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Koizumi S, Keiichi I, Sakai T, Kubota Y, Yokota H, Takaoka H, Kohno H, Matsumiya G. Cardiac Magnetic Resonance Feature Tracking Analysis for Change in Right Ventricular Function After Cardioplegic Arrest. Heart Lung Circ 2024; 33:1457-1464. [PMID: 38964943 DOI: 10.1016/j.hlc.2024.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 03/09/2024] [Accepted: 05/19/2024] [Indexed: 07/06/2024]
Abstract
BACKGROUND Using echocardiography to assess right ventricular (RV) function after cardioplegic arrest is challenging. Cardiac magnetic resonance (CMR) imaging is a superior alternative, with the feature tracking technique enabling quantitative assessment of myocardial deformation. METHODS This single-centre, prospective study from 2020 to 2022 assessed RV function in 42 patients who underwent open heart surgery with cardioplegic arrest. CMR data were collected preoperatively, one week postoperatively, and at follow-up (6-12 months after surgery), and assessed using the CMR feature tracking technique. RESULTS Postoperatively, there was no significant change in RV end-diastolic volume, but RV end-systolic volume significantly decreased, leading to a notable increase in RV ejection fraction. By follow-up, both RV end-diastolic and end-systolic volumes had significantly reduced compared with the preoperative values. Right ventricular longitudinal contractility decreased after surgery but recovered to the preoperative values by follow-up, while RV circumferential contractility improved postoperatively and remained superior to the preoperative levels at follow-up. CONCLUSION On CMR imaging, significant changes in RV systolic motion were observed after cardioplegic arrest, with decreased longitudinal but increased circumferential contractility. At follow up, these changes had reverted to the preoperative patterns by the mid-term (6-12 months).
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Affiliation(s)
- Shintaroh Koizumi
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan; Department of Cardiovascular Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan.
| | - Ishida Keiichi
- Department of Cardiovascular Surgery, Eastern Chiba Medical Center, Togane, Chiba, Japan; Department of Cardiovascular Surgery, Chibaken Saiseikai Narashino Hospital, Narashino, Chiba, Japan
| | - Takayuki Sakai
- Department of Radiology, Eastern Chiba Medical Center, Togane, Chiba, Japan
| | - Yoshihiro Kubota
- Department of Diagnostic Radiology and Radiation Oncology, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Hajime Yokota
- Department of Diagnostic Radiology and Radiation Oncology, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Hiroyuki Takaoka
- Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Hiroki Kohno
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
| | - Goro Matsumiya
- Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Chiba, Japan
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Sharifkazemi M, Ghazinour M, Lotfi M, Khorshidi S, Davarpasand T. Retrosternal hematoma causing torsade de pointes after coronary artery bypass graft surgery; a case report. Front Cardiovasc Med 2024; 11:1331873. [PMID: 38832318 PMCID: PMC11144857 DOI: 10.3389/fcvm.2024.1331873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Accepted: 05/02/2024] [Indexed: 06/05/2024] Open
Abstract
Myocardial infarction is among the top causes of mortality worldwide. Survivors may also experience several complications. Infarct-related torsade de pointes (TdP) is an uncommon complication. In the context of myocardial infarction, coronary artery bypass graft (CABG) surgery is the prevalent therapeutic modality associated with several early and late complications. Ventricular tachyarrhythmias, including TdP, because of electrical inhomogeneity, would potentially be a lethal complication of CABG. Here, we report the occurrence of medically intractable TdP in the presence of an uncommon case of a post-CABG retrosternal hematoma. Arrhythmia was properly resolved after hematoma removal surgically. It showed the possibility of a "cause and effect" relationship between these two complications. This unique case emphasizes the post-CABG medically-resistant TdP, considering the mechanical pressure effect of retrosternal hematoma that stimulates this potentially malignant arrhythmia, especially in the absence of electrolyte disturbances and evident symptoms of ongoing ischemia.
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Affiliation(s)
| | - Mohammad Ghazinour
- Department of Surgery, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehrzad Lotfi
- Department of Radiology, Shahid Faghihi Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Soorena Khorshidi
- Department of Cardiology, Nemazee Hospital, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Tahereh Davarpasand
- Department of Cardiology, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran
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3
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Gorton AJ, Keshavamurthy S, Lowry C, Sekela ME. Caught in the Act: A Recurrent Tamponade After Coronary Artery Bypass Grafting With Culprit Lesion Identified on Computed Tomography Angiogram. Cureus 2023; 15:e49278. [PMID: 38143632 PMCID: PMC10746957 DOI: 10.7759/cureus.49278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/22/2023] [Indexed: 12/26/2023] Open
Abstract
Delayed cardiac tamponade after cardiac surgery is a rare complication with significant diagnostic challenges. The recurrence of cardiac tamponade physiology after initial intervention creates another degree of difficulty in the management of already medically complex patients. We present the case of a 65-year-old male who underwent four-vessel coronary artery bypass grafting that was complicated by the delayed presentation of cardiac tamponade requiring mediastinal exploration. Following this he developed a recurrence of cardiac tamponade with bleeding from a vein graft identified on multiphase spiral computed tomography angiography.
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Affiliation(s)
- Andrew J Gorton
- Department of Surgery, Division of Cardiothoracic Surgery, University of Kentucky, Lexington, USA
| | - Suresh Keshavamurthy
- Department of Surgery, Division of Cardiothoracic Surgery, University of Kentucky, Lexington, USA
| | - Conor Lowry
- Department of Radiology, University of Kentucky, Lexington, USA
| | - Michael E Sekela
- Department of Surgery, Division of Cardiothoracic Surgery, University of Kentucky, Lexington, USA
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van Dinter S, Li W, Wollersheim L, Rodwell L, van Royen N, Dieker HJ, Verhagen A. Variations in current clinical practice of postoperative pericardial effusion: a questionnaire study. Open Heart 2023; 10:openhrt-2023-002271. [PMID: 37094990 PMCID: PMC10152046 DOI: 10.1136/openhrt-2023-002271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2023] [Accepted: 03/31/2023] [Indexed: 04/26/2023] Open
Abstract
OBJECTIVE Postoperative pericardial effusion (PPE) occurs frequently after cardiac surgery, potentially leading to life-threatening cardiac tamponade. Specific treatment guidelines are currently lacking, possibly leading to variations in clinical practice. Our goal was to assess clinical PPE management and evaluate variation between centres and clinicians. METHODS A nationwide survey was sent to all interventional cardiologists and cardiothoracic surgeons in the Netherlands, regarding their preferred diagnostic and treatment modality of PPE. Clinical preferences were explored utilising four patient scenarios, each with a high/low echocardiographic and clinical suspicion of cardiac tamponade. Scenarios were also stratified by three PPE sizes (<1 cm, 1-2 cm, >2 cm). RESULTS In total, 46/140 interventional cardiologists and 48/120 cardiothoracic surgeons responded (27/31 contacted centres). Cardiologists favoured routine postoperative echocardiography in all patients (44%), whereas cardiothoracic surgeons preferred routine imaging after specific procedures, especially mitral (85%) and tricuspid (79%) valve surgery. Overall, pericardiocentesis (83%) was preferred over surgical evacuation (17%). Regarding all patient scenarios, cardiothoracic surgeons significantly preferred evacuation compared with cardiologists (51% vs 37%, p<0.001). This was also observed with cardiologists employed in surgical centres compared with non-surgical centres (43% vs 31%, p=0.02). Inter-rater analysis varied from poor to near-excellent (к 0.22-0.67), suggesting varying PPE treatment preferences within one centre. CONCLUSION There is significant variation in the preferred management of PPE between hospitals and clinicians, even within the same centre, possibly due to the lack of specific guidelines. Therefore, robust results of a systematic approach to PPE diagnosis and treatment are needed to formulate evidence-based recommendations and optimise patient outcome.
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Affiliation(s)
| | - Wilson Li
- Cardiothoracic Surgery, Radboudumc, Nijmegen, The Netherlands
| | - Laurens Wollersheim
- Cardiothoracic Surgery, Medisch Centrum Leeuwarden, Leeuwarden, The Netherlands
| | - Laura Rodwell
- Department for Health Evidence, Radboudumc, Nijmegen, The Netherlands
| | | | | | - Ad Verhagen
- Cardiothoracic Surgery, Radboudumc, Nijmegen, The Netherlands
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Karan A, Ali AA, Esmail K, Akinjogbin T, Lamsal S, Missov E. Post-op cocaine use resulting in catastrophic cardiovascular compromise. J Geriatr Cardiol 2023; 20:155-158. [PMID: 36910240 PMCID: PMC9992950 DOI: 10.26599/1671-5411.2023.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/14/2023] Open
Affiliation(s)
- Abhinav Karan
- Internal Medicine, University of Florida College of Medicine-Jacksonville, Florida, USA
| | - Aleem Azal Ali
- Internal Medicine, University of Florida College of Medicine-Jacksonville, Florida, USA
| | - Khadeeja Esmail
- Division of Cardiology, University of Florida College of Medicine-Jacksonville, Florida, USA
| | - Temitope Akinjogbin
- Division of Cardiology, University of Florida College of Medicine-Jacksonville, Florida, USA
| | - Sanjay Lamsal
- Department of Radiology, University of Florida College of Medicine-Jacksonville, Florida, USA
| | - Emil Missov
- Division of Cardiology, University of Florida College of Medicine-Jacksonville, Florida, USA
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Periappuram J, Thomas J, Philipose S, Vijayan A, Mohammed Y, Padmanabhan M, George A, Wilson J, George G, Abraham J, Sunil GS, Ranganathan B. Postoperative outcomes of cardio-thoracic surgery in post-COVID versus non-COVID patients - Single-center experience. JOURNAL OF THE PRACTICE OF CARDIOVASCULAR SCIENCES 2022. [DOI: 10.4103/jpcs.jpcs_66_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Ellenbroek DFJ, van Kessel L, Compagner W, Brouwer T, Bouwman RA, van Straten BAHM, Otterspoor LC, De Bie AJR. Diagnostic performance of echocardiography to predict cardiac tamponade after cardiac surgery. Eur J Cardiothorac Surg 2021; 62:6430389. [PMID: 34791128 PMCID: PMC9257667 DOI: 10.1093/ejcts/ezab468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 08/14/2021] [Accepted: 09/23/2021] [Indexed: 11/29/2022] Open
Affiliation(s)
- Dennis F J Ellenbroek
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, Netherlands
| | - Luc van Kessel
- Department of Intensive Care, Catharina Hospital, Michelangelolaan 2, Eindhoven, Netherlands
| | - Wilma Compagner
- Department of Intensive Care, Catharina Hospital, Michelangelolaan 2, Eindhoven, Netherlands
| | - Tim Brouwer
- Department of Intensive Care, Catharina Hospital, Michelangelolaan 2, Eindhoven, Netherlands
| | - R Arthur Bouwman
- Department of Anesthesiology, Catharina Hospital, Eindhoven, Netherlands
| | | | - Luuk C Otterspoor
- Department of Cardiology, Catharina Hospital, Eindhoven, Netherlands
| | - Ashley J R De Bie
- Department of Intensive Care, Radboud University Medical Center, Nijmegen, Netherlands.,Department of Intensive Care, Catharina Hospital, Michelangelolaan 2, Eindhoven, Netherlands
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Ay Y, Kahraman Ay N. Diagnostic value of transthoracic echocardiography and computerized tomography for surgically confirmed late tamponade after cardiac surgery. J Card Surg 2019; 34:1486-1491. [DOI: 10.1111/jocs.14269] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Affiliation(s)
- Yasin Ay
- Department of Cardiovascular Surgery Bezmialem Vakif University Fatih Istanbul Turkey
| | - Nuray Kahraman Ay
- Department of Cardiology Bezmialem Vakif University Fatih Istanbul Turkey
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Sridhara S, Lichtenwalter C, Mazdeh S, Yeneneh BT. Positive Murphy's Sign in Pericardial Hematoma from a Right Atrial Tear. Cureus 2018; 10:e3402. [PMID: 30533336 PMCID: PMC6279000 DOI: 10.7759/cureus.3402] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
A positive Murphy's sign in a patient with right upper quadrant abdominal pain is the arrest of inspiration during deep palpation of the quadrant. It is usually suggestive of acute cholecystitis. We report an unusual case of a positive Murphy's sign not due to acute cholecystitis, but rather from a pericardial hematoma from a right atrial tear causing right heart failure. The patient required an atrial tear repair to prevent a cardiac tamponade.
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Coronary artery bypass graft surgery complications: A review for emergency clinicians. Am J Emerg Med 2018; 36:2289-2297. [PMID: 30217621 DOI: 10.1016/j.ajem.2018.09.014] [Citation(s) in RCA: 61] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 09/05/2018] [Accepted: 09/07/2018] [Indexed: 01/28/2023] Open
Abstract
INTRODUCTION Coronary artery bypass graft (CABG) surgery remains a high-risk procedure, and many patients require emergency department (ED) management for complications after surgery. OBJECTIVE This narrative review provides an evidence-based summary of the current data for the emergency medicine evaluation and management of post-CABG surgery complications. DISCUSSION While there has been a recent decline in all cardiac revascularization procedures, there remains over 200,000 CABG surgeries performed in the United States annually, with up to 14% of these patients presenting to the ED within 30 days of discharge with post-operative complications. Risk factors for perioperative mortality and morbidity after CABG surgery can be divided into three categories: patient characteristics, clinician characteristics, and postoperative factors. Emergency physicians will be faced with several postoperative complications, including sternal wound infections, pneumonia, thromboembolic phenomena, graft failure, atrial fibrillation, pulmonary hypertension, pericardial effusion, strokes, renal injury, gastrointestinal insults, and hemodynamic instability. Critical patients should be evaluated in the resuscitation bay, and consultation with the primary surgical team is needed, which improves patient outcomes. This review provides several guiding principles for management of acute complications. Understanding these complications and an approach to the management of hemodynamic instability is essential to optimizing patient care. CONCLUSIONS Postoperative complications of CABG surgery can result in significant morbidity and mortality. Physicians must rapidly diagnose these conditions while evaluating for other diseases. Early surgical consultation is imperative, as is optimizing the patient's hemodynamics, including preload, heart rate, cardiac rhythm, contractility, and afterload.
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Demirtas K, Ozeke O, Karakurt M, Karanfil M, Golbasi Z. Delayed cardiac tamponade by loculated pericardial hematoma. J Echocardiogr 2017; 16:87-88. [PMID: 28965216 DOI: 10.1007/s12574-017-0355-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 09/14/2017] [Accepted: 09/22/2017] [Indexed: 10/18/2022]
Affiliation(s)
- Koray Demirtas
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, 06100, Ankara, Turkey
| | - Ozcan Ozeke
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, 06100, Ankara, Turkey.
| | - Mustafa Karakurt
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, 06100, Ankara, Turkey
| | - Mustafa Karanfil
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, 06100, Ankara, Turkey
| | - Zehra Golbasi
- Department of Cardiology, Turkiye Yuksek Ihtisas Training and Research Hospital, Health Sciences University, 06100, Ankara, Turkey
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Claffey C. A 24-Year-Old Woman with Shortness of Breath. J Emerg Nurs 2016; 43:164-165. [PMID: 27130190 DOI: 10.1016/j.jen.2015.11.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2015] [Revised: 10/31/2015] [Accepted: 11/02/2015] [Indexed: 10/19/2022]
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Cantinotti M, Giordano R, Assanta N, Murzi B, Gargani L. Chest Ultrasound: A New, Easy, and Radiation-Free Tool to Detect Retrosternal Clot After Pediatric Cardiac Surgery. J Cardiothorac Vasc Anesth 2015; 29:e59-60. [DOI: 10.1053/j.jvca.2015.03.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Indexed: 11/11/2022]
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Kanzaki H. Editorial: Invisible hematoma causing shock after open-heart surgery: Localized cardiac tamponade. J Cardiol Cases 2014; 9:243-244. [PMID: 30534337 PMCID: PMC6278562 DOI: 10.1016/j.jccase.2014.02.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2013] [Indexed: 11/20/2022] Open
Affiliation(s)
- Hideaki Kanzaki
- Department of Cardiovascular Medicine, Heart Failure Division, National Cerebral and Cardiovascular Center, 5-7-1 Fujishiro-dai, Suita, Osaka 565-8565, Japan
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Abstract
Up to 30% of patients undergoing cardiac surgery develop AKI, with 1% requiring RRT. AKI is an independent risk factor for morbidity and mortality. Postoperatively, even minimal changes in serum creatinine are associated with a substantial increase in mortality. No intervention has been definitely proven effective in reducing kidney injury. The successful prevention and management of AKI involves identifying patients at risk for AKI, recognizing subtle abnormalities in a timely manner, performing basic clinical assessments, and responding appropriately to data obtained. With that in mind, in this Attending Rounds, a woman with AKI in the setting of cardiac surgery is presented to highlight the use of history, physical exam, hemodynamic monitoring, laboratory data trends, and urine indices in establishing the correct diagnosis and appropriate management.
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Affiliation(s)
- Ashita J Tolwani
- Division of Nephrology, University of Alabama, Birmingham, Alabama
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