Clinical conference: aprotinin use during deep hypothermic circulatory arrest for type A aortic dissection and cesarean section in a woman with preeclampsia.
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Adult↗
Biomedical subjects
B L Milas
Publications and source records attributed to B L Milas.
Case 8-2001. Resolution of systolic anterior motion after mitral valve repair with atrial pacing.
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Aged↗
Management of bleeding and coagulopathy after heart surgery.
Mechanisms of bleeding common to virtually all patients after heart surgery are platelet dysfunction, enhanced fibrinolysis, dilution of all components of the coagulation system, and the presence of heparin and protamine. The use of warfarin is increasing in patients with heart disease requiring surgery. The replenishment of vitamin K-dependent factors beyond a normal prothrombin time is not assessable, and the dilution associated with cardiopulmonary bypass can reach coagulopathic levels. Optimal preoperative preparation is required and intraoperative therapy initiated when indicated. Individualized heparin and protamine dosing, antifibrinolytic drug administration, minimization of blood loss and dilution, and minimal time on cardiopulmonary bypass are basic adjuncts to meticulous surgical hemostasis. When bleeding is observed in the postoperative period, a sequential assessment of the probable cause leads to initial therapy while laboratory test results are obtained. Ongoing assessment for hemodynamic instability caused by accumulated mediastinal blood is needed while managing the bleeding patient. A chest radiograph and transesophageal echocardiogram can be useful in diagnosing cardiac tamponade.
Algorithms↗
Circulatory management of the unstable cardiac patient.
The objective of this article is to provide an orderly and concise approach to the treatment of the unstable cardiac surgery patient. The common causes of hemodynamic instability in this patient population are reviewed. The various pharmacologic, mechanical, and electric therapeutic options available for each clinical situation are explored, and a sequential treatment algorithm is developed.
Assisted Circulation↗
Atrioventricular dissociation.
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Anesthetics↗
Pseudoaneurysm of the ascending aorta after aortic valve replacement.
A 58-year-old man with fever and chest wall tenderness was seen 8 weeks after aortic valve replacement. His initial postoperative course had been complicated by mediastinitis, requiring antibiotics and surgical debridement. A transthoracic echocardiogram did not reveal the culprit lesion. Pseudoaneurysm of the ascending aorta was suspected, based on computerized tomographic and magnetic resonance images of the chest. Intraoperative transesophageal echocardiography confirmed the diagnosis of pseudoaneurysm and was a key component in the patient's operative management.
Aneurysm, False↗