","pages":"225 - 227"},"PeriodicalIF":0.0,"publicationDate":"2022-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75116899","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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