BACKGROUND Veno-arterial extra corporeal membrane oxygenation(VA-ECMO)support is commonly complicated with left ventricle(LV)distension in patients with cardiogenic shock.We resolved this problem by transeptally conve...BACKGROUND Veno-arterial extra corporeal membrane oxygenation(VA-ECMO)support is commonly complicated with left ventricle(LV)distension in patients with cardiogenic shock.We resolved this problem by transeptally converting VAECMO to left atrium veno-arterial(LAVA)-ECMO that functioned as a temporary paracorporeal left ventricular assist device to resolve LV distension.In our case LAVA-ECMO was also functioning as a bridge-to-transplant device,a technique that has been scarcely reported in the literature.CASE SUMMARY A 65 year-old man suffered from acute myocardial injury that required percutaneous stents.Less than two weeks later,noncompliance to antiplatelet therapy led to stent thrombosis,cardiogenic shock,and cardiac arrest.Femorofemoral VA-ECMO support was started,and the patient underwent a second coronary angiography with re-stenting and intra-aortic balloon pump placement.The VA-ECMO support was complicated by left ventricular distension which we resolved via LAVA-ECMO.Unfortunately,episodes of bleeding and sepsis complicated the clinical picture and the patient passed away 27 d after initiating VA-ECMO.CONCLUSION This clinical case demonstrates that LAVA-ECMO is a viable strategy to unload the LV without another invasive percutaneous or surgical procedure.We also demonstrate that LAVA-ECMO can also be weaned to a left ventricular assist device system.A benefit of this technique is that the procedure is potentially reversible,should the patient require VA-ECMO support again.A transeptal LV venting approach like LAVA-ECMO may be indicated over ImpellaTM in cases where less LV unloading is required and where a restrictive myocardium could cause LV suctioning.Left ventricular over-distention is a well-known complication of peripheral VA-ECMO in cardiogenic shock and LAVA ECMO through transeptal cannulation offers a novel and safe approach for treating LV overloading,without the need of an additional percutaneous access.展开更多
BACKGROUND Very little is known about the role of extracorporeal membrane oxygenation(ECMO)for the management of patients undergoing major aortic surgery with particular reference to aortic dissection.AIM To review th...BACKGROUND Very little is known about the role of extracorporeal membrane oxygenation(ECMO)for the management of patients undergoing major aortic surgery with particular reference to aortic dissection.AIM To review the available literature to determine if there was any evidence.METHODS A systematic literature search through PubMed and EMBASE was undertaken according to specific key words.RESULTS The search resulted in 29 publications relevant to the subject:1 brief communication,1 surgical technique report,1 invited commentary,1 retrospective case review,1 observational study,4 retrospective reviews,13 case reports and 7 conference abstracts.A total of 194 patients were included in these publications of whom 77 survived.CONCLUSION Although there is no compelling evidence for or against the use of ECMO in major aortic surgery or dissection,it is enough to justify its use in this patient population despite current adverse attitude.展开更多
Aim: To study the effect of extra-corporeal shock wave (ESW) on the penile hemodynamics and histopathology in rats. Methods: Adult male Sprague-Dawley rats were divided at random into 3 groups. ESW application was per...Aim: To study the effect of extra-corporeal shock wave (ESW) on the penile hemodynamics and histopathology in rats. Methods: Adult male Sprague-Dawley rats were divided at random into 3 groups. ESW application was performed with a Siemens Lithostar with the rats under anesthesia lying prone on the balloon probe. Rats in Group Ⅰ received a total of 1000 shocks at 18 kV and immediately underwent hemodynamic evaluation performed by direct electrostimulation of the cavernous nerve and measurement of intracavernous pressure (ICP). Rats in Group Ⅱ received 3 times 1000 shocks at 18 kV at weekly intervals and hemodynamic evaluation was performed 1 month after the last ESW application. Group Ⅲ served as the control. Histopathological examinations of penile tissues were done on Masson's trichrome and hematoxylin and eosin stained sections. Results: Penile hemodynamic evaluation showed a trend toward a diminished mean maximal ICP, duration of erection, ICP during the plateau phase and maximal ICP/blood pressure ratio in Group Ⅰ, although there was no significant significance. The mean latency period in Groups Ⅰ and Ⅱ was prolonged. Petechial bleeding within tunical layers and small loci of hemorrhage within the corpora cavernosa were observed in Group Ⅰ. However, histopathological examination failed to reveal any significant differences between the groups in terms of smooth muscle content, tunical thickness, organization of collagen bundles and elastic fiber-lattice framework. Conclusion: ESW has certain damaging effects on the penis. (Asian J Androl 2002 Dec; 4: 249-253)展开更多
Use of an apico-aortic conduit （AAC） serves as an alternative method to treat severe aortic stenosis inelder patients, especially in those with a heavily calcified ascending aorta or prior cardiac surgery. The resul...Use of an apico-aortic conduit （AAC） serves as an alternative method to treat severe aortic stenosis inelder patients, especially in those with a heavily calcified ascending aorta or prior cardiac surgery. The results of long-term follow-up of AAC are very rare. We reported a case about a successful replacement of late degenerated prosthetic valve following AAC procedure, assisted with extra corporeal membrane oxygenation （ECMO）.展开更多
基金Supported by EUROSETS srl Italy for the Open Access Fee.
文摘BACKGROUND Veno-arterial extra corporeal membrane oxygenation(VA-ECMO)support is commonly complicated with left ventricle(LV)distension in patients with cardiogenic shock.We resolved this problem by transeptally converting VAECMO to left atrium veno-arterial(LAVA)-ECMO that functioned as a temporary paracorporeal left ventricular assist device to resolve LV distension.In our case LAVA-ECMO was also functioning as a bridge-to-transplant device,a technique that has been scarcely reported in the literature.CASE SUMMARY A 65 year-old man suffered from acute myocardial injury that required percutaneous stents.Less than two weeks later,noncompliance to antiplatelet therapy led to stent thrombosis,cardiogenic shock,and cardiac arrest.Femorofemoral VA-ECMO support was started,and the patient underwent a second coronary angiography with re-stenting and intra-aortic balloon pump placement.The VA-ECMO support was complicated by left ventricular distension which we resolved via LAVA-ECMO.Unfortunately,episodes of bleeding and sepsis complicated the clinical picture and the patient passed away 27 d after initiating VA-ECMO.CONCLUSION This clinical case demonstrates that LAVA-ECMO is a viable strategy to unload the LV without another invasive percutaneous or surgical procedure.We also demonstrate that LAVA-ECMO can also be weaned to a left ventricular assist device system.A benefit of this technique is that the procedure is potentially reversible,should the patient require VA-ECMO support again.A transeptal LV venting approach like LAVA-ECMO may be indicated over ImpellaTM in cases where less LV unloading is required and where a restrictive myocardium could cause LV suctioning.Left ventricular over-distention is a well-known complication of peripheral VA-ECMO in cardiogenic shock and LAVA ECMO through transeptal cannulation offers a novel and safe approach for treating LV overloading,without the need of an additional percutaneous access.
文摘BACKGROUND Very little is known about the role of extracorporeal membrane oxygenation(ECMO)for the management of patients undergoing major aortic surgery with particular reference to aortic dissection.AIM To review the available literature to determine if there was any evidence.METHODS A systematic literature search through PubMed and EMBASE was undertaken according to specific key words.RESULTS The search resulted in 29 publications relevant to the subject:1 brief communication,1 surgical technique report,1 invited commentary,1 retrospective case review,1 observational study,4 retrospective reviews,13 case reports and 7 conference abstracts.A total of 194 patients were included in these publications of whom 77 survived.CONCLUSION Although there is no compelling evidence for or against the use of ECMO in major aortic surgery or dissection,it is enough to justify its use in this patient population despite current adverse attitude.
基金Correspondence to: Ahmet Tefeldi, M.D., Department of Urology, Medical Faculty of Istanbul, University of Istanbul, 34390-Capa, Istanbul, Turkey.
文摘Aim: To study the effect of extra-corporeal shock wave (ESW) on the penile hemodynamics and histopathology in rats. Methods: Adult male Sprague-Dawley rats were divided at random into 3 groups. ESW application was performed with a Siemens Lithostar with the rats under anesthesia lying prone on the balloon probe. Rats in Group Ⅰ received a total of 1000 shocks at 18 kV and immediately underwent hemodynamic evaluation performed by direct electrostimulation of the cavernous nerve and measurement of intracavernous pressure (ICP). Rats in Group Ⅱ received 3 times 1000 shocks at 18 kV at weekly intervals and hemodynamic evaluation was performed 1 month after the last ESW application. Group Ⅲ served as the control. Histopathological examinations of penile tissues were done on Masson's trichrome and hematoxylin and eosin stained sections. Results: Penile hemodynamic evaluation showed a trend toward a diminished mean maximal ICP, duration of erection, ICP during the plateau phase and maximal ICP/blood pressure ratio in Group Ⅰ, although there was no significant significance. The mean latency period in Groups Ⅰ and Ⅱ was prolonged. Petechial bleeding within tunical layers and small loci of hemorrhage within the corpora cavernosa were observed in Group Ⅰ. However, histopathological examination failed to reveal any significant differences between the groups in terms of smooth muscle content, tunical thickness, organization of collagen bundles and elastic fiber-lattice framework. Conclusion: ESW has certain damaging effects on the penis. (Asian J Androl 2002 Dec; 4: 249-253)
文摘目的观察恢刺联合超声引导下冲击波对卒中后痉挛(post-stroke spasticity,PSS)患者肌张力和运动功能的影响。方法将96例PSS患者随机分为观察组和对照组,每组48例。对照组给予超声引导下体外冲击波(extra-corporeal shock wave therapy,ESWT)治疗,观察组在对照组基础上采用恢刺阳陵泉穴治疗。观察两组治疗前后改良Ashworth量表(modified Ashworth scale,MAS)、Wolf运动功能测试(Wolf motor function test,WMFT)、功能综合评定(functional comprehensive assessment,FCA)量表、肌电均方根值(root mean square,RMS)和积分肌电值(integrated electromyogram,iEMG)变化。结果两组治疗后肌张力评分等级分布优于治疗前(P<0.05),且观察组等级分布优于对照组(P<0.05)。治疗后,两组WMFT评分均高于治疗前(P<0.05),且观察组高于对照组(P<0.05);两组FCA日常生活功能、认知功能及总分高于治疗前(P<0.05),且观察组高于对照组(P<0.05);两组RMS、iEMG低于治疗前(P<0.05),且观察组低于对照组(P<0.05)。结论恢刺联合超声引导下冲击波治疗PSS效果显著,可有效改善肌电生理指标、肌张力及运动功能,提高日常生活能力及认知水平。
文摘Use of an apico-aortic conduit （AAC） serves as an alternative method to treat severe aortic stenosis inelder patients, especially in those with a heavily calcified ascending aorta or prior cardiac surgery. The results of long-term follow-up of AAC are very rare. We reported a case about a successful replacement of late degenerated prosthetic valve following AAC procedure, assisted with extra corporeal membrane oxygenation （ECMO）.
