1/198. Fatal cardiac ischaemia associated with prolonged desflurane anaesthesia and administration of exogenous catecholamines.PURPOSE: Four cardiac ischaemic events are reported during and after prolonged anaesthesia with desflurane. CLINICAL FEATURES: We have evaluated desflurane in 21 consecutive patients undergoing advanced head and neck reconstructive surgery. Four deaths occurred which were associated with cardiac ischaemic syndromes either during or immediately after operation. All patients in the study received a similar anaesthetic. This comprised induction with propofol and maintenance with alfentanil and desflurane in oxygen-enriched air. Inotropic support (either dopamine or dobutamine in low dose, 5 micrograms.kg.min-1) was provided as part of the anaesthetic technique in all patients. Critical cardiovascular incidents were observed in each of the four patients during surgery. These were either sudden bradycardia or tachycardia associated with ST-segment electrocardiographic changes. The four patients who died had a documented past history of coronary heart disease and were classified American Society of Anesthesiologists (ASA) II or III. One patient (#2) did not survive anaesthesia and surgery and the three others died on the first, second and twelfth postoperative days. Enzyme increases (CK/CK-MB) were available in three patients and confirmed myocardial ischaemia. CONCLUSION: These cases represent an unexpected increase in the immediate postoperative mortality for these types of patients and this anaesthetic sequence.- - - - - - - - - - ranking = 1keywords = cardiac, sudden, death (Clic here for more details about this article) |
2/198. Pulmonary rhizopus rhizopodiformis cavitary abscess in a cardiac allograft recipient.Pulmonary mucormycosis is rare in solid organ transplant recipients. Only one case has been reported previously in a cardiac allograft recipient. However, the rhizopus species in that study was not identified. We report a case of successful surgical treatment of pulmonary cavitary mucormycosis due to rhizopus rhizopodiformis in a cardiac allograft transplant recipient. A review of the literature on pulmonary mucormycosis occurring in solid organ transplant recipients is also presented.- - - - - - - - - - ranking = 0.98977459697135keywords = cardiac (Clic here for more details about this article) |
3/198. Giant cervico-mediastinal lipoma. A clinical case.The lipoma is a circumscribed mesenchymal tumour originating from adipose tissue. The lesion is usually small and asymptomatic, and is most frequently located in the neck region. The case of a 77-year-old woman with chronic extrasystolic arrhythmia caused by a non-specified ischemic cardiopathy is reported. The woman presented a swelling at the front of her neck, observed for the first time about 6 months previously. This swelling progressively increased in size, provoking dysphagia, dysphonia, persistent cough, dyspnea, light jugular turgor and palpitations. Chest x-rays showed and opaque area at the front of the neck, which extended beyond the jugular incisure by about 2 cm. NMR of the neck showed a gross lipomatous formation at the front, mainly of the left, continuing in the front mediastinal region; the trachea was dislocated to the right and compressed at the back; the vasculo-nervous fasciculus, especially on the left, was compressed and enveloped by the adipose formation. The Holter test confirmed the presence of ventricular and supra-ventricular extrasystoles. Surgery was carried out under local anaesthesia because the displacement of the laryngo-tracheal axes precluded intubation. Histological analysis of the 9 x 4 x 2.2 cm mass confirmed the diagnosis of lipoma. After removal of the mass all the symptoms, which had been provoked by compression, as well as the cardiac arrhythmias disappeared. The prompt disappearance of the latter was particularly surprising. The possibility of the external compression of the nervous structures of the neck should be taken into consideration in cases of ventricular arrhythmia of unknown origin, and systematic study of the region carried out.- - - - - - - - - - ranking = 0.16496243282856keywords = cardiac (Clic here for more details about this article) |
4/198. myocardial bridging as a cause of acute transient left heart dysfunction.The significance of myocardial bridging is still a matter of debate, and although several reports have underlined its pathologic potential, myocardial bridging is often considered to be a benign phenomenon. We present here the case of a 63-year-old woman with a history of acute left heart failure and ECG evidence of ischemia, and whose primary abnormality on extensive workup was myocardial bridging. This case further underlines that myocardial bridging can lead to significant cardiac events.- - - - - - - - - - ranking = 0.16496243282856keywords = cardiac (Clic here for more details about this article) |
5/198. Anesthetic management of high-risk cardiac patients undergoing noncardiac surgery under the support of intraaortic balloon pump.patients with severely impaired left ventricular function, an uncorrectable coronary artery disease, and a recent myocardial infarction are at high risk of cardiac complications after major noncardiac surgery. We present two patients with extensive three-vessel coronary artery disease who underwent intraperitoneal surgery under the support of intraaortic balloon pump (IABP). In one patient, the IABP was inserted urgently because of the development of chest pain with significant ST depression on arrival in the operating room, and the other patient was managed with prophylactic IABP. There were no intraoperative or postoperative cardiac events in either patient. Thus, IABP should be considered in the perioperative management of patients with severe cardiac diseases.- - - - - - - - - - ranking = 1.9795491939427keywords = cardiac (Clic here for more details about this article) |
6/198. Sudden natural death 'at the wheel': a retrospective study over a 15-year time period (1982-1996).In order to investigate the incidence and implications of sudden natural death at the wheel, a retrospective study was carried out over a 15-year time period ranging from 1982 until 1996. During this time period 147 drivers of motor vehicles were found out of 34,554 cases examined at the Institute of Legal medicine, Ludwig-Maximilians University, Munich, germany. There were 13 females and 134 males and the mean age was 56.8 years (range 20-86 years). The main cause of death was ischemic heart disease which was found in 113 cases. There were mainly minor injuries to the driver, or to other passengers, or to other road users and only minor property damage. Our study confirms previous investigations that sudden natural death at the wheel is a rare event in proportion to unnatural death at the wheel and is not a substantial threat to other road users. Despite existing guidelines for granting a driving licence, medical screening to exclude high risk patients from driving cannot prevent the occurrence of sudden natural death at the wheel.- - - - - - - - - - ranking = 0.051890103448884keywords = sudden, death (Clic here for more details about this article) |
7/198. Stenting of an unprotected left main coronary artery stenosis in a cardiac transplant patient.Cardiac allograft vasculopathy is the leading cause of death in cardiac transplant patients who survive the first year. Retransplantation is limited by shortage of donors and reduced survival rates compared with the initial transplant. Recent reports of successful stenting in these patients may offer some hope, although randomized trials are lacking. Successful stenting of an 'unprotected' left main coronary artery stenosis under cardiopulmonary support is presented in a cardiac transplant patient. A 16-month follow-up angiogram demonstrated a patent stent without restenosis and no interim clinical events.- - - - - - - - - - ranking = 0.99331024603184keywords = cardiac, death (Clic here for more details about this article) |
8/198. Prolonged perioperative myocardial ischemia in a young male: due to topical intranasal cocaine?We present a case of prolonged myocardial ischemia in a young healthy male presenting for nasal polypectomy and tonsillectomy. Induction of anesthesia proceeded uneventfully. Immediately after surgical incision, the patient developed a sinus tachycardia with ST-segment depression in leads II and III, and ST elevation in leads aVR, aVL, aVF, and V. Depth of anesthesia was increased, esmolol was administered, which slowed the heart rate, and the procedure was terminated. However, myocardial ischemia only gradually resolved, leaving residual T-wave flattening in lead III by day 3 postoperatively. After extensive investigation to rule out other causes of ischemia, we considered cardiotoxicity due to intranasally administered cocaine with epinephrine to be the most likely precipitant. Nasal packing with gauze soaked in a solution containing cocaine 3 mg/kg and epinephrine 1 mg occurred just 40 minutes prior to induction of anesthesia. Topical intranasal cocaine is rapidly and reliably absorbed systemically, with peak plasma concentrations occurring within 30 to 60 minutes, corresponding to the time course of cocaine administration and surgical stimulation in this patient. Systemic absorption of topical intranasal cocaine has previously been reported to cause adverse cardiac sequelae, including myocardial infarction. This report reinforces the need for caution regarding the use of topical intranasal cocaine, particularly if used in combination with epinephrine.- - - - - - - - - - ranking = 0.16496243282856keywords = cardiac (Clic here for more details about this article) |
9/198. myocardial bridging.Human myocardial bridging is a normal anatomic variation in which a coronary artery is bridged by a short segment of myocardium. It can cause variable degrees of systolic obstruction. The majority of patients are asymptomatic. A wide variety of syndromes can occur, including myocardial infarction and sudden death. All patients with myocardial bridges have systolic artery compression, but it is postulated that ischemia develops only in those who have a concomitant decrease in diastolic coronary artery blood flow. Surgical removal of the myocardial bridge can be curative, and various other treatments can alleviate symptoms. The overall prognosis is good.- - - - - - - - - - ranking = 0.023650057997992keywords = sudden death, sudden, death (Clic here for more details about this article) |
10/198. First clinical experience with the DeBakey VAD continuous-axial-flow pump for bridge to transplantation.BACKGROUND: A shortage of donor organs and increased numbers of deaths of patients on the waiting list for cardiac transplantation make mechanical circulatory support for a bridge to transplantation a standard clinical procedure. Continuous-flow rotary blood pumps offer exciting new perspectives. methods AND RESULTS: Two male patients (ages 44 and 65 years) suffering from end-stage left heart failure were implanted with a DeBakey VAD axial-flow pump for use as a bridge to transplant. In the initial postoperative period, the mean pump flow was 3.9 /-0.5 L/min, which equals a mean cardiac index (CI) of 2.3 /-0.2 L. min(-1). m(-2). In both patients, the early postoperative phase was characterized by a completely nonpulsatile flow profile. However, with the recovery of heart function 8 to 12 days after implantation, increasing pulse pressures became evident, and net flow rose to 4.5 /-0.6 L/min, causing an increase of mean CI up to 2.7 /-0.2 L. min(-1). m(-2). patients were mobilized and put through regular physical training. hemolysis stayed in the physiological range and increased only slightly from 2. 1 /-0.8 mg/dL before surgery to 3.3 /-1.8 mg/dL 6 weeks after implantation. CONCLUSIONS:The first clinical implants of the DeBakey VAD axial-flow pump have demonstrated the device to be a promising measure of bridge-to-transplant mechanical support.- - - - - - - - - - ranking = 0.3334605147176keywords = cardiac, death (Clic here for more details about this article) |
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