Abstract
To share our experience highlighting the additional use of cardiopulmonary bypass (CPB) in cases other than the conventional ischemic, congenital and valvular heart diseases. All patients undergoing non-traditional cardiac surgery utilizing the cardiopulmonary bypass during a period from 1999 to 2009 reviewed. Their preoperative presentation, operative strategy and immediate postoperative status were assessed. A total of six such cases were identified including three female and three male patients. Two patients presented with road traffic accident having aortic transection along with other injuries. They underwent repair utilizing partial cardiopulmonary bypass. One patient presented with large PDA aneurysm and symptoms related to its pressure effect on respiratory system. He underwent repair under hypothermic circulatory arrest. These three patients were done via left thoracotomy. Three patients underwent deep hypothermic circulatory arrest, one for removal of thrombus from right atrium after complicated liver abscess, one patient required vascular graft interposition in left internal carotid artery for aneurysm extending into cranium and the third one underwent resection of vascular tumor of posterior cranial fossa. One patient required exploration for bleeding. One patient died after prolonged hospitalization. Rest of the patient had unremarkable postoperative course and were discharged home. Our short experience highlights the extended use of cardiopulmonary bypass in a multidisciplinary hospital, facilitating to perform complex, technically challenging non cardiac procedures which otherwise may not be possible.
Highlights
Three patients underwent deep hypothermic circulatory arrest, one for removal of thrombus from right atrium after complicated liver abscess, one patient required vascular graft interposition in left internal carotid artery for aneurysm extending into cranium and the third one underwent resection of vascular tumor of posterior cranial fossa
A 32 years old gentleman with long standing history of high grade fever with rigors presented to us and on investigations found to have marked leukocytosis and a liquefied large abscess in the liver which was drained under ultrasound guidance. His CAT scan and subsequent echocardiography confirmed a thrombus in the inferior vena cava (IVC) with its free mobile extension into right atrium with high likelihood of embolization
The open repair of traumatic aortic transection was performed on partial left heart bypass, the other possible way of dealing is recently popularized endovascular repair which need appropriate device and expertise in its deployment. [6, 7] The internal carotid artery aneurysms extending into cranium are repaired without the use of cardiopulmonary bypass (CPB) as well
Summary
Methodology: All patients undergoing non-traditional cardiac surgery utilizing the cardiopulmonary bypass during a period from 1999 to 2009 reviewed. Their preoperative presentation, operative strategy and immediate postoperative status were assessed. Two patients presented with road traffic accident having aortic transection along with other injuries They underwent repair utilizing partial cardiopulmonary bypass. One patient presented with large PDA aneurysm and symptoms related to its pressure effect on respiratory system He underwent repair under hypothermic circulatory arrest. Conclusion: Our short experience highlights the extended use of cardiopulmonary bypass in a multidisciplinary hospital, facilitating to perform complex, technically challenging non cardiac procedures which otherwise may not be possible. Due to technical advancement and increase safety of cardiopulmonary bypass, its uses are stretched for non-traditional cases and the extended indications are well established. [4] The aim of this study is to share our short experience highlighting extended use of CPB for infrequently performed procedures in a multidisciplinary setting in this part of the world
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