Abstract
Objective: To describe the first case of minimally invasive modified Bentall Operation done at our institution that resulted in an excellent outcome. Method: We describe a 28 year old Chinese male, without past medical history and risk factors, who presented with sudden shortness of breath on exertion associated with one month duration of lethargy and intermittent fever and was diagnosed with severe aortic regurgitation secondary to infective endocarditis on echocardiography. He was planned for a minimally invasive aortic valve replacement. Intra-operatively, the aortic wall was noted to be infected with vegetation in the background of bicuspid aortic valve and decision was made on table to perform minimally invasive modified Bentall Operation. He was also noted to have a rare presentation of rudimentary left coronary ostia, with only single right coronary ostia which supplies to the 3 coronary arteries. Results: The patient had an uncomplicated clinical course post-operatively and was discharged on post-operative day five in excellent condition. He was started on life-long anticoagulation. The patient was asymptomatic on follow-up and is progressing well. Conclusion: The initial surgical plan was for minimally invasive aortic valve replacement, but it was a decision made on table that changed to a minimally invasive modified Bentall Operation. The patient subsequently did well and benefitted from the advantages of a minimally invasive heart surgery.
Highlights
The Acute Respiratory Distress Syndrome (ARDS) is a rapidly progressive form of acute respiratory failure characterized by severe hypoxemia and non-hydrostatic pulmonary edema [1]
We found only four randomized control trials (RCTs) reporting the impact that Extracorporeal Membrane Oxygenation (ECMO) has in ARDS
N=55 (11 patients requiring ECMO for more than 3 8 (73%) patients receiving long-term and 25 (57%) patients weeks) Pneumonia 23 (Bacterial-14, viral-9); sepsis receiving short-term ECMO support survived to 30 days and
Summary
The Acute Respiratory Distress Syndrome (ARDS) is a rapidly progressive form of acute respiratory failure characterized by severe hypoxemia and non-hydrostatic pulmonary edema [1]. This implies that the native lung and the membrane lung are in series–the oxygenated blood returned from the membrane lung is perfused in the native lung and the subsequently circulated in the body This technique supports the lung function but not the cardiac function, and is the most common form of ECMO used in ARDS patients. VA ECMO patients require vigorous cardiac monitoring-the continuous venous return from the bronchial vessels coupled with the poor unloading of the left ventricle can cause distension and dysfunction of the left ventricle This reduces the pulsatile blood flow and increases the risk of stasis and clot formation.
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