Stephanie Flicker

Effects of Colloid or Crystalloid Administration on Pulmonary Extravascular Water in the Postoperative Period After Coronary Artery Bypass Grafting

The effect of postoperative fluid management on pulmonary extravascular thermal volume (ETV1) as in index of pulmonary extravascular water after coronary artery bypass grafting was compared, using the thermal-dye technique, among five patients who received 5% albumin (group A), five patients who received 6% hydroxyethyl starch (group H), and five who received lactated Ringers solution (group C). lntraoperatively, all patients received lactated Ringers solution intravenously, and the cardiopulmonary bypass (CPB) circuit prime included 5% albumin. No statistically significant changes in ETV1 occurred postoperatively in any group, nor did ETV1 differ significantly between groups. After CPB, colloid osmotic pressure (COP) significantly decreased and pulmonary artery wedge pressure (WP) and the WP-COP gradient significantly increased in each group, implying an increase in transcapillary fluid flux. Cardiac index. changed variably. Pulmonary shunt fraction (Qsp/Qt) did not change in groups A and C but decreased during CPB in group H (from 0.22 ± 0.03 to 0.16 ± 0.11). Postoperatively, patients in the three groups received similar volumes of fluids and had similar perioperative weight gains. By the next morning (AM1), COP increased in all groups, returning to levels noted before CPB in group C, and exceeding these levels in groups A and H. Wedge pressure was similar in all three groups on AM1. PaO2 decreased significantly, and alveolar-arterial oxygen partial pressure difference increased significantly in all groups on AM1. In Group H, Qsp/Qt returned to levels observed before CPB by AM1 (0.27 ± 0.09). We conclude that in patients without postoperative increases in WP, ETV1 changes minimally during CPB and is not influenced by the type of fluid administered as the primary volume replacement in the postoperative period.

Congenital heart disease in the adult patient: the value of plain film chest radiology.

Congenital heart disease (CHD) is a major clinical problem in children, occurring in 0.8% of newborns (1). In the past, most patients with CHD died in infancy. With improved surgical and postoperative care, as well as more accurate preoperative evaluation, the overall 10-year survival rate is >90%. As a result, >500,000 adults in the United States have surgically treated CHD (2). In addition, at least 150,000 adults are thought to have unrecognized, misdiagnosed, or recognized but untreated CHD (3,4). Diagnostic imaging procedures for the evaluation of CHD include plain film radiology, fluoroscopy, angiocardiography, echocardiography, scintigraphy, computed tomography (CT), and magnetic resonance imaging (MRI). Each has unique as well as overlapping abilities to characterize precisely cardiovascular anatomy and pathophysiology. We emphasize those congenital cardiac disorders found predominantly in adults. In addition, conditions that are usually unrecognized in childhood, “slip through the system”, and become clinically recognized in adults for the first time, often with an atypical clinical presentation, are discussed (5). The interpreter of the plain film radiograph has a unique opportunity to identify and often characterize the severity of a congenital cardiac disorder that may be unrecognized by the patients physician. Important clues found on plain film radiographs will suggest either additional studies to pinpoint the type of CHD more precisely or that no additional studies are needed because the recognized lesion is incidental and not of clinical significance.

Computed Tomographic Localization of Malposition of Pacing Electrodes: The Value of Cardiovascular Computed Tomography

Three patients with uncertain pacemaker electrode position on plain film radiography were studied with fast cine cardiovascular computed tomography (CT) imaging. The value of this new Technique in determining the position of pacing electrodes is discussed.

Cardiovascular computed tomography (cine CT) of abnormal left ventricular wall motion due to epicardial pacing electrodes

A patient with an abnormal cardiac silhouette on chest X-ray was studied by fast cardiovascular computed tomography (cine CT). The location of epicardial pacing electrodes and their relationship to myocardial wall motion abnormalities were examined. This eliminated the need for cardiac catheterization.

Rapid-acquisition computed tomography demonstration of chronic calcified pericardial constriction

Dynamic imaging by a new ultrafast computed tomography scanner of a patient with chronic calcified pericardial constriction is presented. Images of the heart throughout the cardiac cycle demonstrate compression of the right ventricle by calcified pericardium. Hemodynamic data was derived from the scan study to support the diagnosis of pericardial constriction, which was confirmed on cardiac catheterization.

The Radiology of Prosthetic Heart Valves

The development of prosthetic heart valves in the late 1950s ushered in a new era in the treatment of heart disease. The radiologist has an important role to play preoperatively in the diagnosis of valvular heart disease. Radiology is valuable in identification of the implanted prosthetic valve and recognition of complications associated with valve implantation. Radiologists must be familiar with the imaging techniques best suited to evaluate the function of the valve prosthesis in question (1-3).

An unusual case of pulmonary emboli

The authors present an interesting case of pulmonary embolus serendipitously diagnosed during an evaluation for a presumed metastatic pulmonary nodule.

Beryllium-Induced Disease

Reaction of the lung to inhalation of dust depends on several factors, including the chemical nature of the dust, the size and concentration of the dust particles, the duration of exposure, and individual susceptibility. These factors are important in themselves and in combination, as they may be interdependent.1

Ultrafast computed tomography techniques in cardiac disease.

Ultrafast computed tomography (UFCT) with scan times in milliseconds has matured as an important diagnostic instrument since it was first introduced. Dynamic scanning can be performed virtually anywhere and the short scan times give cross-sectional images free of artifacts. These factors allow one to obtain CT studies in many different heart disorders, even in the postoperative period while the patient is on cardiopulmonary assist devices. The evaluation of coronary artery bypass graft patency remains an important use of the modality.