Background: Ventricular fibrillation (VF) is a known complication after the release of the aortic cross-clamp (ACC) during cardiopulmonary bypass (CPB) surgery. Various factors contribute to persistent refractory VF, making its management challenging. This case report describes the successful treatment of postoperative refractory VF by coronary artery bypass grafting (CABG) in a patient undergoing aortic valve replacement (AVR) with ACC release. Case Presentation: A 52-year-old woman with a history of hypertension and ischemic cerebral infarction presented with symptoms of chest tightness, dyspnoea and palpitations. She underwent a modified maze procedure of radiofrequency ablation, mitral repair, left atrial appendage closure and mechanical AVR under a CPB procedure. Following the ACC release, the patient experienced recurrent VF that was unresponsive to standard interventions such as lidocaine, amiodarone and direct current shocks. The suspicion of right coronary artery (RCA) insufficiency led to the decision to perform CABG using the great saphenous vein. After the CABG procedure, the patient's heart rhythm gradually returned to sinus rhythm, and she had an uneventful recovery. Discussion and Conclusions: Refractory VF after the ACC release can pose diagnostic and treatment challenges. In this case, RCA insufficiency was suspected as the cause of refractory VF. The absence of blood flow in the proximal RCA and the presence of distal blood return during cardiac surface exploration supported this suspicion. Coronary artery bypass grafting using the great saphenous vein successfully restored normal sinus rhythm, confirming the diagnosis. This case emphasises the importance of considering coronary artery stenosis or occlusion as a potential cause of refractory VF after the ACC release during CPB, with CABG serving as a viable alternative treatment.
{"title":"Coronary Artery Bypass Grafting for Refractory Ventricular fibrillation after the Release of the Aortic Cross-Clamp in Patients Undergoing Aortic Valve Replacement: A Case Report","authors":"Xiao-Jie Yu, Da-Shi Ma, Mu-Shui Qiu","doi":"10.59958/hsf.6713","DOIUrl":"https://doi.org/10.59958/hsf.6713","url":null,"abstract":"Background: Ventricular fibrillation (VF) is a known complication after the release of the aortic cross-clamp (ACC) during cardiopulmonary bypass (CPB) surgery. Various factors contribute to persistent refractory VF, making its management challenging. This case report describes the successful treatment of postoperative refractory VF by coronary artery bypass grafting (CABG) in a patient undergoing aortic valve replacement (AVR) with ACC release. Case Presentation: A 52-year-old woman with a history of hypertension and ischemic cerebral infarction presented with symptoms of chest tightness, dyspnoea and palpitations. She underwent a modified maze procedure of radiofrequency ablation, mitral repair, left atrial appendage closure and mechanical AVR under a CPB procedure. Following the ACC release, the patient experienced recurrent VF that was unresponsive to standard interventions such as lidocaine, amiodarone and direct current shocks. The suspicion of right coronary artery (RCA) insufficiency led to the decision to perform CABG using the great saphenous vein. After the CABG procedure, the patient's heart rhythm gradually returned to sinus rhythm, and she had an uneventful recovery. Discussion and Conclusions: Refractory VF after the ACC release can pose diagnostic and treatment challenges. In this case, RCA insufficiency was suspected as the cause of refractory VF. The absence of blood flow in the proximal RCA and the presence of distal blood return during cardiac surface exploration supported this suspicion. Coronary artery bypass grafting using the great saphenous vein successfully restored normal sinus rhythm, confirming the diagnosis. This case emphasises the importance of considering coronary artery stenosis or occlusion as a potential cause of refractory VF after the ACC release during CPB, with CABG serving as a viable alternative treatment.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"120 1-3","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139877350","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}
Background: Ventricular fibrillation (VF) is a known complication after the release of the aortic cross-clamp (ACC) during cardiopulmonary bypass (CPB) surgery. Various factors contribute to persistent refractory VF, making its management challenging. This case report describes the successful treatment of postoperative refractory VF by coronary artery bypass grafting (CABG) in a patient undergoing aortic valve replacement (AVR) with ACC release. Case Presentation: A 52-year-old woman with a history of hypertension and ischemic cerebral infarction presented with symptoms of chest tightness, dyspnoea and palpitations. She underwent a modified maze procedure of radiofrequency ablation, mitral repair, left atrial appendage closure and mechanical AVR under a CPB procedure. Following the ACC release, the patient experienced recurrent VF that was unresponsive to standard interventions such as lidocaine, amiodarone and direct current shocks. The suspicion of right coronary artery (RCA) insufficiency led to the decision to perform CABG using the great saphenous vein. After the CABG procedure, the patient's heart rhythm gradually returned to sinus rhythm, and she had an uneventful recovery. Discussion and Conclusions: Refractory VF after the ACC release can pose diagnostic and treatment challenges. In this case, RCA insufficiency was suspected as the cause of refractory VF. The absence of blood flow in the proximal RCA and the presence of distal blood return during cardiac surface exploration supported this suspicion. Coronary artery bypass grafting using the great saphenous vein successfully restored normal sinus rhythm, confirming the diagnosis. This case emphasises the importance of considering coronary artery stenosis or occlusion as a potential cause of refractory VF after the ACC release during CPB, with CABG serving as a viable alternative treatment.
{"title":"Coronary Artery Bypass Grafting for Refractory Ventricular fibrillation after the Release of the Aortic Cross-Clamp in Patients Undergoing Aortic Valve Replacement: A Case Report","authors":"Xiao-Jie Yu, Da-Shi Ma, Mu-Shui Qiu","doi":"10.59958/hsf.6713","DOIUrl":"https://doi.org/10.59958/hsf.6713","url":null,"abstract":"Background: Ventricular fibrillation (VF) is a known complication after the release of the aortic cross-clamp (ACC) during cardiopulmonary bypass (CPB) surgery. Various factors contribute to persistent refractory VF, making its management challenging. This case report describes the successful treatment of postoperative refractory VF by coronary artery bypass grafting (CABG) in a patient undergoing aortic valve replacement (AVR) with ACC release. Case Presentation: A 52-year-old woman with a history of hypertension and ischemic cerebral infarction presented with symptoms of chest tightness, dyspnoea and palpitations. She underwent a modified maze procedure of radiofrequency ablation, mitral repair, left atrial appendage closure and mechanical AVR under a CPB procedure. Following the ACC release, the patient experienced recurrent VF that was unresponsive to standard interventions such as lidocaine, amiodarone and direct current shocks. The suspicion of right coronary artery (RCA) insufficiency led to the decision to perform CABG using the great saphenous vein. After the CABG procedure, the patient's heart rhythm gradually returned to sinus rhythm, and she had an uneventful recovery. Discussion and Conclusions: Refractory VF after the ACC release can pose diagnostic and treatment challenges. In this case, RCA insufficiency was suspected as the cause of refractory VF. The absence of blood flow in the proximal RCA and the presence of distal blood return during cardiac surface exploration supported this suspicion. Coronary artery bypass grafting using the great saphenous vein successfully restored normal sinus rhythm, confirming the diagnosis. This case emphasises the importance of considering coronary artery stenosis or occlusion as a potential cause of refractory VF after the ACC release during CPB, with CABG serving as a viable alternative treatment.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"5 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-02-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139817724","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}
Ping Zhang, Chun Liu, Wen Qi, Xiaoli Xie, Yunyan Su
Background: The aim of this study was to estimate the potential influencing factors of postoperative constipation in patients undergoing cardiovascular surgery. Methods: This study included a cohort of 379 patients who underwent cardiovascular surgery at Nanjing Drum Tower Hospital. The patient cohort was stratified into two groups based on the presence or absence of postoperative constipation. Utilizing logistic regression analysis, both univariate and multivariate analyses were conducted to elucidate the factors influencing defecation problems. The predictive accuracy of the findings was subsequently evaluated through the receiver operating characteristic (ROC) curve. Results: Among the cohort of 379 patients subjected to cardiovascular surgery, a noteworthy 20.8% (n = 79) reported incidences of postoperative defecation issues. A multivariate logistic regression analysis showed that age (odds ratio (OR) = 1.063, 95% confidence interval (CI) 1.034–1.097, p < 0.001), operation time (OR = 1.004, 95% CI: 1.000–1.008, p = 0.028), ventilator usage time (OR = 1.032, 95% CI: 1.010–1.055, p = 0.004), polypharmacy (OR = 2.134, 95% CI: 1.069–4.321, p = 0.032), use of cough medicine (OR = 2.981, 95% CI: 1.271–6.942, p = 0.011) and psychological or behavioral barriers to defecation in the hospital environment (OR = 31.039, 95% CI: 14.313–73.179, p < 0.001) were independent risk factors for postoperative constipation in patients undergoing cardiovascular surgery. The area under the curve (AUC) for predicting postoperative constipation was 0.885. Conclusion: In the pursuit of optimizing postoperative recovery and mitigating postoperative constipation incidence, a targeted approach is imperative. Specifically, a focused intervention directed towards elderly patients, extended operation and prolonged ventilator durations, polypharmacy regimens, use of cough medicine, and those with psychological or behavioral barriers to defecation within the hospital milieu emerges as pivotal.
{"title":"Analysis of the Influencing Factors of Postoperative Constipation in Patients Undergoing Cardiovascular Surgery: A Cross-Sectional and Prospective Study","authors":"Ping Zhang, Chun Liu, Wen Qi, Xiaoli Xie, Yunyan Su","doi":"10.59958/hsf.7031","DOIUrl":"https://doi.org/10.59958/hsf.7031","url":null,"abstract":"Background: The aim of this study was to estimate the potential influencing factors of postoperative constipation in patients undergoing cardiovascular surgery. Methods: This study included a cohort of 379 patients who underwent cardiovascular surgery at Nanjing Drum Tower Hospital. The patient cohort was stratified into two groups based on the presence or absence of postoperative constipation. Utilizing logistic regression analysis, both univariate and multivariate analyses were conducted to elucidate the factors influencing defecation problems. The predictive accuracy of the findings was subsequently evaluated through the receiver operating characteristic (ROC) curve. Results: Among the cohort of 379 patients subjected to cardiovascular surgery, a noteworthy 20.8% (n = 79) reported incidences of postoperative defecation issues. A multivariate logistic regression analysis showed that age (odds ratio (OR) = 1.063, 95% confidence interval (CI) 1.034–1.097, p < 0.001), operation time (OR = 1.004, 95% CI: 1.000–1.008, p = 0.028), ventilator usage time (OR = 1.032, 95% CI: 1.010–1.055, p = 0.004), polypharmacy (OR = 2.134, 95% CI: 1.069–4.321, p = 0.032), use of cough medicine (OR = 2.981, 95% CI: 1.271–6.942, p = 0.011) and psychological or behavioral barriers to defecation in the hospital environment (OR = 31.039, 95% CI: 14.313–73.179, p < 0.001) were independent risk factors for postoperative constipation in patients undergoing cardiovascular surgery. The area under the curve (AUC) for predicting postoperative constipation was 0.885. Conclusion: In the pursuit of optimizing postoperative recovery and mitigating postoperative constipation incidence, a targeted approach is imperative. Specifically, a focused intervention directed towards elderly patients, extended operation and prolonged ventilator durations, polypharmacy regimens, use of cough medicine, and those with psychological or behavioral barriers to defecation within the hospital milieu emerges as pivotal.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"9 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139526223","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}
Background: This study mainly investigated the mechanism and effects of AKAP1 in renal patients with acute heart failure (AHF). Methods: Patients with renal patients with AHF and normal volunteers were collected. The left anterior descending arteries (LAD) of mice were ligated to induce myocardial infarction. Results: AKAP1 messenger RNA (mRNA) expression was found to be down-regulated in renal patients with AHF. The serum levels of AKAP1 mRNA expression were negatively correlated with collagen I/III in patients. AKAP1 mRNA and protein expression in the heart tissue of mice with AHF were also found to be down-regulated in a time-dependent manner. Short hairpin (Sh)-AKAP1 promotes AHF in a mouse model. AKAP1 up-regulation reduces reactive oxygen species (ROS)-induced oxidative stress in an In Vitro model. AKAP1 up-regulation also reduces ROS-induced lipid peroxidation ferroptosis in an In Vitro model. AKAP1 induces NDUFS1 expression to increase GPX4 activity levels. AKAP1 protein interlinked with the NDUFS1 protein. Up-regulation of the AKAP1 gene reduced NDUFS1 ubiquitination, while down-regulation of the AKAP1 gene increased NDUFS1 ubiquitination in a model. In vivo imaging showed that the sh-AKAP1 virus reduced NDUFS1 expression in the heart of a mouse model. Conclusions: AKAP1 reduced ROS-induced lipid peroxidation ferroptosis through the inhibition of ubiquitination of NDUFS by mitochondrial damage in model of renal patients with AHF, suggest a novel target for AHF treatment.
{"title":"AKAP1 in Renal Patients with AHF to Reduce Ferroptosis of Cardiomyocyte","authors":"Yifeng Fang, Junpeng Xu, Ruofei Huang","doi":"10.59958/hsf.5717","DOIUrl":"https://doi.org/10.59958/hsf.5717","url":null,"abstract":"Background: This study mainly investigated the mechanism and effects of AKAP1 in renal patients with acute heart failure (AHF). Methods: Patients with renal patients with AHF and normal volunteers were collected. The left anterior descending arteries (LAD) of mice were ligated to induce myocardial infarction. Results: AKAP1 messenger RNA (mRNA) expression was found to be down-regulated in renal patients with AHF. The serum levels of AKAP1 mRNA expression were negatively correlated with collagen I/III in patients. AKAP1 mRNA and protein expression in the heart tissue of mice with AHF were also found to be down-regulated in a time-dependent manner. Short hairpin (Sh)-AKAP1 promotes AHF in a mouse model. AKAP1 up-regulation reduces reactive oxygen species (ROS)-induced oxidative stress in an In Vitro model. AKAP1 up-regulation also reduces ROS-induced lipid peroxidation ferroptosis in an In Vitro model. AKAP1 induces NDUFS1 expression to increase GPX4 activity levels. AKAP1 protein interlinked with the NDUFS1 protein. Up-regulation of the AKAP1 gene reduced NDUFS1 ubiquitination, while down-regulation of the AKAP1 gene increased NDUFS1 ubiquitination in a model. In vivo imaging showed that the sh-AKAP1 virus reduced NDUFS1 expression in the heart of a mouse model. Conclusions: AKAP1 reduced ROS-induced lipid peroxidation ferroptosis through the inhibition of ubiquitination of NDUFS by mitochondrial damage in model of renal patients with AHF, suggest a novel target for AHF treatment.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"87 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139530439","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}
The use of extracorporeal membrane oxygenation (ECMO) in critically ill patients has been on the rise in recent years. While ECMO has provided substantial benefit to patients who need cardiopulmonary support, its required use of large-bore catheters in major blood vessels often precludes the use of other transcatheter therapies. In this article, we demonstrate that two transcatheter procedures, AngioVac right-sided cardiac thrombus removal and Micra leadless pacemaker placement, both requiring large bore access, can both be safely and effectively implemented in patients who are dependent on ECMO to maintain cardiopulmonary function.
{"title":"Working Around: The Use of AngioVac and Micra Transcatheter Leadless Pacemaker Implantation in a Critically Ill Patient Receiving Extracorporeal Membrane Oxygenation","authors":"Ryan Morse, Mark Joseph","doi":"10.59958/hsf.6223","DOIUrl":"https://doi.org/10.59958/hsf.6223","url":null,"abstract":"The use of extracorporeal membrane oxygenation (ECMO) in critically ill patients has been on the rise in recent years. While ECMO has provided substantial benefit to patients who need cardiopulmonary support, its required use of large-bore catheters in major blood vessels often precludes the use of other transcatheter therapies. In this article, we demonstrate that two transcatheter procedures, AngioVac right-sided cardiac thrombus removal and Micra leadless pacemaker placement, both requiring large bore access, can both be safely and effectively implemented in patients who are dependent on ECMO to maintain cardiopulmonary function.","PeriodicalId":503802,"journal":{"name":"The Heart Surgery Forum","volume":"25 4","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-01-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139535125","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}
京公网安备 11010802042870号
京ICP备2023020795号-1
扫码关注我们
求助内容：
应助结果提醒方式：