Post-cardiopulmonary bypass coagulopathy in a neonate with a family history of von Willebrand disease.
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Blood Coagulation Disorders↗
Biomedical subjects
Sana Ullah
Publications and source records attributed to Sana Ullah.
Cardiac organ donor management.
There is a critical shortage of donor organs. According to the United Network for Organ Sharing (UNOS), 20% of organs are discarded after procurement. Many of these may be potentially salvageable. Brain death is particularly detrimental to cardiac function. The initial sympathetic storm can produce direct myocardial injury. The ensuing spinal shock reduces global oxygen delivery. There is a change to anaerobic metabolism due to global mitochondrial dysfunction. Diabetes insipidus worsens hypovolemia and thyroid deficiency impairs cardiac function. Inadequate replacement of blood loss from trauma and coagulopathy worsens anemia and oxygen delivery. In the mid-1990s, the Papworth Hospital group in the UK advocated early invasive hemodynamic monitoring and administration of a 'hormonal cocktail', consisting of triiodothyronine (T3), vasopressin, methylprednisolone and insulin. This has been widely accepted and is endorsed by UNOS. Ventricular function, volume status and adequacy of resuscitation should be guided by invasive monitoring and serial echocardiography. Dopamine or epinephrine is used for inotropic support. If hypotension persists, vasopressin should be added which may allow reduction of inotropes. Donor lung function and ventilation should be optimized. Recently, two large retrospective studies have shown that, with aggressive pharmacological and hormonal resuscitation, a significant increase in the number and quality of organs harvested can be achieved.
Heart Transplantation↗
Electrophysiology studies without fluoroscopy.
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Anesthesiology↗
The extracardiac Fontan procedure without cardiopulmonary bypass: technique and intermediate-term results.
BACKGROUND: The extracardiac Fontan procedure (ECF) usually requires cardiopulmonary bypass (CPB). In this report, the results and techniques of this procedure without CPB at a single institution are presented. METHODS: Between August 1992 and December 2001, ECF without CPB was achieved in 24 of 44 patients undergoing an ECF. Mean age at surgery was 5.9 +/- 2.9 years, and mean weight was 20.7 +/- 12.6 kg. Diagnoses were tricuspid atresia in 9 patients, single-ventricle with pulmonary outflow tract obstruction in 7, pulmonary atresia/intact septum in 5, and other complex single-ventricle physiology in 3. Initial palliation was by arterial to pulmonary artery shunt in 21 and pulmonary artery banding in 1. A bidirectional cavopulmonary connection was created in 23 patients. A temporary inferior vena caval-to-atrial shunt was used to complete the procedure without CPB. Median graft size was 16 mm (range 14 to 20 mm). RESULTS: There was no early mortality, and 68% of patients were discharged without complications. Complications included persistent cyanosis in 4 patients, persistent pleural effusions in 2 (one chylous), and phrenic nerve injury in 1. Median postoperative hospital stay was 16 days (range 10 to 50) days. At a mean follow-up of 44 +/- 28 months, there was no conduit obstruction. One patient died 11 months postoperatively, and 1 patient received a heart transplant 26 months post-ECF. CONCLUSIONS: At intermediate term follow-up, the ECF without CPB appears to be safe and technically reproducible in selected cases. Ongoing follow-up of these patients is necessary to document the theoretical advantages of avoiding CPB.
Child, Preschool↗