DOCSLIB.ORG

Fate of the Coronary Ostial and Distal Aortic Anastomoses After Modified Bentall’S Operation (UKC’S Modification)

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text

Load more

Chowdhury UK, George N, Singh S, Hasija S, Sankhyan LK, Sharma S, Pandey NN, Sengupta S, Kalaivani M. Fate of the Coronary Ostial and Distal Aortic Anastomoses after Modified Bentall’s Operation (UKC’s Modification). J Surg & Journal of Surgical Tech.2020;2(1):11-20 Surgery and Surgical Technology Original Research Article Open Access Fate of the Coronary Ostial and Distal Aortic Anastomoses after Modified Bentall’s Operation (UKC’s Modification) Ujjwal K. Chowdhury1*, Niwin George1, Sukhjeet Singh1, Suruchi Hasija2, Lakshmikumari Sankhyan1, Srikant Sharma1, Niraj Nirmal Pandey3, Sanjoy Sengupta1, Mani Kalaivani4 1Departments of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India. 2Department of Cardiac Anaesthesia, All India Institute of Medical Sciences, New Delhi, India. 3Department of Cardiac Radiology ,All India Institute of Medical Sciences, New Delhi, India. 4Department of Biostatistics, All India Institute of Medical Sciences, New Delhi, India. Article Info Article Notes Received: May 04, 2020 Accepted: June 13, 2020 *Correspondence: Dr. Ujjwal Kumar Chowdhury, M.Ch, Diplomate NB, Professor, Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, Ansari Nagar, New Delhi-110029, India; Telephone No: 91-11-26594835; Fax No: 91-11- 26588663, 26588641; Email: [email protected], [email protected]; Orcid ID: http://orcid.org/0000-0002-1672-1502. ©2020 Chowdhury UK. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License. Keywords: Anastomotic pseudo-aneurysm Graphical Abstract: Graphic display (n=140) showing widely patent left and Bentall’s procedure Computed tomographic angiography right coronary arterial systems, intact proximal and distal anastomoses without Coronary ostial aneurysm coronary ostial kinking/narrowing/aneurysm or pseudo-aneurysm formation Coronary button technique Retrograde cold blood cardioplegia Antegrade cold blood cardioplegia Abstract Myocardial preservation Objectives: To ascertain the influence of technique of coronary button implantation in patients undergoing Bentall’s procedure with respect to survival, re-exploration for bleeding, anastomotic complications of proximal and distal aortic suture lines, formation of coronary aneurysm and pseudo-aneurysm, kinking and coronary ostial narrowing. Methods: We reviewed 140 patients (75 males) aged between 22 and 66 years (mean±SD 48.21±1.36 years) receiving a composite aortic conduit from January 1998 to December 2019 for annulo-aortic ectasia (n=98), aortic dissection (n=41), and repaired tetralogy of Fallot (n=1), 24 of whom had Marfan’s syndrome. All patients underwent modified “button technique” by interposing a glutaraldehyde- treated pericardial strip at the graft-coronary anastomoses and proximal aortic conduit suturing using interlocking, interrupted, pledgeted mattress sutures. To detect anastomotic complications of the coronary ostia, proximal and distal aortic anastomoses, survivors underwent echocardiography every 6 months and computed tomographic angiography at 12 months or whenever indicated. Results: Seven (5%) patients died of cardiac-related cause, 45% had transient hemodynamic instability, 55% had low cardiac output and 87.1% had spontaneous return of sinus rhythm. At a mean follow-up of 161.6±69.9 months, the actuarial survival was 92.6±0.02% (95% CI: 86.9%-96.1) and there were no anastomotic aneurysm or pseudo-aneurysm formation, no kinking of the coronary ostia or ostial narrowing. Conclusion: The modified open button technique and proximal aortic conduit suturing is associated with reduced perioperative bleeding, no aneurysm or pseudo-aneurysm formation at the coronary and distal aortic anastomoses. We recommend more extensive use of pericardial strip reinforcement of coronary button and new imaging techniques. Page 11 of 20 Chowdhury UK, George N, Singh S, Hasija S, Sankhyan LK, Sharma S, Pandey NN, Sengupta S, Kalaivani M. Fate of the Coronary Ostial and Distal Aortic Anastomoses after Journal of Surgery and Surgical Technology Modified Bentall’s Operation (UKC’s Modification). J Surg & Surgical Tech.2020;2(1):11-20 Introduction Table 1: Demographic, operative, and postoperative details of the patients in the study (n=140) Long-term results after composite graft aortic root Variables Number (%) replacement may depend on the implantation technique. 48.21±13.6 years Mean age at operation (range) The original Bentall’s procedure employed an in situ (22-66 years) circumferential suture line around the coronary ostia, then Sex- Males 75 (53.5%) complete aortic wrap around to control bleeding. Tension Annulo-aortic ectasia 98 (70%) developing at the suture line of the side-to-side coronary Type A aortic dissection 41 (29.3%) anastomosis and/or blood accumulation within the space Repaired tetralogy of Fallot with aortic valvular 1 (0.7%) reconstruction artery dehiscence, pseudo-aneurysm formation and Moderate-to-severe aortic regurgitation 134 (95.7%) reoperationaround the 1, graft2. Hematoma conveyed in significant the space riskmay ofadditionally coronary Moderate mitral regurgitation 6 (4.3%) compress the graft or cause prosthetic valve dysfunction1-3. Left ventricular ejection fraction <0.40 103 (73.6%) Marfan’s syndrome 24 (17.1%) atrial appendage and subsequently adopted interposition Renal dysfunction 72 (51.4%) To avoid this complication, Cabrol used a fistula to the right Concomitant coronary artery bypass grafting 8 (5.7%) of graft thrombosis and persistent aorto-right atrial Operation timing Dacron4, 5conduits to the coronary ostia with the new risk Emergency 37 (26.4%) Elective 103 (73.6%) fistula . For these reasons, a modified open technique 111.8 ± 28.2 that basically eliminate the prosthetic wrap and allows Mean aortic cross-clamp time (range) reattachmenthas been developed of adequately by Kouchoukos mobilized and coronary associates buttons in 1986 to (89-186 minutes) 154 ± 28.8 the graft with tension free sutures1. Mean cardiopulmonary bypass time (range) (136-218 minutes) In-hospital mortality 7 (5%) complications after composite graft replacement of the Late death 3 (2.1%) ascendingDespite theaorta introduction have not of thesebeen technicaleliminated. modifications, Problems 19±7 days encountered with these techniques include bleeding from Mean hospital stay (range) (6-52 days, median the proximal conduit implant site and reattached coronary 9 days) Low cardiac output artery origins, suture line disruption, coronary artery 77 (55%) Yes distortion and late development of pseudoaneurysms . 63 (45%) No To address these concerns, we interposed a glutaraldehyde-6-14 Average postoperative drainage (12 hours) 242±60 ml treated autologous pericardial strip between the graft and native coronary ostia during coronary ostial implantation by a single surgeon (corresponding author) after obtaining informed consent and institutional ethics committee approval. sutures to ensure perfect haemostatic suture lines and Patients’ demographic details are shown in Table 1. publishedand placed our interlocking, initial experience interrupted, in 2017 pledgeted15-17. mattress Surgical Techniques The objective(s) of this retrospective study were to Intraoperative trans-esophageal echocardiography evaluate: i) the stability of the modified Bentall’s procedure or 5500 ultrasound system on all patients both before for reattachment of the coronary ostia in the fate of the (TEE) was performed with a Hewlett-Packard Sonos 1500 coronaryover time; anastomoses; ii) the influence iii) ofthe surgical occurrence technique of coronary adopted techniques were used throughout the study period. The ostial pseudo-aneurysms, aneurysm of the anastomotic site operationsand after weresurgery. performed Standard under anaesthetic moderately and hypothermic operative cardiopulmonary bypass (CPB) through arterial narrowingto the composite of the graft coronary and aneurysms ostia during of the follow-up, left main and trunk v) and right coronary artery, iv) the occurrence of kinking and and bicaval venous cannulation through the femoral vein andcannulation superior (axillary vena cava. artery n=28; femoral artery n=112) on the short and long-term results in composite aortic root replacement.the influence of technique of coronary artery implantation Patients and Methods wasA usedretrograde in all coronary patients. sinus Trans-atrial cannula withblind self-inflatable cannulation This study conforms to the principles outlined in balloon (RCO 14, Edwards Lifesciences, Irvine, CA, USA) wasof the cannulated coronary sinusthrough was a performedshort right inatriotomy 92 patients. under In the declaration of Helsinki. Between January 1998 and cases of difficult cannulation (n=48), the coronary sinus Bentall’sDecember operation 2019, 140 using consecutive the surgical patients techniques (80 males), described aged observing distension of the posterior inter-ventricular 22-66 years (mean 48.21±13.6 years) underwent modified direct vision. The proper placement was confirmed by Page 12 of 20 Chowdhury UK, George N, Singh S, Hasija S, Sankhyan LK, Sharma S, Pandey NN, Sengupta S, Kalaivani M. Fate of the Coronary Ostial and Distal Aortic Anastomoses after Journal of Surgery and Surgical Technology Modified Bentall’s Operation (UKC’s Modification). J Surg & Surgical Tech.2020;2(1):11-20 vein, maintenance of coronary sinus pressure, palpation of repeated every 20 minutes. Cardioplegic infusions by both the coronary sinus cannula
Recommended publications
  • Guidelines on the Diagnosis and Management of Pericardial

    Guidelines on the Diagnosis and Management of Pericardial

    European Heart Journal (2004) Ã, 1–28 ESC Guidelines Guidelines on the Diagnosis and Management of Pericardial Diseases Full Text The Task Force on the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology Task Force members, Bernhard Maisch, Chairperson* (Germany), Petar M. Seferovic (Serbia and Montenegro), Arsen D. Ristic (Serbia and Montenegro), Raimund Erbel (Germany), Reiner Rienmuller€ (Austria), Yehuda Adler (Israel), Witold Z. Tomkowski (Poland), Gaetano Thiene (Italy), Magdi H. Yacoub (UK) ESC Committee for Practice Guidelines (CPG), Silvia G. Priori (Chairperson) (Italy), Maria Angeles Alonso Garcia (Spain), Jean-Jacques Blanc (France), Andrzej Budaj (Poland), Martin Cowie (UK), Veronica Dean (France), Jaap Deckers (The Netherlands), Enrique Fernandez Burgos (Spain), John Lekakis (Greece), Bertil Lindahl (Sweden), Gianfranco Mazzotta (Italy), Joa~o Morais (Portugal), Ali Oto (Turkey), Otto A. Smiseth (Norway) Document Reviewers, Gianfranco Mazzotta, CPG Review Coordinator (Italy), Jean Acar (France), Eloisa Arbustini (Italy), Anton E. Becker (The Netherlands), Giacomo Chiaranda (Italy), Yonathan Hasin (Israel), Rolf Jenni (Switzerland), Werner Klein (Austria), Irene Lang (Austria), Thomas F. Luscher€ (Switzerland), Fausto J. Pinto (Portugal), Ralph Shabetai (USA), Maarten L. Simoons (The Netherlands), Jordi Soler Soler (Spain), David H. Spodick (USA) Table of contents Constrictive pericarditis . 9 Pericardial cysts . 13 Preamble . 2 Specific forms of pericarditis . 13 Introduction. 2 Viral pericarditis . 13 Aetiology and classification of pericardial disease. 2 Bacterial pericarditis . 14 Pericardial syndromes . ..................... 2 Tuberculous pericarditis . 14 Congenital defects of the pericardium . 2 Pericarditis in renal failure . 16 Acute pericarditis . 2 Autoreactive pericarditis and pericardial Chronic pericarditis . 6 involvement in systemic autoimmune Recurrent pericarditis . 6 diseases . 16 Pericardial effusion and cardiac tamponade .
  • Myocardiial Protection Strategy Utilizing Retrograde Cardioplegia

    Myocardiial Protection Strategy Utilizing Retrograde Cardioplegia

    Myocardial Protection Strategy Utilizing Retrograde Cardioplegia Item Type text; Electronic Thesis Authors Karbasi, Michael Publisher The University of Arizona. Rights Copyright © is held by the author. Digital access to this material is made possible by the College of Medicine - Phoenix, University of Arizona. Further transmission, reproduction or presentation (such as public display or performance) of protected items is prohibited except with permission of the author. Download date 25/09/2021 11:23:01 Link to Item http://hdl.handle.net/10150/281195 Myocardial Protection Strategy Utilizing Retrograde Cardioplegia for Neonatal Arterial Switch Operations Michael Karbasi1, John Nigro, M.D.2,3, Bradford Sanders, CCP,, MS2,3, Cyrus Kosar, MS4, Brigham C. Willis, M.D.1,2,3 1 University of Arizona, College of Medicine-Phoenix; 2Children’s Heart Center, Phoenix Children’s Hospital, Phoenix, AZ; 3Eller Congenital Heart Center at St. Joseph’s Hospital and Medical Center, Phoenix, AZ; and 4Institute for Aging Research in Affiliation with Harvard Medical School ABSTRACT RESULTS 30.0 Introduction: Myocardial protection strategies are a central component of neonatal arterial switch operations. Traditionally antegrade cardioplegia 25.0 through the aortic root has been the method of delivery, but use of retrograde cardioplegia via the coronary sinus has become the standard 20.0 of practice by many in the field. Methods: After obtaining IRB approval 15.0 Retrograde and informed consent, a retrospective chart review was done to assess Days Antegrade outcomes between 48 patients receiving antegrade (n= 5) and retrograde 10.0 (n= 43) cardioplegia during neonatal switch operations. Preoperative demographics and postoperative outcomes were compared between the 5.0 two groups and compared with historical studies.
  • Comparison of Del Nido Cardioplegia

    Comparison of Del Nido Cardioplegia

    ORIGINAL ARTICLE Braz J Cardiovasc Surg 2021;36(2):158-64 Comparison of Del Nido Cardioplegia and Blood Cardioplegia in Terms of Development of Postoperative Atrial Fibrillation in Patients Undergoing Isolated Coronary Artery Bypass Grafting Umut Serhat Sanrı1, MD; Kadir Kaan Özsin1, MD; Faruk Toktaş1, MD; Şenol Yavuz1, MD DOI: 10.21470/1678-9741-2020-0047 Abstract length of hospital stay remain significantly higher in the BC group Objective: Del Nido cardioplegia (DNC) has been used in (P=0.044, P<0.001, respectively). In addition, the aortic cross-clamp pediatric cardiac surgery for many years with a single dose time and the cardioplegia volume delivered were significantly application and its usage in adult cardiac surgery has been lower in the DNC group (P=0.042, P<0.001, respectively). In increasing in recent years, with results being published. In multivariate logistic regression analysis, only higher cardioplegia this study, we aimed to investigate the effect of DNC on the volume was determined as an independent predictor for PoAF development of postoperative atrial fibrillation (PoAF). development (OR 1.001; 95% CI 1.000-1.001; P=0.033). We did not Methods: In this retrospective observational comparative found difference between groups in terms of troponin T, inotropic study, 255 patients who underwent isolated on-pump coronary drug support, need for intraaortic balloon pump and mortality. artery bypass grafting, between January 2019 and November Conclusion: This study showed that DNC can be used safely 2019, were enrolled. The patients were divided into two groups: in adult coronary bypass surgery and PoAF development effect DNC (n=132) and blood cardioplegia (BC) (n=123).
  • Bentall Procedure: Quarter Century of Clinical Experiences of a Single

    Bentall Procedure: Quarter Century of Clinical Experiences of a Single

    Benke et al. Journal of Cardiothoracic Surgery (2016) 11:19 DOI 10.1186/s13019-016-0418-y RESEARCHARTICLE Open Access Bentall procedure: quarter century of clinical experiences of a single surgeon Kálmán Benke1,3*, Bence Ágg1,3, Lilla Szabó1, Bálint Szilveszter1,4, Balázs Odler2, Miklós Pólos1, Chun Cao1, Pál Maurovich-Horvat1,4, Tamás Radovits1, Béla Merkely1 and Zoltán Szabolcs1,3 Abstract Background: We retrospectively analyzed 25 years of experiences with the button Bentall procedure in patients with aortic root pathologies. Even though this procedure has become widespread, there are only a few very long term follow-ups available in the clinical literature, especially regarding single surgeon results. Methods: Between 1988 and 2013, a total of 147 patients underwent the Bentall procedure by the same surgeon. Among them there were 62 patients with Marfan syndrome. At the time of the surgery the mean age was 46.5 ± 17.6 years. The impact of surgical experience on long-term survival was evaluated using a cumulative sum analysis chart. Results: The Kaplan-Meier estimated overall survival rates for the 147 patients were 91.8 ± 2.3 %, 84.3 ± 3.1 %, 76.3 ± 4.9 % and 59.5 ± 10.7 % at 1,5,10 and 20 years, respectively. Multivariate Cox regression analysis identified EuroSCORE II over 3 % (OR 4.245, 95 % CI, 1.739–10.364, p = 0.002), acute indication (OR 2.942, 95 % CI, 1.158–7.480, p = 0.023), use of deep hypothermic circulatory arrest (OR 3.267, 95 % CI, 1.283–8.323, p = 0.013), chronic kidney disease (OR 6.865, 95 % CI, 1.339–35.189, p = 0.021) and early complication (OR 3.134, 95 % CI, 1.246–7.883, p = 0.015) as significant risk factors for the late overall death.
  • A Common Occurrence After Coronary Bypass Surgery

    A Common Occurrence After Coronary Bypass Surgery

    CORE Metadata, citation and similar papers at core.ac.uk Provided by Elsevier - Publisher Connector lACC Vol. 15, No.6 1261 May 1990:1261-9 Acute Myocardial Dysfunction and Recovery: A Common Occurrence After Coronary Bypass Surgery WARREN M. BREISBLATT, MD, FACC, KEITH L. STEIN, MD, CYNTHIA J. WOLFE, RN, WILLIAM P. FOLLANSBEE, MD, FACC, JOHN CAPOZZI, CNMT, JOHN M. ARMITAGE, MD, ROBERT L. HARDESTY, MD, FACC Pittsburgh, Pennsylvania To evaluate whether acute myocardial dysfunction was min after coronary bypass and showed complete recovery common in the early postoperative period, serial hemody• within 48 h. Left ventricular end-systolic and end-diastolic namic measurements and radionuclide evaluation of ven• volume index increased significantly postoperatively, but tricular function were performed before and after opera• recovery in left ventricular ejection fraction was mostly due tion in 24 patients undergoing elective coronary bypass to decreases in end-systolic volume index (50 ± 22 ml at surgery. All patients had uncomplicated surgery, and no trough and 32 ± 16 ml at recovery). Depressed myocardial patient sustained an intraoperative infarction. In 96% of function was independent of bypass time, number of grafts patients, significant depression in right and left ventricular placed, preoperative medications or core temperatures ejection fraction was seen postoperatively, reaching a nadir postoperatively. Postoperative therapy with pressors or at 262 ± 116 min after coronary bypass. Left ventricular inotropic agents delayed but did
  • Selected Terms Used in Adult Congenital Heart Disease Jack M

    Selected Terms Used in Adult Congenital Heart Disease Jack M

    SELECTED TERMS USED IN ADULT CONGENITAL HEART DISEASE JACK M. COLMAN | ERWIN NOTKER OECHSLIN | MATTHIAS GREUTMANN | DANIEL TOBLER ambiguus A With reference to cardiac situs, neither right nor left sided aberrant innominate artery (indeterminate). Latin spelling is generally used for situs ambig- A rare abnormality associated with right aortic arch compris- uus. Syn: ambiguous sidedness. See also situs. ing a sequence of arteries arising from the aortic arch—right carotid artery, right subclavian artery, and then (left) innomi- Amplatzer device nate artery—with the last passing behind the esophagus. This A group of self-centering devices delivered percutaneously by is in contrast to the general rule that the first arch artery gives catheter for closure of abnormal intracardiac and vascular con- rise to the carotid artery contralateral to the side of the aortic nections such as secundum atrial septal defect, patent foramen arch (ie, right carotid artery in left aortic arch and left carotid ovale or patent ductus arteriosus. artery in right aortic arch). Syn: retroesophageal innominate artery. Anderson-Fabry disease See Fabry disease aberrant subclavian artery Right subclavian artery arising from the aorta distal to the left aneurysm of sinus of Valsalva subclavian artery. Left aortic arch with (retroesophageal) aber- See sinus of Valsalva/aneurysm. rant right subclavian artery is the most common aortic arch anomaly. It was first described in 1735 by Hunauld and occurs anomalous pulmonary venous connection in 0.5% of the general population. Syn: lusorian artery. See also Pulmonary venous connection to the right side of the heart, vascular ring. which may be total or partial.
  • Appendix A: Surgical Procedure Terms and Definitions

    Appendix A: Surgical Procedure Terms and Definitions

    Appendix A: Surgical Procedure Terms and Definitions Anomalous Systemic Venous Connection Anomalous Systemic Venous Connection Repair Repair includes a range of surgical approaches, including, among others: ligation of anomalous vessels, reimplantation of anomalous vessels (with or without use of a conduit), or redirection of anomalous systemic venous flow through directly to the pulmonary circulation (bidirectional Glenn to redirect LSVC or RSVC to left or right pulmonary artery, respectively). Aortic Aneurysm Aortic aneurysm repair Aortic aneurysm repair by any technique. Aortic Dissection Aortic Dissection repair Aortic dissection repair by any technique. Aortic Root Replacement Aortic Root Replacement, Bioprosthetic Replacement of the aortic root (that portion of the aorta attached to the heart; it gives rise to the coronary arteries) with a bioprosthesis (e.g., porcine) in a conduit, often composite. Aortic Root Replacement, Mechanical Replacement of the aortic root (that portion of the aorta attached to the heart; it gives rise to the coronary arteries) with a mechanical prosthesis in a composite conduit. Aortic Root Replacement, Homograft Replacement of the aortic root (that portion of the aorta attached to the heart; it gives rise to the coronary arteries) with a homograft Aortic Root Replacement, Valve sparing Replacement of the aortic root (that portion of the aorta attached to the heart; it gives rise to the coronary arteries) without replacing the aortic valve (using a tube graft). Aortic Valve Disease Ross Procedure Replacement of the aortic valve with a pulmonary autograft and replacement of the pulmonary valve with a homograft conduit. Konno Procedure (with and without aortic valve replacement) Relief of left ventricular outflow tract obstruction associated with aortic annular hypoplasia, aortic valvar stenosis and/or aortic valvar insufficiency via Konno aortoventriculoplasty.
  • Surgical Treatment

    Surgical Treatment

    Arch Dis Child: first published as 10.1136/adc.58.2.137 on 1 February 1983. Downloaded from Archives of Disease in Childhood, 1983, 58, 137-141 Congenital heart disease in the neonate: results of surgical treatment E L BOVE, C BULL, J STARK, M DE LEVAL, F J MACARTNEY, AND J F N TAYLOR Thoracic Unit, The Hospitalfor Sick Children, London SUMMARY All 212 neonates undergoing cardiac surgery at this hospital during the 5-year period from 1976 to 1980 inclusive were reviewed. Forty required open heart surgery with 23 (57%) deaths. One hundred and seventy-four neonates underwent non-bypass procedures and could be divided into three groups: group 1 (82 patients) had inadequate pulmonary blood flow, group 2 (33 patients) had increased pulmonary blood flow or inadequate mixing, and group 3 (59 patients) had coarctation of the aorta, alone or with associated lesions. Forty-four (25 %) of the neonates undergoing non- bypass procedures died. Two required bypass surgery later in the first month of life. Metabolic acidosis and the need for preoperative respiratory support were appreciably greater in non-surviving patients. The spectrum of diagnoses encountered and types of operative procedures performed are analysed. Refinements in the surgical treatment of congenital Bypass procedures. Forty patients underwent pro- heart disease in the neonate continue to evolve. cedures involving cardiopulmonary bypass. Neonates copyright. Previous reports of cardiac surgery in the newborn constitute only 3-5 % of our patients undergoing have shown small numbers of patients and a high such operations as the procedures were undertaken operative mortality.1-35-8 The form of treatment only when both the cardiologist and surgeon caring chosen depends on the complexity of the cardiac for the patient felt that survival was unlikely without anomaly as well as the overall condition of the open heart surgery.
  • CARDIOPLEGIA SOLUTION a (Solution)

    CARDIOPLEGIA SOLUTION a (Solution)

    NEW ZEALAND DATA SHEET 1 CARDIOPLEGIA SOLUTION A (solution) 2 QUALITATIVE AND QUANTITATIVE COMPOSITION Each 1000mL contains the following active substances: Sodium chloride B.P. 6.43g Potassium chloride B.P. 1.19g Magnesium chloride hexahydrate B.P. 3.25g Calcium chloride dihydrate B.P. 176mg The mixture contains the following ions in 1000mL: Sodium 110mmol Magnesium 16mmol Chloride 160mmol Potassium 16mmol Calcium 1.2mmol For the full list of excipients, see Section 6.1. 3 PHARMACEUTICAL FORM Solution. Cardioplegia Solution A is a sterile, non‐pyrogenic solution for cardiac perfusion in a Viaflex bag. It is used to induce cardiac stasis and to protect the myocardium during open‐heart surgery. Cardioplegia Solution A is an isotonic crystalloid solution based on extracellular fluid ionic concentrations. Approximate osmolality is 275mOsm/kg and approximate pH is 3.7. Cardioplegia Solution A requires the aseptic addition of 10mL Sodium Bicarbonate 8.4% w/v Injection B.P. prior to use to adjust the pH to 7.4 ‐ 7.8. Following pH adjustment the total sodium ionic concentration is 120mmol/L. 4 CLINICAL PARTICULARS 4.1 Therapeutic indications Following pH adjustment with 10mL of Sodium Bicarbonate 8.4% w/v Injection B.P., Cardioplegia Solution A is used in combination with ischaemia and hypothermia to induce cardiac arrest during open heart surgery and to preserve the myocardium during asystole. 4.2 Dose and method of administration It is important that an appropriate dose of Cardioplegia Solution A is used to ensure that all areas of the myocardium are cooled evenly, especially those areas distal to arterial obstruction in patients with coronary‐artery disease.
  • Macdonald N Phd Final 130919

    Macdonald N Phd Final 130919

    Barriers to the Use of Goal Directed Therapy in a High Risk Surgical Patient Group A thesis submitted in fulfilment of the requirements of the degree of Doctor of Philosophy Neil MacDonald William Harvey Research Institute Barts and the London School of Medicine and Dentistry Queen Mary University of London 1 DECLARATION I, Neil MacDonald, confirm that the research included within this thesis is my own work or that where it has been carried out in collaboration with, or supported by, others that this is duly acknowledged below, and my contribution indicated. The work in chapter three is a result of large collaborative project and my contribution is outlined in chapter two. Previously published material is also acknowledged below. I attest that I have exercised reasonable care to ensure that the work is original, and does not to the best of my knowledge break any UK law, infringe any third party’s copyright or other Intellectual Property Right, or contain any confidential material. I accept that the College has the right to use plagiarism detection software to check the electronic version of the thesis. I confirm that this thesis has not been previously submitted for the award of a degree by this or any other university. The copyright of this thesis rests with the author and no quotation from it or information derived from it may be published without the prior written consent of the author. Neil MacDonald 2 LIST OF COLLABORATION AND PUBLICATIONS Rupert M. Pearse, David A. Harrison, Neil MacDonald, Michael A. Gillies, Mark Blunt et al for the OPTIMISE study group.
  • 42 Pericardiocentesis (Perform) 341

    42 Pericardiocentesis (Perform) 341

    PROCEDURE Pericardiocentesis (Perform) 42 Kathleen M. Cox PURPOSE: Pericardiocentesis is the removal of excess fl uid from the pericardial sac for identifi cation of the etiology of pericardial effusion by fl uid analysis (diagnostic pericardiocentesis) and/or prevention or treatment of cardiac tamponade (therapeutic pericardiocentesis). result of trauma, myocardial infarction, or iatrogenic PREREQUISITE NURSING injury, whereas chronic effusions can result from condi- KNOWLEDGE tions such as bacterial or viral pericarditis, cancer, autoim- mune disorders, uremia, etc. 2 With a decrease in cardiac • Advanced cardiac life support (ACLS) knowledge and output, the patient often develops chest pain, dyspnea, skills are required. tachycardia, tachypnea, pallor, cyanosis, impaired cere- • Knowledge and skills related to sterile technique are bral and renal function, diaphoresis, hypotension, neck needed. vein distention, distant or faint heart sounds, and pulsus • Clinical and technical competence in the performance of paradoxus. 4 pericardiocentesis is required. • The amount of fl uid in the pericardium is evaluated • Knowledge of cardiovascular anatomy and physiology is through chest radiograph, two-dimensional echocardio- needed. gram, electrocardiography (ECG), and clinical fi ndings. • The pericardial space normally contains 20–50 mL of Chest x-rays may not be diagnostically signifi cant in fl uid. patients with acute traumatic tamponade. 6 • Pericardial fl uid has electrolyte and protein profi les similar • Pericardiocentesis to remove fl uid from the pericardial to plasma. sac is performed therapeutically to relieve tamponade or • Pericardial effusion is generally defi ned as the accumula- to diagnose the etiology of the effusion. An acute tampon- tion of fl uid within the pericardial sac that exceeds the ade resulting in hemodynamic instability necessitates an stretch capacity of the pericardium, generally more than emergency procedure.
  • Complete Draft Code Set Table of Contents

    Complete Draft Code Set Table of Contents

    Draft 2012 Procedural Coding System ICD~10~PCS Complete Draft Code Set Table of Contents Introduction . 1 Eye 080–08Y . 75 The ICD-10 Procedure Coding System (ICD-10-PCS) . 1 Ear Nose and Sinus 090–09W . 86 Introduction . 1 Respiratory System 0B1–0BY . 99 General Development Principles . 1 Mouth and Throat 0C0–0CX . 112 ICD-10-PCS Structure . .. 1 Gastrointestinal System 0D1–0DY . 123 ICD-10-PCS Format . 1 Hepatobiliary System and Pancreas 0F1–0FY . 141 Medical and Surgical Section (0) . 2 Endocrine System 0G2–0GW . 150 Obstetrics Section . 5 Skin and Breast 0H0–0HY . 155 Placement Section . 5 Subcutaneous Tissue and Fascia 0J0–0JX . .166 Administration Section . 6 Muscles 0K2–0KX . 181 Measurement and Monitoring Section . 6 Tendons 0L2–0LX . 189 Extracorporeal Assistance and Performance Section . 7 Bursae and Ligaments 0M2–0MX . .197 Extracorporeal Therapies Section . 7 Head and Facial Bones 0N2–0NW . 207 Osteopathic Section . 7 Upper Bones 0P2–0PW . 217 Other Procedures Section . 8 Lower Bones 0Q2–0QW . 227 Chiropractic Section . 8 Upper Joints 0R2–0RW . 237 Imaging Section . 8 Lower Joints 0S2–0SW . 249 Nuclear Medicine Section . 9 Urinary System 0T1–0TY . 262 Radiation Oncology Section . 9 Female Reproductive System 0U1–0UY . 272 Physical Rehabilitation and Diagnostic Audiology Male Reproductive System 0V1–0VW . 284 Section . 10 Anatomical Regions, General 0W0–0WW . 295 Mental Health Section . 10 Anatomical Regions, Upper Extremities 0X0–0XX . 303 Substance Abuse Treatment Section . 10 Anatomical Regions, Lower Extremities 0Y0–0YR . 309 Modifications to ICD-10-PCS . 10 Obstetrics 102–10Y . 315 Number of Codes in ICD-10-PCS . 11 Placement, Anatomical Regions 2W0–2W6 .