Fabrizio Sansone, MD

Division of Cardiac Surgery, Mauriziano Umberto I Hospital, Turin, Italy

This is a case report of a young male admitted to the hospital for acute cardiac failure in chronic di- lated cardio-myopathy due to aortic regurgitation (AR). The patient had previously refused aortic valve replacement (AVR) fearing a poor postopera- tive outcome. He suffered from ongoing dyspnea and peripheral edema with a serious asthenia. His clinical condition was poor with a seriously im- paired bi-ventricular function (ejection fraction of about 10-15% and moderate dilation of the right ventricle with TAPSE of about 12 mm) caused by a severe AR and pulmonary edema.

The question was: what could we do? Surgery, “wait and see” or biventricular support?

Drs T. Antonius, neonatoloog
UMC St. Radboud

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ir I. Groenenberg EKP, P.W. Weerwind, U. Strauch, Y.M. Ganushchak, P. Roekaerts, J.G. Maessen.

We describe the use of plasmapheresis as an adjuvant treatment during veno- venous extracorporeal life support (VV- ELS) complicated by heparin-induced thrombocytopenia (HIT).

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In the period November 2004 till November 2010 we performed 30 Extra Corporeal Life Support (ECLS) procedures on 28 patients suffering from acute cardiac and/or pulmonary failure.

The age of the patients varied between 16 and 76 years of age (mean age 42.9 ± 17.7). 17 Female patients (mean age 38.8 ± 18.7) and 11 male patients (mean age 48.5 ± 16.2). Two patients were supported twice in 1 year. They suffered from ischemic heart failure and received ECLS as bridge to bridge (Heartmate II implantation). Both patients finally underwent heart transplantation.

A.P. Simons PhD, M.D. Lanceé**, K.D. Reesink***, F.H. van der Veen*, P.W. Weerwind*, J.G. Maessen*.

We describe a case of a patient assisted by extracorporeal life support, in which data from the pulmonary artery catheter became unavailable during cardiac reloading. As a result, the assessment of cardiac load-responsiveness became limited to transesophageal echocardiography, and central venous and radial artery pressure monitoring. In addition, we obtained the dynamic filling index, a validated measure for venous volume during extracorporeal life support, and used this index to assess cardiac load-responsiveness during acute reloading. While reloading, the obtained findings on cardiac pump function by the dynamic filling index in absence of the pulmonary artery catheter were supported by transesophageal echocardiography and standard pressure measurement. This suggests that the dynamic filling index can be used to support the monitoring of cardiac load-responsiveness when pulmonary artery pressure and cardiac output monitoring are unavailable during extra-corporeal life support.

De eerste openhartoperatie werd uitgevoerd door de afro-amerikaanse arts Daniel Hale Williams. In de zomer van 1893 kreeg hij een 18-jarige man, met een steekwond in de borst, hevig bloedend en in shock op de operatietafel. Dokter Williams besloot om de borstkas te openen, en het letsel te overhechten. Na 51 dagen verliet deze jongeman in goede gezondheid het ziekenhuis. Er zijn andere chirurgen van wie gezegd wordt dat ze de eerste openhart operatie uitgevoerd hebben, maar Daniel Hale Williams is de enige die wordt bezongen. Door Stevie Wonder nog wel, in zijn nummer ‘Black Man’ uit 1976. Het hart was in die tijd een ontoegankelijk gebied voor de operateur: niet alleen stond de kennis van het fysiologie van het hart nog in de kinderschoenen (waardoor men angst had voor een verstoring van de hartcontracties, en dus de circulatie), maar ook het gegeven dat er zo’n 4 a 5 liter bloed per minuut door het hart stroomt, maakte een operatie op het hart een zeer bloederige, en daardoor zeer kortdurende aangelegenheid.

Wetenschappelijk beleidsmedewerker van de Dopingautoriteit

E.W.M. Bakker EKP, K. Visser EKP

Abstract

The generation of gaseous microemboli still remains an issue in cardiopulmonary bypass. We report the testing of the air handling capacity of the Capiox FX25, the Quadrox i (both with integrated arterial filter) and the Quadrox D plus separate Quart arterial filter. Therefore we in- troduce air in an extracorporeal circuit in a water filled laboratory setup. Number of emboli, bubble size and the total volume of air are measured with the GAMPT BCC200. In a first test we measure bubbles after introduction of a 50 ml bolus of air just prior to the oxygenator. In a second test we apply a subtle stream of micro emboli in a reproducible way. In the first test we find a total volume of 0.041, 0.173 and 4.215 μl measured distal to the arterial filter for the Capiox, Quadrox i and Quadrox D respectively. In Test 2 we compare bubble counts, air volume reduction, reduction in number of emboli and mean diameter index for the oxygenator/filter combinations. We find volume reductions of 99.8%, 88.5% and 93% respectively. Therefore we conclude that the Capiox may be superior to the Quadrox D and Quadrox i concerning air handling. Clinical testing and greater data collection are required to prove the significance of our findings.