AIM:To retrospectively evaluate the management and outcome of venous obstruction after living donor liver transplantation(LDLT).METHODS:From February 1999 to May 2009,1 intraoperative hepatic vein(HV) tension induced ...AIM:To retrospectively evaluate the management and outcome of venous obstruction after living donor liver transplantation(LDLT).METHODS:From February 1999 to May 2009,1 intraoperative hepatic vein(HV) tension induced HV obstruction and 5 postoperative HV anastomotic stenosis occurred in 6 adult male LDLT recipients.Postoperative portal vein(PV) anastomotic stenosis occurred in 1 pediatric left lobe LDLT.Patients ranged in age from 9 to 56 years(median,44 years).An air balloon was used to correct the intraoperative HV tension.Emergent surgical reoperation,transjugular HV balloon dilatation with stent placement and transfemoral venous HV balloon dilatation was performed for HV stenosis on days 3,15,50,55,and 270 after LDLT,respectively.Balloon dilatation followed with stent placement via superior mesenteric vein was performed for the pediatric PV stenosis 168 d after LDLT.RESULTS:The intraoperative HV tension was corrected with an air balloon.The recipient who underwent emergent reoperation for hepatic stenosis died of hemorrhagic shock and renal failure 2 d later.HV balloon dilatation via the transjugular and transfemoral venous approach was technically successful in all patients.The patient with early-onset HV stenosis receiving transjugular balloon dilatation and stent placement on the 15th postoperative day left hospital 1 wk later and disappeared,while the patient receiving the same interventional procedures on the 50th postoperative day died of graft failure and renal failure 2 wk later.Two patients with late-onset HV stenosis receiving balloon dilatation have survived for 8 and 4 mo without recurrent stenosis and ascites,respectively.Balloon dilatation and stent placement via the superior mesenteric venous approach was technically successful in the pediatric left lobe LDLT,and this patient has survived for 9 mo without recurrent PV stenosis and ascites.CONCLUSION:Intraoperative balloon placement,emergent reoperation,proper interventional balloon dilatation and stent placement can be effective as a way to manage hepatic and PV stenosis during and after LDLT.展开更多
Hepatic venous stenosis may be a cause of graft failure in living donor liver transplantation （LDLT）. Balloon dilation and metallic frame approaches have been used successfully to treat hepatic venous stenosis. Here...Hepatic venous stenosis may be a cause of graft failure in living donor liver transplantation （LDLT）. Balloon dilation and metallic frame approaches have been used successfully to treat hepatic venous stenosis. Here, we report the effect of transfemoral venous balloon dilation for treating a child with hepatic venous stenosis after LDLT .展开更多
Purpose: Patients scheduled to undergo the transcatheter aortic valve replacement (TAVR) are usually octogenarians with severe co-morbidities and an increased risk of surgery-associated complications. The aim of this ...Purpose: Patients scheduled to undergo the transcatheter aortic valve replacement (TAVR) are usually octogenarians with severe co-morbidities and an increased risk of surgery-associated complications. The aim of this study was to determine the incidence of insufficient oxygen delivery as measured by mixed venous oxygen saturation (SvO2) via invasive continuous cardiopulmonary monitoring and the low cardiac output syndrome (LCOS) in patients undergoing the TAVR procedure. The second objective was to examine how these hemodynamic measurements would change during critical events, such as rapid ventricular pacing (RVP) during this procedure. Methods: This prospective, observational study, examined twenty patients undergoing TAVR under general anesthesia. Hemodynamic variables, SvO2 and the continuous cardiac output (CO) were assessed using pulmonary artery catheter (PAC) and a Vigilance? monitor. Insufficient oxygen delivery was defined as a SvO2 value under 58% and LCOS as a cardiac index (CI) under 2 L/min/m2. Total intravenous anesthesia and hemodynamic management protocol were standardized. RVP was induced twice during the procedure at a frequency of 180 - 200/min. Predefined clinical endpoints were assessed during the procedure and hemodynamic values were analyzed before and after twelve critical events. Results: The data of twenty patients with a mean age of 80 ± 4 years and EuroSCORE 18 ± 10 were analyzed. Fourteen (70%) of the TAVR procedures were performed transapically, the other six (30%) transfemorally. The SvO2 value under 58% (mean 54 ± 6) and the CI under 2 L/min/m2 (mean 1.6 ± 0.2) were detected in 60% of patients (n = 12) before the use of RVP. All of these patients received perioperative inotropic medication and required norepinephrine infusion for maintenance of adequate blood pressure. The SvO2, CO and CI were significantly decreased after the use of RVP (P 2 reverted rapidly to the same level as before the application of RVP (1 min), CO, and CI 10 min later. At the end of the operation SvO2 values were at same level as before RVP and CO and CI were higher than before RVP. Conclusion: A high incidence of insufficient oxygen delivery and low cardiac output syndrome were detected in patients undergoing TAVR procedures. Nonetheless, all hemodynamic values returned rather rapidly to the same level as before the use of the RVP and were at the optimal level at the end of the procedure. According to the current study, the most hemodynamically hazardous steps during TAVR are the use of RVP sequences, the induction of anesthesia and the initiation of surgery.展开更多
Background Central venous stenosis and obstruction （CVD） is a serious and prevalent challenge to both resolve the venous hypertension symptoms and maintain the pantency of the ipsilateral hemodialysis access in hemo...Background Central venous stenosis and obstruction （CVD） is a serious and prevalent challenge to both resolve the venous hypertension symptoms and maintain the pantency of the ipsilateral hemodialysis access in hemodialysis patients. This study aimed to summarize our experience of the endovascular management of the central venous stenosis or obstruction in hemodialysis patients. Methods Twenty-four haemodialysis cases of central vein stenosis or obstruction with ipsilateral functional vascular access in our hospital between July 2006 and February 2012 were treated by interventional therapy and the data were analyzed retrospectively. Results Eighteen males and six females with mean age of （66.4±13.8） years and manifesting with arm swelling and venous hypertension were enrolled; 62.5% of them had a history of catheterization. Venography showed stenotic lesion in 10 cases including eight cases of brachiocephalic vein stenosis and two cases of subclavian vein stenosis and 14 cases of obstruction lesions including seven cases of short brachiocephalic obstruction and seven cases of long segment obstruction. Interventional therapy was performed and the technique success rate was 83.3%. Percutaneous transluminal angioplasty （PTA） was performed in nine cases and stent was performed in 11 cases firstly. The symptoms of venous hypertension were resolved after intervention in all the cases. There was no major complication and death perioperatively. During follow-up, reintervention was done, the primary patency rates were （88.9±10.5）%, （64.8±10.5）% and （48.6±18.7）% at 3 months, 6 months and 1 year after treatment in the PTA group; （90.0±9.5）% and （77.1±14.4）% at 6 months and 1 year after treatment in the stent group, respectively. The secondary patency rates were （48.6±18.7）% in the PTA group and （83.3±15.2）% in the stent group 1 year after treatment, respectively. There was no significant difference between the two groups （primary patency, P=0.20; secondary patency, P=0.10）. Conclusions The endovascular intervention is a safe and effective method for CVD in short term; enhanced follow-up and repeated interventions are required to maintain patency for long term. The prevention is most important. Avoiding and minimizing the placement of the central venous catheter may be the key point for the prevention.展开更多
文摘AIM:To retrospectively evaluate the management and outcome of venous obstruction after living donor liver transplantation(LDLT).METHODS:From February 1999 to May 2009,1 intraoperative hepatic vein(HV) tension induced HV obstruction and 5 postoperative HV anastomotic stenosis occurred in 6 adult male LDLT recipients.Postoperative portal vein(PV) anastomotic stenosis occurred in 1 pediatric left lobe LDLT.Patients ranged in age from 9 to 56 years(median,44 years).An air balloon was used to correct the intraoperative HV tension.Emergent surgical reoperation,transjugular HV balloon dilatation with stent placement and transfemoral venous HV balloon dilatation was performed for HV stenosis on days 3,15,50,55,and 270 after LDLT,respectively.Balloon dilatation followed with stent placement via superior mesenteric vein was performed for the pediatric PV stenosis 168 d after LDLT.RESULTS:The intraoperative HV tension was corrected with an air balloon.The recipient who underwent emergent reoperation for hepatic stenosis died of hemorrhagic shock and renal failure 2 d later.HV balloon dilatation via the transjugular and transfemoral venous approach was technically successful in all patients.The patient with early-onset HV stenosis receiving transjugular balloon dilatation and stent placement on the 15th postoperative day left hospital 1 wk later and disappeared,while the patient receiving the same interventional procedures on the 50th postoperative day died of graft failure and renal failure 2 wk later.Two patients with late-onset HV stenosis receiving balloon dilatation have survived for 8 and 4 mo without recurrent stenosis and ascites,respectively.Balloon dilatation and stent placement via the superior mesenteric venous approach was technically successful in the pediatric left lobe LDLT,and this patient has survived for 9 mo without recurrent PV stenosis and ascites.CONCLUSION:Intraoperative balloon placement,emergent reoperation,proper interventional balloon dilatation and stent placement can be effective as a way to manage hepatic and PV stenosis during and after LDLT.
基金supported by a grant from Jiangsu Health Department of China (RC2007058)
文摘Hepatic venous stenosis may be a cause of graft failure in living donor liver transplantation （LDLT）. Balloon dilation and metallic frame approaches have been used successfully to treat hepatic venous stenosis. Here, we report the effect of transfemoral venous balloon dilation for treating a child with hepatic venous stenosis after LDLT .
文摘Purpose: Patients scheduled to undergo the transcatheter aortic valve replacement (TAVR) are usually octogenarians with severe co-morbidities and an increased risk of surgery-associated complications. The aim of this study was to determine the incidence of insufficient oxygen delivery as measured by mixed venous oxygen saturation (SvO2) via invasive continuous cardiopulmonary monitoring and the low cardiac output syndrome (LCOS) in patients undergoing the TAVR procedure. The second objective was to examine how these hemodynamic measurements would change during critical events, such as rapid ventricular pacing (RVP) during this procedure. Methods: This prospective, observational study, examined twenty patients undergoing TAVR under general anesthesia. Hemodynamic variables, SvO2 and the continuous cardiac output (CO) were assessed using pulmonary artery catheter (PAC) and a Vigilance? monitor. Insufficient oxygen delivery was defined as a SvO2 value under 58% and LCOS as a cardiac index (CI) under 2 L/min/m2. Total intravenous anesthesia and hemodynamic management protocol were standardized. RVP was induced twice during the procedure at a frequency of 180 - 200/min. Predefined clinical endpoints were assessed during the procedure and hemodynamic values were analyzed before and after twelve critical events. Results: The data of twenty patients with a mean age of 80 ± 4 years and EuroSCORE 18 ± 10 were analyzed. Fourteen (70%) of the TAVR procedures were performed transapically, the other six (30%) transfemorally. The SvO2 value under 58% (mean 54 ± 6) and the CI under 2 L/min/m2 (mean 1.6 ± 0.2) were detected in 60% of patients (n = 12) before the use of RVP. All of these patients received perioperative inotropic medication and required norepinephrine infusion for maintenance of adequate blood pressure. The SvO2, CO and CI were significantly decreased after the use of RVP (P 2 reverted rapidly to the same level as before the application of RVP (1 min), CO, and CI 10 min later. At the end of the operation SvO2 values were at same level as before RVP and CO and CI were higher than before RVP. Conclusion: A high incidence of insufficient oxygen delivery and low cardiac output syndrome were detected in patients undergoing TAVR procedures. Nonetheless, all hemodynamic values returned rather rapidly to the same level as before the use of the RVP and were at the optimal level at the end of the procedure. According to the current study, the most hemodynamically hazardous steps during TAVR are the use of RVP sequences, the induction of anesthesia and the initiation of surgery.
文摘Background Central venous stenosis and obstruction （CVD） is a serious and prevalent challenge to both resolve the venous hypertension symptoms and maintain the pantency of the ipsilateral hemodialysis access in hemodialysis patients. This study aimed to summarize our experience of the endovascular management of the central venous stenosis or obstruction in hemodialysis patients. Methods Twenty-four haemodialysis cases of central vein stenosis or obstruction with ipsilateral functional vascular access in our hospital between July 2006 and February 2012 were treated by interventional therapy and the data were analyzed retrospectively. Results Eighteen males and six females with mean age of （66.4±13.8） years and manifesting with arm swelling and venous hypertension were enrolled; 62.5% of them had a history of catheterization. Venography showed stenotic lesion in 10 cases including eight cases of brachiocephalic vein stenosis and two cases of subclavian vein stenosis and 14 cases of obstruction lesions including seven cases of short brachiocephalic obstruction and seven cases of long segment obstruction. Interventional therapy was performed and the technique success rate was 83.3%. Percutaneous transluminal angioplasty （PTA） was performed in nine cases and stent was performed in 11 cases firstly. The symptoms of venous hypertension were resolved after intervention in all the cases. There was no major complication and death perioperatively. During follow-up, reintervention was done, the primary patency rates were （88.9±10.5）%, （64.8±10.5）% and （48.6±18.7）% at 3 months, 6 months and 1 year after treatment in the PTA group; （90.0±9.5）% and （77.1±14.4）% at 6 months and 1 year after treatment in the stent group, respectively. The secondary patency rates were （48.6±18.7）% in the PTA group and （83.3±15.2）% in the stent group 1 year after treatment, respectively. There was no significant difference between the two groups （primary patency, P=0.20; secondary patency, P=0.10）. Conclusions The endovascular intervention is a safe and effective method for CVD in short term; enhanced follow-up and repeated interventions are required to maintain patency for long term. The prevention is most important. Avoiding and minimizing the placement of the central venous catheter may be the key point for the prevention.
