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Instrumentation and Operating Theater Set up in Minimally Invasive Cardiac Surgery
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
Blood from the vena cava is usually drained via a venous cannula into a reservoir. A two-stage single venous cannula is commonly used, but the use of a selective venous cannula is not rare. A roller pump is used to send the venous blood to a heat exchanger and then into a membrane oxygenator. The oxygenated blood then splits into two separate stream – a left-sided flow passes through a bubble filter and is then delivered to the systemic circulation via ascending aorta (after aortic cross clamp), and a right-sided flow passes through a cardioplegia pump, a cardioplegia heat exchanger and is then delivered into the ascending aorta in the pre-cross clamp area. The operative site blood is returned to the CPB by cardiotomy suction, which then filters and defoams the blood before sending it back to the oxygenator (Figure 4.53).
The Chest
Published in Kenneth D Boffard, Manual of Definitive Surgical Trauma Care: Incorporating Definitive Anaesthetic Trauma Care, 2019
Complications from myocardial injuries include recurrent tamponade, mediastinitis and post-cardiotomy syndrome. The former can be avoided by placing a mediastinal chest tube or leaving the pericardium partially open following repair. Most cardiac injuries are treated through a left anterolateral thoracotomy, and only occasionally via a median sternotomy. If mediastinitis does develop, the wound should be opened (including the sternum), and debridement carried out with secondary closure in 4–5 days.
Extracorporeal life support for neonatal cardiorespiratory failure
Published in Prem Puri, Newborn Surgery, 2017
William Middlesworth, Jeffrey W. Gander, Charles J. H. Stolar
ECMO is used with increasing frequency and success to support infants who develop myocardial dysfunction and hemodynamic instability in the period surrounding repair of congenital heart disease.9 The transient myocardial dysfunction that is sometimes seen in the post cardiotomy period is an example of a reversible process well suited to ECMO support.
Primary cardiac lymphoma: the management and outcome of a single-centre cohort of 22 patients
Published in Acta Oncologica, 2021
Xiao-Juan Wei, Hui Yuan, Pek-Lan Khong, Fen Zhang, Peng-Jun Liao, Xin-Miao Jiang, Ling Huang, Han-Guo Guo, Fei-Li Chen, Si-Chu Liu, Yan-Ying Huang, Shu-Xia Wang, Wen-Yu Li
Whole-body imaging was performed to evaluate disease characteristics and determine the optimal biopsy route. Whole-body 18-fluorodeoxyglucose positron emission tomography/computed tomography (18 F-FDG PET/CT) combined with contrast-enhanced CT (CECT) was the imaging modality of choice, but for patients with limited economic resources whole-body CECT was also accepted (see Document S1 for a description of the imaging techniques). Bulky disease was defined as the largest dimension ≥7.5 cm of a cardiac tumour. If imaging revealed extracardiac involvement, biopsy was performed at the least invasive site. Peripheral lymph node or mass biopsy was the priority, followed by cytological investigation of pleural or pericardial effusion, and intrathoracic or intra-abdominal biopsy (mediastinoscopy or CT-guided fine needle aspiration biopsy [CT-FNAB]). For patients presenting with only intrapericardial lesions, we attempted transjugular endocardial biopsy, endobronchial ultrasonography-guided fine-needle aspiration biopsy (EBUS-FNAB), or video-assisted thoracic surgery (VATS), depending on the lesion location. Cardiotomy was the final option. All histological samples were reviewed by an experienced pathologist (F Z) as previously described [13].
A case of mediastinitis with an exposed artificial blood vessel that was associated with right ventricular wall damage during treatment
Published in Case Reports in Plastic Surgery and Hand Surgery, 2019
Ryuichi Yoshida, Naoto Yamamoto, Akio Nishijima, Eri Maruyama, Megumi Takikawa, Satoshi Yanagibayashi
Mediastinitis after cardiotomy has been reported to occur in 1%–3% of cases, and its mortality rate has been reported to be 19%–29% [1]. Mediastinitis is a serious complication, and its treatment becomes difficult when an artificial blood vessel is exposed.