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Fukuda M, Sakai H, Koh K, Sakuraba S, Ando N, Hayashida M, Kawagoe I. Unusual severe hypoxemia due to unilateral pulmonary edema after conventional cardiopulmonary bypass salvaged by veno-venous extracorporeal membrane oxygenation: a case report. JA Clin Rep 2023; 9:65. [PMID: 37803183 PMCID: PMC10558410 DOI: 10.1186/s40981-023-00656-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 09/25/2023] [Accepted: 09/26/2023] [Indexed: 10/08/2023] Open
Abstract
BACKGROUND We report a case in which veno-venous extracorporeal membrane oxygenation (V-V ECMO) saved the life of a patient who developed severe hypoxemia due to unusual unilateral pulmonary edema (UPE) after cardiopulmonary bypass (CPB). CASE PRESENTATION A 69-year-old man underwent aortic valve replacement and coronary artery bypass grafting. Following uneventful weaning off CPB, he developed severe hypoxemia. The ratio of arterial oxygen tension to inspired oxygen fraction (PaO2/FiO2) decreased from 301 mmHg 5 min after CPB to 42 mmHg 90 min after CPB. A chest X-ray revealed right-sided UPE. Immediately established V-V ECMO increased PaO2/FiO2 to 170 mmHg. Re-expansion pulmonary edema (REPE) was likely, as the right lung remained collapsed during CPB following the accidental opening of the right chest cavity during graft harvesting. CONCLUSIONS V-V ECMO was effective in improving oxygenation and saving the life of a patient who had fallen into unilateral REPE unusually developing after conventional CPB.
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Affiliation(s)
- Masataka Fukuda
- Department of Anesthesiology and Pain Medicine, Juntendo University Hospital, Tokyo, 113-8431, Japan
| | - Hiroaki Sakai
- Department of Anesthesia, Fujieda Municipal General Hospital, Shizuoka, Japan
| | - Keito Koh
- Department of Anesthesiology and Pain Medicine, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Sonoko Sakuraba
- Department of Anesthesiology and Pain Medicine, Juntendo University Shizuoka Hospital, Shizuoka, Japan
| | - Nozomi Ando
- Department of Anesthesiology and Pain Medicine, Juntendo University Hospital, Tokyo, 113-8431, Japan
| | - Masakazu Hayashida
- Department of Anesthesiology and Pain Medicine, Juntendo University Hospital, Tokyo, 113-8431, Japan
| | - Izumi Kawagoe
- Department of Anesthesiology and Pain Medicine, Juntendo University Hospital, Tokyo, 113-8431, Japan.
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López-Baamonde M, Eulufi S, Ascaso M, Arguis MJ, Navarro-Ripoll R, Rovira I. Unilateral pulmonary edema associated factors after minimally invasive mitral valve surgery. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2022; 69:134-142. [PMID: 35305949 DOI: 10.1016/j.redare.2021.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2020] [Accepted: 03/29/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVES In recent years, minimally invasive cardiac surgery (MICS) has been developed and applied to a greater number of pathologies, especially in mitral valve surgeries, as it obtains results comparable to those of conventional techniques while entailing lower surgical trauma and shorter recovery time. MICS requiring one-lung ventilation has been associated to the appearance of unilateral pulmonary edema (UPE), which is a potentially serious complication. The objective is determining the incidence of UPE after mitral MICS and its development associated factors. MATERIAL AND METHODS Observational descriptive and single-center study analyzing data from patients undergoing mitral valve MICS (right mini-thoracotomy) consecutively collected between the years 2015 and 2017. RESULTS A total of 93 patients were included and 26 presented UPE. The most common complications after mitral valve MICS were atrial fibrillation (38.7%), UPE (28%) and transient and/or definitive second- or third-degree auriculoventricular block (19.4%). The UPE group had longer ICU stay (3.3 ± 8.0 vs. 1.84 ± 2.23 days) and longer total hospitalization length-of-stay (15.5 ± 34.7 vs. 10.6 ± 7.5 days). The mortality in the UPE group was 3.9%. A significant association was found between the following collected variables and the development of postoperative UPE: preoperative baseline pulse oximetry, preoperative use of ACE inhibitors, postoperative atrial fibrillation and 24 first-hours cumulative chest tube drainage volume on the first 24 h. CONCLUSIONS The incidence of UPE is high and its appearance is associated with a longer ICU and total length of stay. More studies are required to understand its pathophysiology and apply measures to help decreasing its appearance.
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Affiliation(s)
- M López-Baamonde
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, Spain.
| | - S Eulufi
- Servicio de Anestesiología y Reanimación, Hospital Luis Calvo Mackenna, Santiago, Chile
| | - M Ascaso
- Servicio de Cirugía Cardiovascular, Hospital Clínic de Barcelona, Barcelona, Spain
| | - M J Arguis
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, Spain
| | - R Navarro-Ripoll
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, Spain
| | - I Rovira
- Servicio de Anestesiología y Reanimación, Hospital Clínic de Barcelona, Barcelona, Spain
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Lai CC, Huang PH, Yang AH, Chiang SC, Tang CY, Tseng KW, Huang CH. Baicalein Attenuates Lung Injury Induced by Myocardial Ischemia and Reperfusion. THE AMERICAN JOURNAL OF CHINESE MEDICINE 2017; 45:791-811. [PMID: 28521514 DOI: 10.1142/s0192415x17500422] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Baicalein is an active component of Scutellaria baicalensis Georgi, which has traditionally been used to treat cardiovascular diseases in China. In this study, we investigated if treatment with baicalein can attenuate the lung injury induced by myocardial ischemia and reperfusion (I/R). Myocardial I/R, induced by a 40-min occlusion of the left anterior descending coronary artery and a 3-h reperfusion, significantly increased histological damage and the wet-to-dry weight ratio of lungs in rats. The terminal deoxynucleotidyl transferase-mediated dUTP nick-end labeling (TUNEL)-positive nuclei and caspase-3 activation was significantly increased in the lungs. Serum and bronchoalveolar lavage fluid levels of tumor necrosis factor-[Formula: see text] (TNF-[Formula: see text]), interleukin-1[Formula: see text] (IL-1[Formula: see text]), and interleukin-6 (IL-6) were significantly elevated, as were TNF-[Formula: see text] levels in the lung. Intravenous administration with baicalein at doses of 3, 10, and 30[Formula: see text]mg/kg for ten minutes before myocardial I/R significantly reduced histological damage, the wet-to-dry weight ratio, and apoptosis in the lung. Baicalein also significantly inhibited the increase in levels of TNF-[Formula: see text], IL-1[Formula: see text], and IL-6. Moreover, baicalein increased Bcl-2 and decreased p53, Bax, and cytochrome [Formula: see text] in lungs. Phosphorylation of the prosurvival kinases, including Akt and extracellular signal-regulated kinases 1 and 2 (ERK1/2), was increased, while the phosphorylation of the pro-apoptotic mitogen-activated protein kinases, including p38 and c-Jun N-terminal kinase (JNK), was decreased. In conclusion, treatment with baicalein attenuates the lung injury induced by myocardial I/R. The mechanisms might be related to the limiting of apoptosis, possibly via the inhibition of both the extrinsic and intrinsic pathways of apoptosis, including the inhibition of TNF-[Formula: see text] production and modulation of pro- and anti-apoptotic signaling elements.
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Affiliation(s)
- Chang-Chi Lai
- * Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan.,† Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,∥ Department of Physical Education and Health, University of Taipei, Taipei, Taiwan
| | - Po-Hsun Huang
- † Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan.,‡ Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan.,** Cardiovascular Research Center, National Yang-Ming University, Taipei, Taiwan
| | - An-Han Yang
- § Department of Pathology and Laboratory Medicine, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Shu-Chiung Chiang
- ¶ Institute of Hospital and Health Care Administration, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Chia-Yu Tang
- * Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan.,† Institute of Clinical Medicine, National Yang-Ming University School of Medicine, Taipei, Taiwan
| | - Kuo-Wei Tseng
- ∥ Department of Physical Education and Health, University of Taipei, Taipei, Taiwan
| | - Cheng-Hsiung Huang
- * Division of Cardiovascular Surgery, Department of Surgery, Taipei Veterans General Hospital, National Yang-Ming University School of Medicine, Taipei, Taiwan
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