Prashant Rao

Intraoperative thermographic imaging to assess myocardial distribution of Del Nido cardioplegia

We describe the intraoperative non‐invasive use of an infrared (IR) camera to monitor Del Nido cardioplegia delivery in patients undergoing cardiac surgery. Thermal pictures were taken pre‐ and post‐cardioplegia and at timed points after arrest, and compared to readings from a transseptal temperature probe. There was good concordance between the transseptal probe and the IR camera temperature readings. This non‐invasive technique, which assesses cardioplegic distribution, may help to determine when additional doses of Del Nido cardioplegia are required during periods of cardioplegic arrest.

The Limits of Cardiac Performance: Can Too Much Exercise Damage the Heart?

Routine moderate-intensity physical activity confers numerous cardiovascular benefits and reduces all-cause mortality. However, the health impact of exercise doses that exceed contemporary physical activity guidelines remains incompletely understood, and an emerging body of literature suggests that high levels of exercise may have the capacity to damage the cardiovascular system. This review focuses on the contemporary controversies regarding high-dose exercise and cardiovascular morbidity and mortality. We discuss the limitations of available studies, explore potential mechanisms that may mediate exercise-related cardiac injury, and highlight the gaps in knowledge for future research.

Ambulatory central VA‐ECMO with biventricular decompression for acute cardiogenic shock

We describe the off‐pump insertion of a biventricular assist device with extra‐corporeal membrane oxygenation (ECMO): a novel technique that allows for ambulatory central veno‐arterial (VA) ECMO with direct biventricular decompression.

Mechanical Cardiopulmonary Resuscitation In and On the Way to the Cardiac Catheterization Laboratory

Cardiac arrest, though not common during coronary angiography, is increasingly occurring in the catheterization laboratory because of the expanding complexity of percutaneous interventions (PCI) and the patient population being treated. Manual chest compression in the cath lab is not easily performed, often interrupted, and can result in the provider experiencing excessive radiation exposure. Mechanical cardiopulmonary resuscitation (CPR) provides unique advantages over manual performance of chest compression for treating cardiac arrest in the cardiac cath lab. Such advantages include the potential for uninterrupted chest compressions, less radiation exposure, better quality chest compressions, and less crowded conditions around the catheterization table, allowing more attention to ongoing PCI efforts during CPR. Out-of-hospital cardiac arrest patients not responding to standard ACLS therapy can be transported to the hospital while mechanical CPR is being performed to provide safe and continuous chest compressions en route. Once at the hospital, advanced circulatory support can be instituted during ongoing mechanical CPR. This article summarizes the epidemiology, pathophysiology and nature of cardiac arrest in the cardiac cath lab and discusses the mechanics of CPR and defibrillation in that setting. It also reviews the various types of mechanical CPR and their potential roles in and on the way to the laboratory. (Circ J 2016; 80: 1292-1299).

Potential Impact of the Proposed Revised UNOS Thoracic Organ Allocation System

The current United States heart allocation system faces 2 main challenges: an evolving landscape of device therapy in advanced heart failure and a rapidly increasing transplant waiting list. The proposed new heart allocation system involves expansion of the 3 tiers and enables greater distinction between different types of mechanical circulatory support devices. In this review, we discuss how the proposed revision reconciles key concerns of the current system to create a more fair and equitable allocation of hearts in the United States.

Regenerative concepts in cardiovascular research: novel hybrid therapy for remodeling ischemic cardiomyopathy

Treatment for coronary artery disease includes medical management, percutaneous coronary interventions (PCI), and coronary artery bypass grafting. However, despite optimal medical therapy and revascularization, ischemic cardiomyopathy is responsible for 538,000 deaths per year in the U.S. alone (1). Stem cell transplantation provides an opportunity to reduce mortality through its potential to fully heal and replace infarcted myocardium.

Poor cough flow in acute stroke patients is associated with reduced functional residual capacity and low cough inspired volume

Introduction Each year 7u2009million people die of stroke worldwide; most deaths are caused by chest infections. Patients with acute stroke have impaired voluntary cough flow, associated with increased risk of chest infections. Reduced functional residual capacity (FRC) could lead to impaired cough flow. We therefore compared FRC in acute hemiparetic stroke patients and controls and explored its relationship with volume inspired before cough and voluntary cough peak flow. Methods 21 patients within 2u2009weeks of first-ever middle cerebral artery territory (MCA) infarct (mean (SD) age 68 (11) years, 10 females) and 30 controls (58 (11) years, 15 females) underwent FRC and voluntary cough testing (cough inspired volume and peak flow) while semirecumbent. FRC was expressed as % predicted; cough inspired volume was expressed as % predicted VC and cough peak flow as % predicted PEF. A clinician scored stroke severity using the National Institutes of Health Stroke Scale (NIHSS). Results Patients’ reclined FRC, voluntary cough peak flowand cough inspired volume were reduced compared with controls (p<0.01 for all): patients’ median (IQR) FRC 76 (67–90) % predicted, mean (SD) cough inspired volume 64 (20) % predicted and mean (SD) peak cough flow 61 (32) % predicted despite them having only mild stroke-related impairments: median NIHSS score 4 (IQR 2–6). Univariate linear regression analyses showed FRC predicted cough inspired volume (adjusted R2=0.45) and cough inspired volume predicted cough flow (adjusted R2=0.56); p<0.01 for both. Sitting patients upright increased their FRC by median 0.210u2009L. Conclusions FRC and cough inspired volume in the reclined position are significantly reduced in acute hemiparetic stroke patients with mild impairments; both factors are associated with poor voluntary cough peak flow.

Peripheral VA-ECMO with direct biventricular decompression for refractory cardiogenic shock:

Cardiogenic shock and cardiac arrest are life-threatening emergencies that result in high mortality rates. Veno-arterial extracorporeal membrane oxygenation (VA-ECMO) via peripheral cannulation is an option for patients who do not respond to conventional therapies. Left ventricular (LV) distention is a major limitation with peripheral VA-ECMO and is thought to contribute to poor recovery and the inability to wean off VA-ECMO. We report on a novel technique that combines peripheral VA-ECMO with off-pump insertion of a trans-apical LV venting cannula and a right ventricular decompression cannula.

Venoarterial Extracorporeal Membrane Oxygenation in Cardiogenic Shock

Keebler etxa0al. [(1)][1] set out an interesting and useful study pertaining to some of the key management issues of veno-arterial extracorporeal membrane oxygenation (ECMO) for refractory cardiogenic shock. As the authors rightly note, avoiding left ventricular distention using a venting strategy is

Total artificial heart implantation in a young Marfan syndrome patient

Introduction: Cardiovascular complications represent the leading cause of morbidity and mortality in patients with Marfan syndrome. Here, we describe a unique case where a total artificial heart was implanted in a young Marfan syndrome woman. Methods: A 22-year-old postpartum African American female with Marfan syndrome developed multiple severe valve dysfunction and biventricular failure that was refractory to medical management. She previously had a Bentall procedure for Type A aortic dissection and repair of a Type B dissection. Results: We implanted a total artificial heart with a good outcome. Conclusion: Total artificial heart is a durable option for severe biventricular failure and multiple valvular dysfunction as a bridge to transplant in a young patient with Marfan syndrome.