Patients with carcinoid heart disease (CHD) are referred for valve replacement if they have sever... more Patients with carcinoid heart disease (CHD) are referred for valve replacement if they have severe symptomatic disease or evidence of right ventricular (RV) failure and an anticipated survival of at least 12 months. Data are lacking, however, on the role of transthoracic echocardiography in predicting outcomes. We carried out a retrospective, single-centre cohort study of patients with a biopsy-confirmed neuroendocrine tumour (NET) and CHD undergoing valve replacement for severe valve disease and symptoms of right heart failure. The aim was to identify factors associated with postoperative mortality, both within one year of surgery and during long-term follow-up. Of 88 patients with NET, 49 were treated surgically (mean age: 64.4 ± 7.6 years; 55% male), of whom 48 had a bioprosthetic tricuspid valve replacement for severe tricuspid regurgitation; 39 patients had a pulmonary valve replacement. Over a median potential follow-up of 96 months (interquartile range: 56–125), there were 37...
Background Acute onset atrial fibrillation is a common dysrhythmia experienced by patients follow... more Background Acute onset atrial fibrillation is a common dysrhythmia experienced by patients following cardiac surgery which can often cause morbidity and extended hospital length of stay. The primary aim of the study was to explore adherence to National Institute for Health and Care Excellence (NICE) guidance which suggests the need for prophylaxis for postoperative atrial fibrillation (POAF). Secondary aims were to explore factors contributing to the development POAF and the impact of POAF on patient-centred outcomes. Methods An analysis consisting of descriptive statistics and regression models was conducted using 138 patient’s records who underwent cardiac surgery between January and March 2017. Results We identified 83 (62%) patients on prophylactic rate control medications prior to surgery. During the study period, a total of 50 patients (36%) developed POAF, of which 28 were on prophylactic medication prior to surgery. Patients who developed POAF had significantly prolonged hos...
Hyperglycemia during cardiopulmonary bypass (CPB) with glucose containing cardioplegia is common;... more Hyperglycemia during cardiopulmonary bypass (CPB) with glucose containing cardioplegia is common; normoglycemia is difficult to maintain and failure to do so may result in worse outcomes. The purpose of this quality improvement initiative was to show that a simple timely insulin bolus is more effective for glucose control during CPB with glucose containing cardioplegia than conventional (not standardized) glucose management in historical case-matched controls. A single bolus of insulin (.2 international units per kilogram; iu/kg) was administered, at the time of aortic cannulation, to 211 consecutive patients undergoing cardiac surgery with CPB and glucose containing cardioplegia. A further .1 iu/kg bolus of insulin was given for blood glucose (BG) measurements greater than 10.0 mmol/L (180 mg/dL) during CPB. The control group of 211 historical case-matched patients had glucose management according to anesthesiologist preference (insulin as a bolus, bolus plus infusion, infusion onl...
Interactive CardioVascular and Thoracic Surgery, 2012
We report a 49-year old female who presented with ST elevation myocardial infarction, in whom thr... more We report a 49-year old female who presented with ST elevation myocardial infarction, in whom thrombolysis and coronary angioplasty failed to perfuse the myocardium. She was unsuitable for emergency coronary artery bypass grafting surgery due to the interval elapsed between the myocardial infarction, thrombolysis and large infracted myocardium. Ventricular-assisted device support for a bridge to recovery or transplantation is a widely accepted treatment modality; however, in this case, it was unadvisable due to the extent of the infarcted myocardium and the risk of suturing outflow ports into the infracted myocardium. The patient's condition was stabilized with cardiac inotropic support, intra-aortic balloon counter pulsation and extracorporeal membrane oxygenation as a last resort until a heart became available for transplantation. The patient received successful orthotopic heart transplantation 4 days after her initial presentation and her postoperative recovery was uneventful.
Therefore, the fibrin-collagen barrier seems to be an invaluable tool to treat refractory bleedin... more Therefore, the fibrin-collagen barrier seems to be an invaluable tool to treat refractory bleeding from the lung parenchyma, also taking into account that biodegradation occurs within 2 to 4 weeks, therefore avoiding potential adverse events, such as chronic adhesions or compression. Last, but not least, the use of such compounds has shown to reduce chest drain indwelling time, as well as hospitalization after lung surgery to treat air leaks [3], indicating that in association with reduce bloodrelated products, such sealing agents may also prove to be cost-effective in these circumstances.
Psychiatric patients were reported to have high risks of contracting HIV infection due to unstabl... more Psychiatric patients were reported to have high risks of contracting HIV infection due to unstable mental symptoms and comorbidity of drug abuse. The author surveyed the seroprevalence of human immunodeficiency virus (HIV) infection among Chinese psychiatric patients hospitalized in 2 psychiatric hospitals in the Taipei City area, Taiwan. No positive case was identified among 834 psychiatric patients in 1 year's survey. The low seropositive rate of HIV infection among Chinese psychiatric patients may be explained by: the low prevalence of HIV infection in Taiwan and low HIV‐related risk behaviors, especially rare comorbidity of drug abuse among Chinese psychiatric patients.
Patients with carcinoid heart disease (CHD) are referred for valve replacement if they have sever... more Patients with carcinoid heart disease (CHD) are referred for valve replacement if they have severe symptomatic disease or evidence of right ventricular (RV) failure and an anticipated survival of at least 12 months. Data are lacking, however, on the role of transthoracic echocardiography in predicting outcomes. We carried out a retrospective, single-centre cohort study of patients with a biopsy-confirmed neuroendocrine tumour (NET) and CHD undergoing valve replacement for severe valve disease and symptoms of right heart failure. The aim was to identify factors associated with postoperative mortality, both within one year of surgery and during long-term follow-up. Of 88 patients with NET, 49 were treated surgically (mean age: 64.4 ± 7.6 years; 55% male), of whom 48 had a bioprosthetic tricuspid valve replacement for severe tricuspid regurgitation; 39 patients had a pulmonary valve replacement. Over a median potential follow-up of 96 months (interquartile range: 56–125), there were 37...
Background Acute onset atrial fibrillation is a common dysrhythmia experienced by patients follow... more Background Acute onset atrial fibrillation is a common dysrhythmia experienced by patients following cardiac surgery which can often cause morbidity and extended hospital length of stay. The primary aim of the study was to explore adherence to National Institute for Health and Care Excellence (NICE) guidance which suggests the need for prophylaxis for postoperative atrial fibrillation (POAF). Secondary aims were to explore factors contributing to the development POAF and the impact of POAF on patient-centred outcomes. Methods An analysis consisting of descriptive statistics and regression models was conducted using 138 patient’s records who underwent cardiac surgery between January and March 2017. Results We identified 83 (62%) patients on prophylactic rate control medications prior to surgery. During the study period, a total of 50 patients (36%) developed POAF, of which 28 were on prophylactic medication prior to surgery. Patients who developed POAF had significantly prolonged hos...
Hyperglycemia during cardiopulmonary bypass (CPB) with glucose containing cardioplegia is common;... more Hyperglycemia during cardiopulmonary bypass (CPB) with glucose containing cardioplegia is common; normoglycemia is difficult to maintain and failure to do so may result in worse outcomes. The purpose of this quality improvement initiative was to show that a simple timely insulin bolus is more effective for glucose control during CPB with glucose containing cardioplegia than conventional (not standardized) glucose management in historical case-matched controls. A single bolus of insulin (.2 international units per kilogram; iu/kg) was administered, at the time of aortic cannulation, to 211 consecutive patients undergoing cardiac surgery with CPB and glucose containing cardioplegia. A further .1 iu/kg bolus of insulin was given for blood glucose (BG) measurements greater than 10.0 mmol/L (180 mg/dL) during CPB. The control group of 211 historical case-matched patients had glucose management according to anesthesiologist preference (insulin as a bolus, bolus plus infusion, infusion onl...
Interactive CardioVascular and Thoracic Surgery, 2012
We report a 49-year old female who presented with ST elevation myocardial infarction, in whom thr... more We report a 49-year old female who presented with ST elevation myocardial infarction, in whom thrombolysis and coronary angioplasty failed to perfuse the myocardium. She was unsuitable for emergency coronary artery bypass grafting surgery due to the interval elapsed between the myocardial infarction, thrombolysis and large infracted myocardium. Ventricular-assisted device support for a bridge to recovery or transplantation is a widely accepted treatment modality; however, in this case, it was unadvisable due to the extent of the infarcted myocardium and the risk of suturing outflow ports into the infracted myocardium. The patient's condition was stabilized with cardiac inotropic support, intra-aortic balloon counter pulsation and extracorporeal membrane oxygenation as a last resort until a heart became available for transplantation. The patient received successful orthotopic heart transplantation 4 days after her initial presentation and her postoperative recovery was uneventful.
Therefore, the fibrin-collagen barrier seems to be an invaluable tool to treat refractory bleedin... more Therefore, the fibrin-collagen barrier seems to be an invaluable tool to treat refractory bleeding from the lung parenchyma, also taking into account that biodegradation occurs within 2 to 4 weeks, therefore avoiding potential adverse events, such as chronic adhesions or compression. Last, but not least, the use of such compounds has shown to reduce chest drain indwelling time, as well as hospitalization after lung surgery to treat air leaks [3], indicating that in association with reduce bloodrelated products, such sealing agents may also prove to be cost-effective in these circumstances.
Psychiatric patients were reported to have high risks of contracting HIV infection due to unstabl... more Psychiatric patients were reported to have high risks of contracting HIV infection due to unstable mental symptoms and comorbidity of drug abuse. The author surveyed the seroprevalence of human immunodeficiency virus (HIV) infection among Chinese psychiatric patients hospitalized in 2 psychiatric hospitals in the Taipei City area, Taiwan. No positive case was identified among 834 psychiatric patients in 1 year's survey. The low seropositive rate of HIV infection among Chinese psychiatric patients may be explained by: the low prevalence of HIV infection in Taiwan and low HIV‐related risk behaviors, especially rare comorbidity of drug abuse among Chinese psychiatric patients.
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