Right ventricular failure after left ventricular assist device implantation: the need for an implantable right ventricular assist device

Right ventricular failure after implantation of a left ventricular assist device is an unremitting problem. Consideration of portal circulation is important for reversing liver dysfunction and preventing multiple organ failure after left ventricular assist device implantation. To achieve these objectives, it is imperative to maintain the central venous pressure as low as possible. A more positive application of right ventricular assistance is recommended. Implantable pulsatile left ventricular assist devices cannot be used as a right ventricular assist device because of their structure and device size. To improve future prospects, it is necessary to develop an implantable right ventricular assist device based on a rotary blood pump.     

Surgical treatment for right ventricular perforation caused by transvenous pacing electrodes: A report of three cases

We experienced three cases of right ventricular perforation that were induced by transvenous pacing electrodes. The patients were a 72-year-old man who underwent percutaneous transluminal coronary recanalization and angioplasty, an 80-year-old woman who had temporary transvenous pacing for a complete atrioventricular block induced by acute valvular heart failure, and a 44-year-old man who had received a permanent pacemaker. All three patients were treated surgically. The first and second patients demonstrated either cardiac tamponade or hemopericardium necessitating pericardial drainage. Spontaneous hemostasis did not occur in cases 1 and 2, due to either anticoagulant therapy or myocardial degeneration. Such patients require surgical closure of the perforation and pericardial drainage as soon as pericardial effusion is confirmed. In contrast, middle-aged individuals without myocardial damage, such as patient 3, need only a simple removal and repositioning of the electrode followed by serial echocardiography.     

腹腔镜手术、开腹手术及保守治疗胃十二指肠溃疡穿孔的对比研究

目的:探讨腹腔镜手术、开腹手术及保守治疗胃十二指肠溃疡穿孔的特点与临床疗效。方法:回顾分析2005年1月至2012年12月237例胃十二指肠溃疡穿孔患者的临床资料,其中56例行腹腔镜手术,147例行传统开腹手术,34例采用非手术治疗,对比3组患者全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)症状改善时间、手术时间、肠蠕动恢复时间、并发症、住院时间、住院花费等指标。结果:腹腔镜组在SIRS症状改善时间、肠蠕动恢复时间、腹腔脓肿与胸腔积液例数、住院时间方面明显优于非手术组与开腹手术组(P<0.05);术中出血量、切口感染例数、术后镇痛次数、术后粘连性肠梗阻发生例数明显少于开腹手术组(P<0.05);手术时间与开腹手术组相比差异无统计学意义(P>0.05);3组患者住院花费差异无统计学意义(P>0.05)。结论:腹腔镜胃十二指肠溃疡穿孔修补术具有患者创伤小、并发症少、疗效显著等优点,体现了微创手术的优越性,是目前治疗胃十二指肠溃疡穿孔的理想方法。     

Left ventricular true aneurysm with pseudo-aneurysm detected five years and nine months following repair for oozing type free wall rupture

A case of true aneurysm of the left ventricle associated with pseudoaneurysm was treated surgically. The condition was detected five years and nine months following repair of an oozing type left ventricular free wall rupture due to myocardial infarction. Over this period, chest radiographs showed gradual cardiomegaly with prominence of the left fourth arch.     

Right ventricular performance during hypotension induced by prostaglandin E1, nicardipine HCl, glycerine trinitrate, and isosorbide dinitrate

This study investigated right ventricular (RV) performance during hypotensive anesthesia and compared the effect of the vasodilators prostaglandin E₁ (PGE₁), nicardipine HCl (Nic), glycerin trinitrate (GTN), and isosorbide dinitrate (ISDN) on RV function. Fifty patients were allocated into four groups [PGE₁ (n=20), Nic (n=10), GTN (n=10), and ISDN (n=10)] in random order. Pulmonary and RV hemodynamics were measured using a rapid-response thermodilution catheter before and during induced hypotension, when systolic arterial pressure was maintained at 80 mmHg. In the PGE₁, GTN, and ISDN groups, RV end-diastolic volume (RVEDV) and pulmonary vascular resistance were reduced in a similar manner. However, RV ejection fraction increased only in the PGE₁ group, and as a consequence, RV stroke volume (RVSV) was maintained. Nic did not change the RV parameters observed, but reduced only systemic vascular resistance (SVR). PGE₁ enhanced RV function during induced hypotension. Nic was a useful alternative agent for hypotensive anesthesia. GTN and ISDN reduced RV preload and RVSV; however, cardiac output was maintained by increasing heart rate (HR). Therefore, such nitrates should be used under an adequate RV preload.     

Changes in left ventricular end-diastolic area, end-systolic wall stress, and fractional area change during anesthetic induction with propofol or thiamylal

Purpose. To elucidate the mechanisms of the more profound hypotensive effects of propofol relative to thiamylal, we monitored changes in left ventricular (LV) preload, afterload, and contractility during the course of anesthetic induction with propofol and thiamylal. Methods. Thirty-two patients (ASA I) were randomly assigned into two groups and injected with propofol (2 mg·kg⁻¹) or thiamylal (4 mg·kg⁻¹) as anesthetic induction agents. Transthoracic echocardiography (TTE) was used to assess LV performance before and during induction by the two anesthetics. The LV end-diastolic area (EDA) and LV end-systolic wall stress (ESWS) were used as indices of LV preload and LV afterload, respectively, while LV contractility was assessed by the fractional area change (FAC). Results. Both propofol and thiamylal significantly reduced EDA and ESWS without significant change in FAC. Propofol-induced reductions in EDA and ESWS were significantly greater than those of thiamylal. Conclusion. The more profound hypotension observed during induction of anesthesia with propofol is due to the greater decrease in preload and afterload than with thiamylal, but not to a decrease in LV contractility. Received: December 8, 1999 / Accepted: April 19, 2000     

Left ventricular assist device insertion and open abdominal aortic aneurysm repair in same admission for an end-stage heart failure patient

Patients suffering from end-stage heart failure also suffer from multiple cardiovascular comorbidities such as abdominal aortic aneurysm (AAA). Mechanical support with left ventricular assist device with open repair of AAA repair has rarely been reported in literature. The authors describe a 60-year-old male with end-stage heart failure and a symptomatic AAA with sequential left ventricular assist device insertion and open AAA repair with aortic cross-clamping.     

介入诊疗室间隔缺损中应用两种剂量对比剂的显像效果

目的观察儿童室间隔缺损（VSD）介入诊治中采用两种对比剂剂量进行造影的图像质量,探讨使用小剂量对比剂的可行性。方法回顾205例先天性VSD介入治疗成功患儿的影像资料,按对比剂用量分为1.0 ml/kg组（n=96）和1.5 ml/kg组（n=109）,注射速率为体质量（kg）×1 ml/s,分别评价影像质量;统计VSD宽度和封堵器柱状部直径的差值;对两组病例的影像质量得分、对比剂用量、曝光时间、造影图像显示帧数进行统计分析。结果两组的影像质量（P=0.338）、VSD宽度和封堵器柱状部直径的差值（P=0.983）差异无统计学意义,均可满足介入诊疗的要求;1.0 ml/kg组较1.5 ml/kg组对比剂量减少33.33%,曝光时间缩短15.38%,造影像帧数减少34.88%（P〈0.05）。结论小儿先天性VSD介入诊疗中,使用1.0 ml/kg体质量对比剂量1 s内注射,可满足诊疗要求,缩短曝光时间,减少辐射剂量。