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One of the dreaded complications of left ventricular assist device implantation is mechanical obstruction of the device secondary to pump thrombosis or mechanical outflow cannula obstruction. We describe a case of outflow cannula obstruction caused by kinking and twisting of the outflow graft after surgical manipulation of the pump. ( Level of Difficulty: Beginner. )

The duration of diffusion hypoxia has to be shorter than SGE, as a limited amount of N 2 O is washed out with a high concentration gradient between blood and alveolar space, especially when ventilation is with an open circuit. Interestingly, we found greater changes in arterial Pa O 2 between the first gas mixture and AIRs, independent of whether it had been nitrous oxide/oxygen or AIRc/oxygen (Fig. 1). By altering from AIRs to AIRc or nitrous oxide, much less effect on the Pa O 2 was produced compared with the above sequence. Obviously, the withdrawal of the low nitric oxide concentrations induces a mismatching in the lungs that cannot be reversed by similar concentrations of nitric oxide. Sometimes new results raise more questions than answers.