Richmondmonrad1903
g and neck circumference can predict OSA.
Transcatheter paravalvular leak (PVL) closure in recent times has emerged as a safe and effective alternate to redo-surgical repair. We sought to examine the clinical efficacy and safety of percutaneous PVL closure at our center.
A retrospective study from August 2012 to December 2019 of 19 patients who underwent 21 procedures for PVL closure. The mean age was 49.25 ± 14.72 years. The target valve was mitral in 11 (57%) and aortic in 7 (36%) cases. One (5%) patient had prosthetic valve in left atrioventricular valve with congenitally corrected transposition of great arteries. Majority of the cohort presented with heart failure without hemolysis (89%), with most of them being in NYHA functional class III (57%) or class IV (21%). A procedural success of 85% was achieved. Post procedure severity of regurgitation reduced from severe in thirteen patients and moderate in six patients to moderate in two patients and mild in fourteen patients. Symptomatic improvement was observed in all cases who had successful closure with NYHA function class improving from 3 ± 0.64 to 1.6 ± 0.94. The mean follow-up duration was 21 ± 13 months (median 24 months). There was one (4.7%) mortality with cumulative survival from all-cause mortality of 95%.
The results of percutaneous PVL closure appear encouraging in our series with modest number of patients and offers a promising alternative to redo-surgery in this high-risk cohort.
The results of percutaneous PVL closure appear encouraging in our series with modest number of patients and offers a promising alternative to redo-surgery in this high-risk cohort.
Postoperative delirium (POD) is a common complication in cardiac surgery especially in elderly population which can lead to a delay of weaning from ventilator and extubation. Cardiopulmonary bypass (CPB)-induced inflammation is related to POD. Anti-inflammatory effect of anesthetic agent might attenuate POD.
The present study was primarily aimed to compare within-24-h POD between ketamine-based anesthesia and propofol-based anesthesia during CPB. The secondary objective was to identify risk factors associated with within-24-h POD.
Our study was a randomized controlled trial in patients undergoing cardiac surgery with CPB. Enrolling patients were aged >65 years, and able to comprehensive communication. Exclusion criteria were aortic surgery, cognitive disorders, cerebrovascular and carotid disease, and positive result of preoperative CAM-ICU.
Patients were randomly assigned to group Ketamine infusion of 1 mg/kg/h and group Propofol infusion of 1.5-6 mg/kg/h during CPB. POD was evaluated by validatederative inflammation was a significant prediction of 24-h POD.
Cardiopulmonary bypass (CPB) induced acute lung injury is accounted for most of the post-operative pulmonary dysfunction which leads to decreased compliance and hypoxemia. Airway Pressure Release Ventilation (APRV) as compared to other modes of ventilation has shown to improve gas exchange in Acute lung injury (ALI)/Acute respiratory distress syndrome (ARDS) lungs.
We hypothesized APRV as a better primary mode of postoperative ventilation in adult post-cardiac surgery patients.
The study included 90 postoperative surgical patients, which were randomized into three groups SIMV-PC(P), APRV(A), and SIMV-VC(V) with 30 patients in each group.
Lung compliance and serial arterial blood gas were assessed at regular intervals. PaO
/FiO
ratio (a measure of oxygenation) and lung compliance were used as an indirect indicator for improvement in lung function. Hemodynamic parameters were closely observed for all the patients.
Statistical analysis was done using 'R' software.
There was a statistically significant improvement in PaO2/FiO2 ratio in the APRV group as compared to other groups. There was also an improvement in lung compliance after 6 h of ventilation and lesser duration of ventilation in the APRV group. However, it was not statistically significant.
Our study suggests that APRV can be a useful alternative primary mode of ventilation to improve lung compliance and oxygenation in adult post-cardiac surgical patients.
Our study suggests that APRV can be a useful alternative primary mode of ventilation to improve lung compliance and oxygenation in adult post-cardiac surgical patients.
In this study we compared noninvasive arterial pressure measurement using ClearSight™ vascular-unloading-technique (Edwards Lifesciences Corp, Irvine, CA) with invasive arterial pressure measurement during induction of anesthesia undergoing mayor cardiac surgery.
Prospective, monocentric.
University hospital.
54 patients undergoing mayor cardiac surgery.
During induction all patients were simultaneously monitored with invasive (reference method) and noninvasive arterial pressure measurement (test-method) over a mean time period of 27 minutes.
We observed slightly lower systolic and mean arterial pressures noninvasive than invasive. For systolic arterial pressure the mean of the differences was -18,05 mmHg (p < 0,05, SD ±16,78 mmHg), the mean arterial pressure MAP -5,47 mmHg (p < 0,05, SD ±11,08 mmHg) and for diastolic pressure -1,09 mmHg (p < 0,05, SD±11,15 mmHg),. The mean of the differences in heartrate was 1,15 (p < 0,05, SD±6,9 mmHg). click here When considering all measured values of the invrement offers sufficient security to safely initiate anesthesia, especially when MAP is of particular interest. The use of non-invasive arterial blood pressure measurement with ClearSight ™ during induction of anesthesia in patients scheduled for major cardiac surgery is reliable and easy to use.Cemento-osseous dysplasia is non-neoplastic, reactive fibro-osseous lesions that affect the tooth-bearing areas of the jaws. Osseous dysplasia is further divided into three subtypes Periapical osseous dysplasia, focal osseous dysplasia, and florid osseous dysplasia. We hereby, present a case of florid cemento-osseous dysplasia occurring in a 40-year old dentulous Indian woman. The patient presented with lesions involving the mandibular right and left quadrant.
