No abstract

Patients suffering from mismatch were twice as likely to undergo reoperation for aortic bioprosthesis replacement for SVD than those without mismatch.

The genesis of cardiogenic oscillations, i.e. the small waves in airway pressure (COS(paw)) and flow (COS(flow)) signals recorded at the airway opening is under debate. We hypothesized that these waves are originated from cyclic changes in pulmonary artery (PA) pressure and flow but not from the physical transmission of heartbeats onto the lungs. The aim of this study was to test this hypothesis. In 10 anesthetized pigs, COS were evaluated during expiratory breath-holds at baseline with intact chest and during open chest conditions at: (1) close contact between heart and lungs; (2) no heart-lungs contact by lifting the heart apex outside the thoracic cavity; (3) PA clamping at the main trunk during 10 s; and (4) during manual massage after cardiac arrest maintaining the heart apex outside the thorax, with and without PA clamping. Baseline COS(paw) and COS(flow) amplitude were 0.70 ± 0.08 cmH(2)O and 0.51 ± 0.06 L/min, respectively. Both COS amplitude decreased during open chest conditions in step 1 and 2 (p < 0.05). However, COS(paw) and COS(flow) amplitude did not depend on whether the heart was in contact or isolated from the surrounding lung parenchyma. COS(paw) and COS(flow) disappeared when pulmonary blood flow was stopped after clamping PA in all animals. Manual heart massages reproduced COS but they disappeared when PA was clamped during this maneuver. The transmission of PA pulsatilty across the lungs generates COS(paw) and COS(flow) measured at the airway opening. This information has potential applications for respiratory monitoring.

Introduction: Acute Kidney Injury (AKI) is common, morbid and costly. Reducing contrast volume is one of the most effective strategies to reduce AKI, but physicians are not necessarily aware of the AKI risk nor limits of contrast use. Therefore, the volume of contrast used during PCI varies tremendously. No study has examined practical strategies to identify a safely tolerated limit of contrast. Methods: We developed a novel, patient-centric strategy to identify a safely tolerated limit of contrast during PCI. We identify AKI risk using the ACC NCDR CathPCI Aki risk model. We then use the contrast volume/eGFR ratio among deciles of AKI risk strata. Multiplying these ratios by eGFR results in the safely tolerated limit of contrast. We implemented this at Barnes Jewish Hospital (N=2,268 PCIs, 2013 -2015), we identified the impact of implementing this method on reducing costs and improving AKI outcomes. Results: For a high risk patient undergoing PCI, the decision aid for identifying safely tolerated risk of AKI is shown (Fig1). Since implementation, contrast volumes have reduced from 240 ml to 135 ml. AKI rates have reduced from7.75% to 3.6%. This has translated into reduced cost, estimated at $ 780,000. Conclusions: We have identified a novel patient centered method to reduce contrast volume during PCI. This has resulted in a greater than 50% reduction in reducing contrast volume and AKI rates. Furthermore, this has resulted in cost-savings of $700,000. Our study underscores an important opportunity of patient

Background Pseudoaneurysms of the sinus of Valsalva are infrequent cardiac pathologies that usually involve a single sinus. Material and Methods We present a case of a 63‐year‐old male who was diagnosed with ascending aortic aneurysm during a routine echocardiogram. Conclusion We report here a patient with giant pseudoaneurysms of two sinuses of Valsalva who successfully underwent a sinus of Valsalva reconstruction.