Aortic Stenosis

Aortic Stenosis Rheumatic heart disease and calcification deposits due to age (senile calcific aortic stenosis) are the most common pathologic conditions associated with aortic stenosis.  Congenital malformations such as a bicuspid aortic valve with a small annulus, or unicuspid valve usually develop symptoms at an early age but occasionally surface in later years.  Calcification of […]

Cardiac Blood Flow & O2 Consumption

“The major vessels of the coronary circulation are the left main coronary that divides into left anterior descending and circumflex branches, and the right main coronary artery.” Source: Cardiovascular Physiology Concepts Richard E. Klabunde, PhD The major vessels of the coronary circulation are the left main coronary that divides into left anterior descending andcircumflex branches, and the right main coronary artery. […]

Myocardial Ischemia: The Best Timing for Engaging CPB for Revascularization

Editors Note: Having been in the field for awhile, and being an STS data coordinator, the timing of surgery for patients suffering from an acute evolving myocardial infarction (AEMI) has always intrigued me. The STS data form is very specific in tracking these intervals, and I am naturally curious as to what the impact on […]

Up Close & Personal: The Bental Procedure

Click images to enlarge (it’s definitely worth it) Editor’s Note: These amazing pictures are brought to you by Nadia Azuero, BS, CCP, LP- who is currently 3/4 way through Medical school. = Nadia joined the “Surfers team as an Associate Editor- in charge of Media &  Photography. Nadia is very gifted, as a skilled clinician, a […]

The Avalon Bi-Caval Dual Lumen Catheter

Have you used a percutaneous venous cannula like this? The AVALONELITE :  Bi-Caval Dual Lumen Catheter (Click image to visit website) A Discussion on Cannula Positioning Proper cannula positioning in single site veno-venous extracorporeal life support (vv-ELS) is cumbersome and necessitates image guidance to obtain a safe and stable position within the heart and the […]

CNS & CPB

CNS & CPB The major postoperative neurological complication associated with open-heart surgery and cardiopulmonary bypass is stroke, which is defined as a sudden onset of a focal deficit of the central nervous system lasting longer than 24 hours.  While this clinical finding occurs in approximately 1-5% of cardiac surgery patients, 70% of cerebrovascular sequelae occur […]

Intracardiac Pressures

Intracardiac Pressures = Right ventricular systolic pressure Right ventricular systolic pressure (RVSP) can be easily assessed in most subjects who present some degree of tricuspid regurgitation. The velocity recorded across the regurgitant jet corresponds to the right ventricular-right atrial gradient (RV-RA ΔP), so that, this value added to mean right atrial pressure (RAP) represents the […]

Intracardiac Shunts

Principles of Intracardiac Shunts Significant hypoxemia can result from right-to-left intracardiac shunting through a patent foramen ovale, an atrial septal defect or a ventricular septal defect. Pulmonary embolus, congenital heart disease and pericardial tamponade are well-recognized causes of right-to-left shunting. With the continued presence of a congenital defect of the cardiac septum or great vessels […]

Mitral Insufficiency

Mitral Insufficiency Six anatomical components must mesh synchronously to insure proper function of the mitral valve.  Disruption of the kinetic interrelationship between the left ventricular wall, the left atrial wall, valve leaflets, annulus, chordae tendineae, and papillary muscles, may lead to dysfunction of the valve.  Chronic mitral valve insufficiency (regurgitation) most often results from rheumatic […]

Right Ventricular Function

Right Ventricle The right ventricle is one of four chambers (two atria and two ventricles) in the human heart. It receives deoxygenated blood from the right atrium via the tricuspid valve, and pumps it into the pulmonary artery via the pulmonary valve and pulmonary trunk. It is triangular in form, and extends from the right […]

A Marvelous VAD Presentation from China

For every ACTION, there is an EQUAL and OPPOSITE REACTION. This theory impacts life’s varied circumstances, the CAUSE and EFFECT implication… Author / Editor: Co-Editor Anna Lou Villena 🙂 [10] Editor’s Note: This is an extraordinary PowerPoint presentation regarding VAD technology.  It is an eye-opener and definitely well worth viewing. Click image above to view […]

Newton’s Theory

For every ACTION, there is an EQUAL and OPPOSITE REACTION. This theory impacts life’s varied circumstances, the CAUSE and EFFECT implication… Author / Editor: Co-Editor Anna Lou Villena 🙂 [9] From the cascade of events, I found myself in a retrospective mood and thought about the fundamentals of science which I learned during primary years- […]

No ROOM for BLIND SPOT

EXPECT the best, PLAN for the Worst and PREPARE to be surprised. Author / Editor: Co-Editor Anna Lou Villena 🙂 [8] A Perfusionist’s principle goes out for Mr. Waitley’s quote : EXPECT the best, PLAN for the Worst and PREPARE to be surprised. GEARING UP One can never EXPECT THE BEST outcome without planning ahead. […]

REALITY CHECK for THRESHOLD Countries

Author / Editor: Co-Editor Anna Lou Villena 🙂 [7] Let me go back to one of the questions in my interview with Circuit Surfers: Q. 11:  Is preventive medicine more prevalent in Asia than in the West? In my opinion, the prevalence of preventive medicine depends on the countries’ economical stability and governance because this […]

Adrenaline Rush … The Aftermath

Author: Co-Editor Anna Lou Villena 🙂 [6]   = The photo was taken with consent from our patient, Mr. Zou. He underwent a 4V CABG and 6 hours after an uneventful surgery, a sudden dilemma happened in ICU that prompted the team to have an emergency IAB insertion and re-operation. That Friday Madness thing was […]

A Friday Madness Adrenaline Rush !

Author: Co-Editor Anna Lou Villena 🙂 [5] =             Just sharing my FRIDAY MADNESS anecdote. I should say the test of a Perfusionist’s character- we have been engaged almost every day of the stressors in our workplace but in reality our job is the stressor per se. However, this depends on how you will be […]

The RING matters

Insert Author: Co-Editor Anna Lou Villena 🙂 [3] = = Essentially, a variety of RING matters. May it be symbolic, just as the wedding ring that married couple tucked in their finger or a clinging geographic phrase “Ring of Fire”, located in the basin of the Pacific ocean where a number of earthquakes and volcanic […]

Ventricular Hypertrophy & Perfusion

LVH :  Photo by:  Srinivas Rao @ Gruppo dei Perfusionisti!!! Ventricular Hypertrophy & Perfusion Subendocardial Q Determinants While subendocardial and sub-epicardial layers have the same determinants for blood flow, subendocardial layers are at greater risk from ischemia and infarction.  The deeper subendocardium is subjected to greater wall tension which then expresses as a metabolic requirement […]

LVADers are all Test Pilots…

Editor’s Note: The title says it all.  Joshua is an on-line friend I met almost 2 years ago.  He has had a HeartMate II in for that entire duration plus I believe at least 1 or more years prior.  His story is amazing- and a year ago I did an interview with Josh.  I revisit […]

Deep Hypothermia: Antegrade & Retrograde Cerebral Perfusion

Editor’s Note: Deep Hypothermic Circulatory Arrest (DHCA), is a concept discussed here in this forum, as well as a significant perfusion event when it comes to the horizon. Obviously an issue for aortic dissections, transections, or congenital malformations that require a surgical approach and repair that can only be accomplished by intermittent or momentary cessation […]

Deep Hypothermia: Rapid Cooling & Nitroglycerine

Editor’s Note: Deep Hypothermic Circulatory Arrest (DHCA), is a concept discussed here in this forum, as well as a significant perfusion event when it comes to the horizon. Obviously an issue for aortic dissections, transections, or congenital malformations that require a surgical approach and repair that can only be accomplished by intermittent or momentary cessation […]

Subendocardial Blood Flow Determinants

Editor’s Note: Subendocardial Blood Flow Determinants While subendocardial and sub-epicardial layers have the same determinants for blood flow, subendocardial layers are at greater risk from ischemia and infarction.  The deeper subendocardium is subjected to greater wall tension which then expresses as a metabolic requirement 10-20% greater than the more superficial epicardium. Higher oxygen demand and […]

Percutaneous AVR

Editor’s Note: I saw an interesting image of an aortic stent on the SUNY FB page, and followed their link to the source.  I think the images and concept are perfusion-review worthy, so I thought I would bring it to you and see what you think. Aortic Valve Replacement Module Provides comprehensive practice on endovascular […]

DextraCardia in Adult CPB

Click image to enlarge Editor’s Note: Once again, just checking early morning news and chatter on Facebook, and another interesting idea rears it’s head.  It involved a picture of a “right Sided” heart. The thread is on Giuseppe Salerno’s online Perfusion group- Gruppo dei Perfusionisti !!! It can be found by clicking here… Dextracadia and […]

Speaking of Aortic Dissections … Brussels, Belgium

AND …. Another Face Book Connection… Authored by:  Olivier Germay Chief Perfusionist · Jan 1995 to present · Brussels, Belgium Chirurgie Cardio-Vasculaire & Thoracique Circulatory Arrest for Cross-tube Anastomosis Ok, man 54 y old, 110 kg, 185 cm, typical chest pain. ETO confirm an ascending aorta dissection no aortic valve insufficiency. Operating room to change […]

Survey Results: Graft Preservation During Heart Transplant

Photograph by Dario Fichera:  Click Image to view Facebook Profile. Editors Note: I contacted Mr. Morton regarding permission to reprint the results of this survey.  I thank him for this opportunity.  It was initially submitted to AMSECT via PERFLIST. Graft Preservation During Heart Transplant Authored by:  John Morton, BS, CCP “I would like to thank […]

The Joshua Story [2]

The Joshua Interview: (Click Image above to Visit Josh’s Website) Editors Note:  Josh is a HeartMate II recipient and is awaiting a heart transplant.  Please click here   if you are unfamiliar with his story and would like to see how we got to the point of doing this interview. On 06/09/2011 Hello Joshua, this is […]

When the Bullet Hits the Bone …

The title of this may seem odd, it is from a song back in the mid-80’s. It just popped into my head when thinking about writing this.  But today it seems an apt metaphor for this particular story.  It’s when reality hits,  the movie part is over, and life turns to get a bit more […]

Mitral Stenosis

Mitral Stenosis The incidence of mitral valve stenosis is associated with scarring of the valve due to rheumatic fever.  Fibrosis restricts the mobility of the valve leaflets and commissures that eventually leads to valve funneling or retraction.  The normal mitral valve diameter is 4-6 cm2.  Hemodynamic changes occur when the valve aperture is diminished to […]

Aortic Insufficiency

Aortic Regurgitation :  101 Rheumatic fever, syphilis, arthritic diseases, or connective tissue disorders (Marfans syndrome), are the common causes for the development of aortic insufficiency (regurgitation). Aortic insufficiency results in greater than normal forward stroke volumes as a result of normal antegrade flow, combined with additional regurgitant filling due to valve incompetence.  This increase in […]

Lungs & CPB

Lungs & CPB The most common pulmonary complication associated with cardiopulmonary bypass is postoperative atelectasis of the lungs. Preoperative conditions that predispose the patient to developing partial or total collapse of the lung are, surfactant depletion and mucus cell hyperplasia associated with chronic bronchitis developed from smoking, decreased FRC encountered with obesity, and cardiogenic pulmonary […]

Descending Aortic Repair

Approaches to the Thoracic Aortic Aneurysm. A YouTube PowerPoint Video / Discussion: Part I Endovascular Stent Grafting for ascending and aortic arch repair by John Ikonomidis MD Part II https://www.youtube.com/watch?v=5__ctxT-C90 Endovascular Stent Grafting for ascending and aortic arch repair by John Ikonomidis MD Anatomy Discussion Below Cited from:  Medscape http://emedicine.medscape.com/article/424904-overview Most aortic aneurysms (AA) occur […]

Renal Review

Renal Anatomy Two bean shaped organs, one on each side, posterior lateral aspect of abdomen below the diaphragm.  Because of the proximity to diaphragm, the possibility of a pneumothorax exists with renal surgery. 1. Microscopically, the kidney is divided into three parts, the cortex, the medulla, and the pelvis. 2. The microscopic functional unit of […]

Bi-Caval Dual Lumen Catheter

Have you used a percutaneous venous cannula like this? The AVALONELITE :  Bi-Caval Dual Lumen Catheter (Click image to visit website) We are looking for a percutaneous cannula that transits the internal jugular to the superior vena cava, right atrium, and inferior vena cava. I have looked at this cannula online, but it looks like […]

The Joshua Story [2]

The Joshua Interview: (Click Image above to Visit Josh’s Website) Editors Note:  Josh is a HeartMate II recipient and is awaiting a heart transplant.  Please click here   if you are unfamiliar with his story and would like to see how we got to the point of doing this interview. On o6/09/2011, Teutonic 13 wrote: Hello […]

HeartMate & HIT

HeartMate XVE :  Explantation in the Setting of Heparin Induced Thrombocytopenia (HIT) Utilizing ACT and TEG Analysis Authored by:   Scott M. Noesges LP, CCP  BAYLOR UNIVERSITY MEDICAL CENTER  DALLAS, TEXAS Scott M. Noesges LP, CCP, offers the community an amazing case study of a case already highly complex in nature, complicated even more so by […]

CEREBRAL PERFUSION

Retrograde Cerebral Perfusion PURPOSE: To provide an alternative method of cerebral protection during procedures which require the cessation of cardiopulmonary bypass.  To provide an alternative method of cerebral protection during procedures where no other means of aortic perfusion, and thus cerebral perfusion, can or will be performed.  To provide an adjunctive therapy for the management […]

Myocardial Flow & Oxygen Supply

Myocardial Flow & Oxygen Supply   Vessels on the epicardial surface of the heart are considered to be conductance vessels and under normal conditions offer little resistance for blood flow and perfusion. The four factors influencing blood flow and resistance dynamics for intramural coronary vasculature are:  aortic root pressure, extravascular compression, myocardial metabolic requirement, and […]

Cardiac Conduction System

Normal Conduction System Function 1. To generate rhythmical impulses. 2. To conduct the impulses throughout the myocardium. Normal Conductive Tissue Specialized muscle tissue that is not or poorly contractile. Sinus node (SA Node) –pacemaker of the heart. Internodal pathways–conductive tissue from SA node through atrial muscle. Bachman’s bundle–interatrial internodal pathway–communicates with the right and left […]

Aortic Stenosis v.1

Aortic Stenosis Rheumatic heart disease and calcification deposits due to age (senile calcific aortic stenosis) are the most common pathologic conditions associated with aortic stenosis.  Congenital malformations such as a bicuspid aortic valve with a small annulus, or unicuspid valve usually develop symptoms at an early age but occasionally surface in later years.  Calcification of […]

Cardiac Blood Flow & O2 Consumption v1.0

Cardiac Blood Flow & O2 Consumption   Source: Cardiovascular Physiology Concepts Richard E. Klabunde, PhD The major vessels of the coronary circulation are the left main coronary that divides into left anterior descending andcircumflex branches, and the right main coronary artery. The left and right coronary arteries originate at the base of the aorta from openings called the coronary ostia located behind […]

Intracardiac Shunts v1.0

Principles of Intracardiac Shunts With the continued presence of a congenital defect of the cardiac septum or great vessels in which there is a communication between the left and right cardiac structures, blood flow is diverted from the area of greater resistance to the chamber or vessel of least resistance.  As a result, a percentage […]

Mitral Insufficiency v.1

Mitral Insufficiency Six anatomical components must mesh synchronously to insure proper function of the mitral valve.  Disruption of the kinetic interrelationship between the left ventricular wall, the left atrial wall, valve leaflets, annulus, chordae tendineae, and papillary muscles, may lead to dysfunction of the valve.  Chronic mitral valve insufficiency (regurgitation) most often results from rheumatic […]

Myocardial Ischemia v.1

Myocardial Ischemia Prevention and treatment of perioperative myocardial ischemia is a primary consideration.  Two consistent factors associated with the pathogenesis of myocardial ischemia are inadequate oxygen supply to the myocardium due to localized coronary lesions, and excessive oxygen demand due to increased hemodynamic workload associated with increased heart rate, blood pressure, or adrenergic stimulation of […]

Myocardial Oxygen Demand

Myocardial Oxygen Demand   The heart extracts more oxygen than other tissues while at rest (50-70%).  The heart’s normal compensation for increased oxygen demand is to increase coronary blood flow (400-600%).  Because cardiac tissue extracts at twice the rate of other tissues and since normal compensation for anemic states involves increased cardiac output, the heart […]

Right Ventricular Function v. 1

Right Ventricular Function Patients with right coronary artery disease may be susceptible to right ventricular ischemia and infarction when right ventricular distension or increased afterload occurs resulting in diminished cardiac performance and reduced right coronary perfusion pressure.  The interrelationships of aortic end-diastolic pressure, afterload volume, coronary perfusion pressure, and pulmonary vascular resistance, play a significant […]