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Pubblicazioni recenti - cardiopulmonary
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Cardiopulmonary resuscitation in the prone position in the operating room or in the intensive care unit: a systematic review.
Anesth Analg2020 Oct;():. doi: 10.1213/ANE.0000000000005289.
Anez Cristobal, Becerra-Bolańos Ángel, Vives-Lopez Ariadna, Rodríguez-Pérez Aurelio,
Abstract
The prone position is commonly used in certain surgical procedures and to improve oxygenation in mechanically ventilated patients with acute respiratory distress syndrome (ARDS). Cardiorespiratory Arrest (CRA) in this position may be more challenging to treat because care providers trained in conventional CPR may not be familiar with CPR in the prone position. The aim of this systematic review is to provide an overview of current evidence regarding the methodology, efficacy and experience of Cardiopulmonary Resuscitation (CPR) in the prone position, in patients with the airway already secured. The search strategy included PubMed, Scopus and Google Scholar. All studies published up to April 2020 including Cardiorespiratory Arrest or Cardiopulmonary Resuscitation in the prone position were included. Out of the 268 articles located, 52 articles were included: 5 review articles, 8 clinical guidelines in which prone CPR was mentioned, 4 originals, 27 case reports, and 8 editorials or correspondences. Data from reviewed clinical studies confirm that CPR in the prone position is a reasonable alternative to supine CPR when the latter cannot be immediately implemented, and the airway is already secured. Defibrillation in the prone position is also possible. Familiarizing clinicians with CPR and defibrillation in the prone position may improve CPR performance in the prone position.
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Corticosteroids are associated with reduced skeletal muscle function in interstitial lung disease patients with mild dyspnea.
Respir Med2020 Oct;174():106184. doi: S0954-6111(20)30324-3.
Hanada Masatoshi, Ishimatsu Yuji, Sakamoto Noriho, Nagura Hiroki, Oikawa Masato, Morimoto Yosuke, Sato Shuntaro, Mukae Hiroshi, Kozu Ryo,
Abstract
BACKGROUND:
Interstitial lung diseases (ILDs) patients receiving steroid treatment tend to be immobilized by dyspnea and muscle weakness as the disease progresses. We therefore expected that steroid treatment for ILDs would have a greater effect on muscle function under severe dyspnea. To test this hypothesis, we evaluated whether the effect of corticosteroid treatment on peripheral muscle force and exercise capacity varied according to patients' dyspnea severity.
METHODS:
In this retrospective cross-sectional study of 87 ILD patients enrolled between 2008 and 2017, quadriceps force (QF), handgrip force (HF), and 6-min walk distance (6 MWD) were compared between a low (grades 0-2) and a high (grades 3-4) modified-Medical Research Council (mMRC) dyspnea scale score group.
RESULTS:
In patients with lower levels of dyspnea, corticosteroid treatments were associated with lower QF and HF (20.0 vs. 30.0 kgf, p = 0.01; 22.5 vs. 28.4 kgf, p = 0.03, respectively) values; however, no significant differences were observed between the corticosteroid and control subgroups in the high mMRC group (QF: 18.5 vs. 17.3 kgf, p = 0.64; HF: 21.0 vs. 17.1 kgf, p = 0.24, respectively). Analysis of covariance indicated that both corticosteroid treatment and mMRC dyspnea scale interacted with QF, HF, and 6 MWD. The effects of the corticosteroid treatment varied according to the level of dyspnea (interaction ? = 7.52, p = 0.034; interaction ? = 8.78, p = 0.048; interaction ? = 131.08, p < 0.001).
CONCLUSIONS:
Muscle weakness and exercise capacity in ILD patients in the low mMRC group were associated with corticosteroid treatment.
Copyright © 2020 Elsevier Ltd. All rights reserved.
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Outcomes in techniques of valve sparing aortic root replacement: A systematic review and meta-analysis.
J Card Surg2020 Oct;():. doi: 10.1111/jocs.15132.
Toh Steven, Ang Juliana, George Joel Jacob, Jayawardena Ovin, Mahbub Samiha, Harky Amer,
Abstract
OBJECTIVE:
To compare clinical outcomes of reimplantation versus remodeling in patients undergoing valve-sparing aortic root replacement (VSRR) surgery.
METHOD:
Electronic database search at PubMed, Scopus, Embase, Ovid, and Google scholar was performed from inception to January 2020. Primary outcomes were aortic valve (AV) reintervention and postoperative grade of aortic insufficiency (AI) while secondary outcomes were 30-day mortality, reoperation for bleeding, and operative times.
RESULTS:
A total of 21 articles met the inclusion criteria. A total of 1283 patients had reimplantation while 1150 had remodeling. No difference in preoperative demographics was noted except reimplantation patients were younger (48?±?16 vs. 56?±?15 years; p?
CONCLUSION:
Our study shows comparable clinical outcomes between both techniques. The practice of each technique is largely center and surgeon dependent. Larger sample size cohorts with minimal confounding factors are required to confirm the above findings.
© 2020 Wiley Periodicals LLC.
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The Use of Angiotensin II for the Treatment of Post-cardiopulmonary Bypass Vasoplegia.
Cardiovasc Drugs Ther2020 Oct;():. doi: 10.1007/s10557-020-07098-3.
Papazisi Olga, Palmen Meindert, Danser A H Jan,
Abstract
PURPOSE:
Vasoplegia is a common complication after cardiac surgery and is related to the use of cardiopulmonary bypass (CPB). Despite its association with increased morbidity and mortality, no consensus exists in terms of its treatment. In December 2017, angiotensin II (AII) was approved by the Food and Drug Administration (FDA) for use in vasodilatory shock; however, except for the ATHOS-3 trial, its use in vasoplegic patients that underwent cardiac surgery on CPB has mainly been reported in case reports. Thus, the aim of this review is to collect all the clinically relevant data and describe the pharmacologic mechanism, efficacy, and safety of this novel pharmacologic agent for the treatment of refractory vasoplegia in this population.
METHODS:
Two independent reviewers performed a systematic search in PubMed, Embase, Web of Science, and Cochrane Library using relevant MeSH terms (Angiotensin II, Vasoplegia, Cardiopulmonary Bypass, Cardiac Surgical Procedures).
RESULTS:
The literature search yielded 820 unique articles. In total, 9 studies were included. Of those, 2 were randomized clinical trials (RCTs) and 6 were case reports and 1 was a retrospective cohort study.
CONCLUSIONS:
AII appears to be a promising means of treatment for patients with post-operative vasoplegia. It is demonstrated to be effective in raising blood pressure, while no major adverse events have been reported. It remains uncertain whether this agent will be broadly available and whether it will be more advantageous in the clinical management of vasoplegia compared to other available vasopressors. For that reason, we should contain our eagerness and enthusiasm regarding its use until supplementary knowledge becomes available.
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Early and mid-term outcomes of total repair of tetralogy of Fallot through a right subaxillary thoracotomy.
Eur J Cardiothorac Surg2020 Nov;58(5):969-974. doi: 10.1093/ejcts/ezaa210.
An Guoying, Yang Weiwei, Zheng Shanguang, Wang Weixin, Huang Jian, Zhang Hongyu, Cheng Qianjin,
Abstract
OBJECTIVES:
We aimed to investigate the safety, feasibility and early and mid-term outcomes of total repair of elective tetralogy of Fallot through a right subaxillary thoracotomy.
METHODS:
Between May 2010 and September 2015, a retrospective review of patients with elective tetralogy of Fallot undergoing primary repair through a right subaxillary thoracotomy was performed. This study included 47 patients [27 males, 20 females; the mean age of 1.7?±?1.5?years (ranging from 3 to 106?months); body weight of 9.7?±?2.8?kg (ranging from 5 to 16?kg); McGoon ratio ?1.5]. The ventricular septal defects were approached through a right atriotomy in 30 patients, a right ventriculotomy in 8 patients and the combination of a right atriotomy and ventriculotomy in 9 patients. Transannular and non-transannular patches were used in 20 and 27 patients, respectively.
RESULTS:
There was 1 operative death (2.1%), and the others recovered uneventfully. The median cardiopulmonary bypass and aortic cross-clamping times was 79?±?20.8 (45-136) and 50?±?15.7 (25-94) min, respectively. The mechanical ventilation time, length of intensive care unit and postoperative hospital stay were 0.9?±?0.6, 2.6?±?1.1 and 10.7?±?2.7?days, respectively. The main complications involved low cardiac output syndrome in 5 patients, arrhythmia in 6 patients, pulmonary infection in 4 patients, small residual shunt in 2 patients, mild residual right ventricular outflow tract obstruction in 2 patients, mild tricuspid regurgitation in 3 patients and atelectasis in 1 patient. The mean follow-up time was 82?±?22.0?months, and no late deaths occurred during the follow-up. One (2.1%) patient received reintervention for residual significant pulmonary artery stenosis. That was in addition to 2 (4.3%) patients having mild residual right ventricular outflow tract, 1 (2.1%) patient with moderate tricuspid regurgitation and 3 (6.4%) patients with moderate pulmonary valve regurgitation to be followed up.
CONCLUSIONS:
The right subaxillary thoracotomy, providing a safe and feasible alternative, can be performed with a low mortality rate and satisfactory early and mid-term outcomes for total repair of elective tetralogy of Fallot.
© The Author(s) 2020. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.
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Maximal Oxygen Uptake and Ventilation Improvement Following Sacubitril-Valsartan Therapy.
Arq Bras Cardiol2020 Oct;():. doi: S0066-782X2020005013202.
Gonçalves António Valentim, Pereira-da-Silva Tiago, Galrinho Ana, Rio Pedro, Soares Rui, Feliciano Joana, Moreira Rita Ilhăo, Silva Sofia, Alves Sandra, Capilé Eunice, Ferreira Rui Cruz,
Abstract
BACKGROUND:
Sacubitril/valsartan had its prognosis benefit confirmed in the PARADIGM-HF trial. However, data on cardiopulmonary exercise testing (CPET) changes with sacubitril-valsartan therapy are scarce.
OBJECTIVE:
This study aimed to compare CPET parameters before and after sacubitril-valsartan therapy.
METHODS:
Prospective evaluation of chronic heart failure (HF) patients with left ventricular ejection fraction ?40% despite optimized standard of care therapy, who started sacubitril-valsartan therapy, expecting no additional HF treatment. CPET data were gathered in the week before and 6 months after sacubitril-valsartan therapy. Statistical differences with a p-value <0.05 were considered significant.
RESULTS:
Out of 42 patients, 35 (83.3%) completed the 6-month follow-up, since 2 (4.8%) patients died and 5 (11.9%) discontinued treatment for adverse events. Mean age was 58.6±11.1 years. New York Heart Association class improved in 26 (74.3%) patients. Maximal oxygen uptake (VO2max) (14.4 vs. 18.3 ml/kg/min, p<0.001), VE/VCO2slope (36.7 vs. 31.1, p<0.001), and exercise duration (487.8 vs. 640.3 sec, p<0.001) also improved with sacubitril-valsartan. Benefit was maintained even with the 24/26 mg dose (13.5 vs. 19.2 ml/kg/min, p=0.018) of sacubitril-valsartan, as long as this was the highest tolerated dose.
CONCLUSIONS:
Sacubitril-valsartan therapy is associated with marked CPET improvement in VO2max, VE/VCO2slope, and exercise duration. (Arq Bras Cardiol. 2020; [online].ahead print, PP.0-0).
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Executive Summary: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.
Circulation2020 Oct;142(16_suppl_1):S2-S27. doi: 10.1161/CIR.0000000000000890.
Nolan Jerry P, Maconochie Ian, Soar Jasmeet, Olasveengen Theresa M, Greif Robert, Wyckoff Myra H, Singletary Eunice M, Aickin Richard, Berg Katherine M, Mancini Mary E, Bhanji Farhan, Wyllie Jonathan, Zideman David, Neumar Robert W, Perkins Gavin D, Castrén Maaret, Morley Peter T, Montgomery William H, Nadkarni Vinay M, Billi John E, Merchant Raina M, de Caen Allan, Escalante-Kanashiro Raffo, Kloeck David, Wang Tzong-Luen, Hazinski Mary Fran,
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Evidence Evaluation Process and Management of Potential Conflicts of Interest: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.
Circulation2020 Oct;142(16_suppl_1):S28-S40. doi: 10.1161/CIR.0000000000000891.
Morley Peter T, Atkins Dianne L, Finn Judith C, Maconochie Ian, Nolan Jerry P, Rabi Yacov, Singletary Eunice M, Wang Tzong-Luen, Welsford Michelle, Olasveengen Theresa M, Aickin Richard, Billi John E, Greif Robert, Lang Eddy, Mancini Mary E, Montgomery William H, Neumar Robert W, Perkins Gavin D, Soar Jasmeet, Wyckoff Myra H, Morrison Laurie J,
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Education, Implementation, and Teams: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.
Circulation2020 Oct;142(16_suppl_1):S222-S283. doi: 10.1161/CIR.0000000000000896.
Greif Robert, Bhanji Farhan, Bigham Blair L, Bray Janet, Breckwoldt Jan, Cheng Adam, Duff Jonathan P, Gilfoyle Elaine, Hsieh Ming-Ju, Iwami Taku, Lauridsen Kasper G, Lockey Andrew S, Ma Matthew Huei-Ming, Monsieurs Koenraad G, Okamoto Deems, Pellegrino Jeffrey L, Yeung Joyce, Finn Judith C, ,
Abstract
For this , the Education, Implementation, and Teams Task Force applied the population, intervention, comparator, outcome, study design, time frame format and performed 15 systematic reviews, applying the Grading of Recommendations, Assessment, Development, and Evaluation guidance. Furthermore, 4 scoping reviews and 7 evidence updates assessed any new evidence to determine if a change in any existing treatment recommendation was required. The topics covered included training for the treatment of opioid overdose; basic life support, including automated external defibrillator training; measuring implementation and performance in communities, and cardiac arrest centers; advanced life support training, including team and leadership training and rapid response teams; measuring cardiopulmonary resuscitation performance, feedback devices, and debriefing; and the use of social media to improve cardiopulmonary resuscitation application.
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Pediatric Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.
Circulation2020 Oct;142(16_suppl_1):S140-S184. doi: 10.1161/CIR.0000000000000894.
Maconochie Ian K, Aickin Richard, Hazinski Mary Fran, Atkins Dianne L, Bingham Robert, Couto Thomaz Bittencourt, Guerguerian Anne-Marie, Nadkarni Vinay M, Ng Kee-Chong, Nuthall Gabrielle A, Ong Gene Y K, Reis Amelia G, Schexnayder Stephen M, Scholefield Barnaby R, Tijssen Janice A, Nolan Jerry P, Morley Peter T, Van de Voorde Patrick, Zaritsky Arno L, de Caen Allan R, ,
Abstract
This (CoSTR) for pediatric life support is based on the most extensive evidence evaluation ever performed by the Pediatric Life Support Task Force. Three types of evidence evaluation were used in this review: systematic reviews, scoping reviews, and evidence updates. Per agreement with the evidence evaluation recommendations of the International Liaison Committee on Resuscitation, only systematic reviews could result in a new or revised treatment recommendation. Systematic reviews performed for this 2020 CoSTR for pediatric life support included the topics of sequencing of airway-breaths-compressions versus compressions-airway-breaths in the delivery of pediatric basic life support, the initial timing and dose intervals for epinephrine administration during resuscitation, and the targets for oxygen and carbon dioxide levels in pediatric patients after return of spontaneous circulation. The most controversial topics included the initial timing and dose intervals of epinephrine administration (new treatment recommendations were made) and the administration of fluid for infants and children with septic shock (this latter topic was evaluated by evidence update). All evidence reviews identified the paucity of pediatric data and the need for more research involving resuscitation of infants and children.
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Neonatal Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.
Circulation2020 Oct;142(16_suppl_1):S185-S221. doi: 10.1161/CIR.0000000000000895.
Wyckoff Myra H, Wyllie Jonathan, Aziz Khalid, de Almeida Maria Fernanda, Fabres Jorge, Fawke Joe, Guinsburg Ruth, Hosono Shigeharu, Isayama Tetsuya, Kapadia Vishal S, Kim Han-Suk, Liley Helen G, McKinlay Christopher J D, Mildenhall Lindsay, Perlman Jeffrey M, Rabi Yacov, Roehr Charles C, Schmölzer Georg M, Szyld Edgardo, Trevisanuto Daniele, Velaphi Sithembiso, Weiner Gary M, ,
Abstract
This (CoSTR) for neonatal life support includes evidence from 7 systematic reviews, 3 scoping reviews, and 12 evidence updates. The Neonatal Life Support Task Force generally determined by consensus the type of evidence evaluation to perform; the topics for the evidence updates followed consultation with International Liaison Committee on Resuscitation member resuscitation councils. The 2020 CoSTRs for neonatal life support are published either as new statements or, if appropriate, reiterations of existing statements when the task force found they remained valid. Evidence review topics of particular interest include the use of suction in the presence of both clear and meconium-stained amniotic fluid, sustained inflations for initiation of positive-pressure ventilation, initial oxygen concentrations for initiation of resuscitation in both preterm and term infants, use of epinephrine (adrenaline) when ventilation and compressions fail to stabilize the newborn infant, appropriate routes of drug delivery during resuscitation, and consideration of when it is appropriate to redirect resuscitation efforts after significant efforts have failed. All sections of the Neonatal Resuscitation Algorithm are addressed, from preparation through to postresuscitation care. This document now forms the basis for ongoing evidence evaluation and reevaluation, which will be triggered as further evidence is published. Over 140 million babies are born annually worldwide (https://ourworldindata.org/grapher/births-and-deaths-projected-to-2100). If up to 5% receive positive-pressure ventilation, this evidence evaluation is relevant to more than 7 million newborn infants every year. However, in terms of early care of the newborn infant, some of the topics addressed are relevant to every single baby born.
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Adult Basic Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.
Circulation2020 Oct;142(16_suppl_1):S41-S91. doi: 10.1161/CIR.0000000000000892.
Olasveengen Theresa M, Mancini Mary E, Perkins Gavin D, Avis Suzanne, Brooks Steven, Castrén Maaret, Chung Sung Phil, Considine Julie, Couper Keith, Escalante Raffo, Hatanaka Tetsuo, Hung Kevin K C, Kudenchuk Peter, Lim Swee Han, Nishiyama Chika, Ristagno Giuseppe, Semeraro Federico, Smith Christopher M, Smyth Michael A, Vaillancourt Christian, Nolan Jerry P, Hazinski Mary Fran, Morley Peter T, ,
Abstract
This (CPR) on basic life support summarizes evidence evaluations performed for 22 topics that were prioritized by the Basic Life Support Task Force of the International Liaison Committee on Resuscitation. The evidence reviews include 16 systematic reviews, 5 scoping reviews, and 1 evidence update. Per agreement within the International Liaison Committee on Resuscitation, new or revised treatment recommendations were only made after a systematic review. Systematic reviews were performed for the following topics: dispatch diagnosis of cardiac arrest, use of a firm surface for CPR, sequence for starting CPR (compressions-airway-breaths versus airway-breaths-compressions), CPR before calling for help, duration of CPR cycles, hand position during compressions, rhythm check timing, feedback for CPR quality, alternative techniques, public access automated external defibrillator programs, analysis of rhythm during chest compressions, CPR before defibrillation, removal of foreign-body airway obstruction, resuscitation care for suspected opioid-associated emergencies, drowning, and harm from CPR to victims not in cardiac arrest. The topics that resulted in the most extensive task force discussions included CPR during transport, CPR before calling for help, resuscitation care for suspected opioid-associated emergencies, feedback for CPR quality, and analysis of rhythm during chest compressions. After discussion of the scoping reviews and the evidence update, the task force prioritized several topics for new systematic reviews.
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Adult Advanced Life Support: 2020 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations.
Circulation2020 Oct;142(16_suppl_1):S92-S139. doi: 10.1161/CIR.0000000000000893.
Berg Katherine M, Soar Jasmeet, Andersen Lars W, Böttiger Bernd W, Cacciola Sofia, Callaway Clifton W, Couper Keith, Cronberg Tobias, D'Arrigo Sonia, Deakin Charles D, Donnino Michael W, Drennan Ian R, Granfeldt Asger, Hoedemaekers Cornelia W E, Holmberg Mathias J, Hsu Cindy H, Kamps Marlijn, Musiol Szymon, Nation Kevin J, Neumar Robert W, Nicholson Tonia, O'Neil Brian J, Otto Quentin, de Paiva Edison Ferreira, Parr Michael J A, Reynolds Joshua C, Sandroni Claudio, Scholefield Barnaby R, Skrifvars Markus B, Wang Tzong-Luen, Wetsch Wolfgang A, Yeung Joyce, Morley Peter T, Morrison Laurie J, Welsford Michelle, Hazinski Mary Fran, Nolan Jerry P, ,
Abstract
This for advanced life support includes updates on multiple advanced life support topics addressed with 3 different types of reviews. Topics were prioritized on the basis of both recent interest within the resuscitation community and the amount of new evidence available since any previous review. Systematic reviews addressed higher-priority topics, and included double-sequential defibrillation, intravenous versus intraosseous route for drug administration during cardiac arrest, point-of-care echocardiography for intra-arrest prognostication, cardiac arrest caused by pulmonary embolism, postresuscitation oxygenation and ventilation, prophylactic antibiotics after resuscitation, postresuscitation seizure prophylaxis and treatment, and neuroprognostication. New or updated treatment recommendations on these topics are presented. Scoping reviews were conducted for anticipatory charging and monitoring of physiological parameters during cardiopulmonary resuscitation. Topics for which systematic reviews and new Consensuses on Science With Treatment Recommendations were completed since 2015 are also summarized here. All remaining topics reviewed were addressed with evidence updates to identify any new evidence and to help determine which topics should be the highest priority for systematic reviews in the next 1 to 2 years.
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Left atrial appendage aneurysm: A case report.
World J Clin Cases2020 Oct;8(19):4443-4449. doi: 10.12998/wjcc.v8.i19.4443.
Belov Dmitry Vladimirovich, Moskalev Vladimir Ivanovich, Garbuzenko Dmitry Victorovich, Arefyev Nikolay Olegovich,
Abstract
BACKGROUND:
An aneurysm of the left atrial appendage is one of the rare but potentially hazardous heart defects. The risk of lethal complications grows with its size. To date, about 150 cases of this defect have been described in the literature. We present a case of left atrial appendage aneurysm with the deformation of the mitral valve and the left main coronary and circumflex artery, which required mitral valve annuloplasty and bifurcation stenting.
CASE SUMMARY:
A 58-year-old man presented to our hospital complaining of shortness of breath, general weakness, dizziness during physical exertion, and fatigue. Based on the results of echocardiography, an aneurysm of the left atrium was suspected. A free-breathing real-time cine magnetic resonance imaging with electrocardiograph synchronization confirmed the diagnosis of left atrial appendage aneurysm. The patient underwent an aneurysmectomy a median sternotomy with cardiopulmonary bypass. Intraoperative transesophageal echocardiography revealed relative mitral insufficiency that was corrected with an annuloplasty ring. Intraoperative coronary angiogram showed impaired blood flow in the left main coronary and circumflex artery and 60% stenosis. For this reason, bifurcation stenting was performed. The patient had an uneventful postoperative clinical course and was discharged from the hospital on the 10th day in a satisfactory condition.
CONCLUSION:
Left atrial appendage aneurysm is a rare and dangerous heart pathology that requires surgery to prevent related complications.
©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
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Aortic aneurysm and dissection in pregnancy: A case report.
Case Rep Womens Health2020 Oct;28():e00261. doi: 10.1016/j.crwh.2020.e00261.
Chin Jennifer M, Bartholomew Marguerite L,
Abstract
We describe a 24-year-old pregnant woman at 34 weeks of gestation who presented to a community hospital with sharp chest pain radiating to her back. She was found to have a 6 cm ascending aortic aneurysm despite not having any established risk factors. She was transported by air ambulance to a tertiary-care hospital. She delivered a live female neonate via cesarean delivery. Her postpartum course was notable for multiple episodes of chest pain and multiple imaging studies that were read as negative for aortic dissection. Definitive valve surgery was postponed by the cardiothoracic surgeons to allow for recovery from severe preeclampsia, treatment of endometritis, and due to concerns for uterine bleeding while on anticoagulation during cardiopulmonary bypass. She was eventually transferred to another hospital in another state for valve-sparing surgery. During transport, she developed a pulmonary embolism, and after arrival an aortic dissection was confirmed. She received a mechanical aortic valve replacement and the aneurysm was repaired. She returned home and recovered without complication. A gene panel revealed a heterozygous pathogenic variant of the Filamin A gene. Aortic aneurysms during pregnancy are rare, and aortic dissections are more rare. We recommend expeditious surgical treatment, a heightened index of suspicion, and testing for a genetic cause of aneurysm when diagnosed in a pregnant or postpartum woman with no known risk factors.
© 2020 The Authors.
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Protocol for a randomised controlled feasibility trial of exercise rehabilitation for people with postural tachycardia syndrome: the PULSE study.
Pilot Feasibility Stud2020 ;6():157. doi: 10.1186/s40814-020-00702-1.
McGregor Gordon, Hee Siew Wan, Eftekhari Helen, Holliday Nikki, Pearce Gemma, Sandhu Harbinder, Simmonds Jane, Joshi Shivam, Kavi Lesley, Bruce Julie, Panikker Sandeep, Lim Boon, Hayat Sajad,
Abstract
Background:
Postural orthostatic tachycardia syndrome (POTS) is an autonomic nervous system disorder causing an abnormal cardiovascular response to upright posture. It affects around 0.2% of the population, most commonly women aged 13 to 50?years. POTS can be debilitating; prolonged episodes of pre-syncope and fatigue can severely affect activities of daily living and health-related quality of life (HRQoL). Medical treatment is limited and not supported by randomised controlled trial (RCT) evidence. Lifestyle interventions are first-line treatment, including increased fluid and salt intake, compression tights and isometric counter-pressure manoeuvres to prevent fainting. Observational studies and small RCTs suggest exercise training may improve symptoms and HRQoL in POTS, but evidence quality is low.
Methods:
Sixty-two people (aged 18-40?years) with a confirmed diagnosis of POTS will be invited to enrol on a feasibility RCT with embedded qualitative study. The primary outcome will be feasibility; process-related measures will include the number of people eligible, recruited, randomised and withdrawn, along with indicators of exercise programme adherence and acceptability. Secondary physiological, clinical and health-related outcomes including sub-maximal recumbent bike exercise test, active stand test and HRQoL will be measured at 4 and 7?months post-randomisation by researchers blinded to treatment allocation. The PostUraL tachycardia Syndrome Exercise (PULSE) intervention consists of (1) individual assessment; (2) 12-week, once to twice-weekly, supervised out-patient exercise training; (3) behavioural and motivational support; and (4) guided lifestyle physical activity. The control intervention will be best-practice usual care with a single 30-min, one-to-one practitioner appointment, and general advice on safe and effective physical activity. For the embedded qualitative study, participants ( = 10 intervention, = 10 control) will be interviewed at baseline and 4?months post-randomisation to assess acceptability and the feasibility of progressing to a definitive trial.
Discussion:
There is very little high-quality research investigating exercise rehabilitation for people with POTS. The PULSE study will be the first randomised trial to assess the feasibility of conducting a definitive multicentre RCT testing supervised exercise rehabilitation with behavioural and motivational support, compared to best-practice usual care, for people with POTS.
Trial registration:
ISRCTN45323485 registered on 7 April 2020.
© The Author(s) 2020.
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A case report of constrictive pericarditis: a forgotten cause of refractory ascites.
Radiol Case Rep2020 Dec;15(12):2565-2568. doi: 10.1016/j.radcr.2020.09.053.
Barry Mohammad, Al-Muhaidb Saud, Fathala Ahmed,
Abstract
Constrictive pericarditis is well known but rare and commonly forgotten cause of ascites. Early diagnosis of constrictive pericarditis is difficult due to absence of typical cardiopulmonary signs and multiple vague symptoms and its insidious course. In this case report, we present a 61-year-old male referred for liver transplantation vs transjugular intrahepatic portosystemic shunt work-up for presumptive diagnosis of nonalcoholic steatohepatitis cirrhosis and refractory ascites. Comprehensive work-up before liver transplantation including liver biopsy, liver ultrasound, and Doppler, magnetic resonance imaging was not consistent with liver cirrhosis. Echocardiographic was suggestive of constrictive pericarditis, further work-up with right heart catheterization, cardiovascular magnetic resonance and multidetector cardiac computed tomography confirmed the diagnosis of constrictive pericarditis. Patient underwent surgical pericardiectomy, he reminded stable after surgery and did not require further paracentesis and discharged in stable condition.
© 2020 The Authors. Published by Elsevier Inc. on behalf of University of Washington.
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While you're waiting, a waiting room-based, cardiovascular disease-focused educational program: protocol for a randomised controlled trial.
BMJ Open2020 Oct;10(10):e036780. doi: 10.1136/bmjopen-2020-036780.
Mcintyre Daniel, Thiagalingam Aravinda, Chow Clara,
Abstract
INTRODUCTION:
Patients with cardiovascular disease (CVD) frequently attend outpatient clinics and spend a significant amount of time in waiting rooms. Currently, this time is poorly used. This study aims to investigate whether providing CVD and cardiopulmonary resuscitation (CPR) education to waiting patients in a cardiology clinic of a large referral hospital improves motivation to change health behaviours, CPR knowledge, behaviours and clinic satisfaction post clinic, and whether there is any impact on reported CVD lifestyle behaviours or relevant CPR outcomes at 30 days.
METHODS AND ANALYSIS:
Randomised controlled trial with parallel design to be conducted among 330 patients in the waiting room of a chest pain clinic in a tertiary referral hospital. Intervention (n=220) participants will receive a tablet-delivered series of educational videos catered to self-reported topics of interest (physical activity, blood pressure, diet, medications, smoking and general health) and level of health knowledge. Control (n=110) participants will receive usual care. In a substudy, intervention participants will be randomised 1:1 to receive an extra video on CPR or no extra video. The primary outcome will be the proportion of intervention and control participants who report high motivation to improve physical activity, diet and blood pressure monitoring at end of clinic. The primary outcome of the CPR study will be confidence to perform CPR post clinic. Secondary analysis will examine impact on clinic satisfaction, lifestyle behaviours, CPR knowledge and willingness to perform CPR post clinic and at 30-day follow-up.
ETHICS AND DISSEMINATION:
Ethics approval has been received from the Western Sydney Local Health District Human Research Ethics Committee. All patients will provide informed consent via a tablet-based eConsent framework. Study results will be disseminated via the usual channels including peer-reviewed publications and presentations at national and international conferences.
TRIAL REGISTRATION NUMBER:
ANZCTR12618001725257.
© Author(s) (or their employer(s)) 2020. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
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Hemophilia: A Review of Perioperative Management for Cardiac Surgery.
J Cardiothorac Vasc Anesth2020 Sep;():. doi: S1053-0770(20)31036-3.
Kwak Jenny, Mazzeffi Michael, Boggio Lisa N, Simpson Mindy L, Tanaka Kenichi A,
Abstract
Hemophilia is an X-linked, recessive bleeding disorder. Improvements in factor replacement therapy and overall approach to hemophilia management have increased the lifespan and quality of life for patients with hemophilia. Thus, they are presenting for cardiac surgery related to age-related atherosclerosis, vascular disorders, and degenerative valvular disease. Although challenging, cardiac surgery can be performed safely with appropriate planning, using a multidisciplinary approach. This article provides a narrative review and framework for the perioperative management of patients with hemophilia A and B undergoing cardiac surgery.
Copyright © 2020 Elsevier Inc. All rights reserved.
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Cardiopulmonary resuscitation during the COVID-19 pandemic: Maintaining provider and patient safety.
Am J Emerg Med2020 Oct;():. doi: S0735-6757(20)30907-4.
Sen-Crowe Brendon, Sutherland Mason, McKenney Mark, Elkbuli Adel,
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