Bypass Support Research Articles

Myocardial Protection in High-Risk Cardiopulmonary Bypass Support

The development of cardioplegia has facilitated complex cardiac surgery and allowed high-risk patients to safely tolerate life-saving procedures. By following the principles of electromechanical arrest, inducing hypothermia, and using adjunctive agents to help mitigate the effects of hypothermia and ischemia reperfusion injury, cardioplegia can be safely induced with various commercially available compositions, which can be delivered by several different surgical techniques. Although many studies have compared these methods, there is little consensus on whether any one method is superior to another. Just as a surgeon may need to modify technique according to individual patient factors, so too must a surgeon be flexible and be prepared to use different cardioplegia strategies according to the clinical circumstances. Increasing evidence shows the advantage of coronary artery bypass grafting (CABG) over percutaneous interventions in patients with low ejection fractions. Thus, optimal myocardial protection will continue to be necessary in this higher-risk cohort. Moreover, while patients in cardiogenic shock rarely present for CABG, the high mortality in this cohort demonstrates the need for ongoing efforts to improve myocardial protection. Lastly, there may be circumstances in which alternative approaches involving fibrillatory arrest or keeping the heart beating are more effective than conventional cardioplegia. These techniques should all be part of the surgeon’s armamentarium, enabling the surgeon to tailor the operation to the individual patient.

Management of fulminating non-cardiogenic pulmonary edema following cardiac surgery

A malignant form of non-cardiogenic pulmonary edema (NCPE) that develops soon after the termination of cardiopulmonary bypass support during cardiac surgery is rarely encountered. It sometimes requires immediate management, including venovenous extracorporeal membrane oxygenation (VV-ECMO). In the first case, a 78-year-old female patient experienced fulminating NCPE after mitral valve plasty, which caused severe respiratory failure and hemodynamic instability due to a huge amount of sputum. In the second case, a 47-year-old male patient presented with right-sided unilateral pulmonary edema with a substantial amount of sputum after minimally invasive cardiac surgery for mitral valve repair. In both cases, VV-ECMO and aggressive fluid replacement were promptly initiated. The NCPE resolved on post-operative day 2, resulting in the successful termination of VV-ECMO. NCPE leads to lethal respiratory failure with multifactorial causes during cardiac surgery. However, as NCPE is potentially transient, immediate treatment comprising VV-ECMO and aggressive fluid replacement can improve clinical outcomes.

High-sensitivity Troponin-t Level after Pediatric Congenital Heart Disease Surgery

Cardiac tissue ischemia can be assessed by a troponin biomarker in adults. However, its effectiveness after pediatric open-heart surgery is still being debated despite the increased demand for congenital heart surgeries. This study assesses the relationship of troponin T levels with many surgical, biochemical, and prognostic variables. This prospective, longitudinal study included 70 patients collected over one year. These patients underwent open-heart surgery and required a cardiopulmonary bypass machine at the Cardiac Center in Erbil, Iraq. Troponin T measurements were taken 4 times for each patient: the day before the operation, 4 and 24 hours post-surgery, and on the discharge day from the hospital. These measurements were correlated with many variables. The study revealed significantly higher troponin levels in children younger than three years old and in those with Fallot surgeries. Most patients with high 4-hour troponin levels developed short-term complications. Furthermore, significant correlations were observed between troponin levels with the duration of the whole operation and the durations of these specific procedures: cardiopulmonary bypass, aortic cross-clamp, and inotropic support. We also found that high troponin levels, particularly 4 hours post-surgery, can predict a longer-than-usual stay in the intensive care unit and hospital, as well as short-term complications

A Mathematical Model of Artificial Pulse Synchronization for the HeartMate3 Left Ventricular Assist Device.

Constant speed control of rotary LVADs attenuates vascular pulsatility, which has been linked to clinical complications such as thrombus formation, bleeding, and valvular dysfunction. Speed modulation can improve pulsatility and washout, but optimization requires coordination with the native heartbeat. A simple mathematical model of the left ventricle-left ventricular assist device (LV-LVAD) flow interaction was developed that sums the individual contributions of the native LV and the HeartMate3 artificial pulse (AP) to predict the total systemic flow. The model flow and pulsatility predictions results were in good agreement with experimental data from a mock circulatory loop measured for full bypass support conditions. The model was used to evaluate three schemes for optimizing the synchronization of the AP with the native heart. The optimized interaction occurred when the AP speed increase occurred during contraction, resulting in a doubling of flow pulsatility, and corresponded to an increase in the area enclosed by the dynamic pressure-flow relation. The model provides a simple tool for exploring the optimization of LVAD speed modulation that can reduce the time and expense of mock loop studies during the development process.

Acute Right Ventricular Failure Immediately Following Subxiphoid Pericardial Window Requiring Temporary Cardiopulmonary Bypass Support: A Case Report of Pericardial Decompression Syndrome

Cardiac tamponade is a life-threatening condition requiring emergent intervention, such as a pericardial window, to drain the pericardial effusion, subsequently improving cardiac output. A rare complication of this procedure is pericardial decompression syndrome which results in a paradoxical cardiovascular collapse. A 65-year-old male with bacterial endocarditis status posts mitral and aortic valve replacement presented for an emergent subxiphoid pericardial window to relieve cardiac tamponade. After draining 850mL of pericardial fluid, the patient suffered a cardiac arrest secondary to acute right ventricular failure seen on an intraoperative transesophageal echocardiogram (TEE). Despite manual compressions and high-dose vasopressors, hemodynamics did not improve, and the patient was emergently placed on cardiopulmonary bypass (CPB) support. Within two hours, CPB support was successfully weaned. Temporary CPB can improve acute right ventricular failure following pericardial decompression without needing longer-term extracorporeal support.

Right-sided heart reperfusion ("Berlin bridge technique") for right ventricle support during left ventricular assist device (LVAD) implantation.

Right-sided heart reperfusion ("Berlin bridge technique") for right ventricle support during left ventricular assist device (LVAD) implantation.

Thirty-day Outcomes of On-Pump and Off-Pump Coronary Artery Bypass Grafting: an Analysis of a Brazilian Sample by Propensity Score Matching.

IntroductionCoronary artery bypass grafting (CABG) performed with and without cardiopulmonary bypass (CPB) support has been widely discussed in the literature. However, little is known about the outcomes of those techniques in Brazil. This study aims at exploring 30-day mortality and morbidity outcomes of on- and off-pump isolated CABG in a large sample from Southern Brazil.MethodsA single-center cohort with 1,767 patients undergoing isolated CABG (January 2013 - December 2018) was initially evaluated. Patients undergoing off-pump (N=397) and on-pump (N=1,370) CABG were identified. To obtain two completely homogeneous study groups, propensity score matching was used. The paired groups were compared by descriptive and univariate analyses. Then, logistic regression was used to verify the effects of on- and off-pump CABG on 30-day mortality.ResultsNone of the baseline characteristics showed significant difference between the groups (P>0.05). None of the analyzed morbidity outcomes showed any difference between the groups, including acute myocardial infarction (3.0% vs. 1.5%; P=0.192), stroke (2.4% vs. 4.2%; P=0.193), and major reoperation (0.6% vs. 0.3%; P=1.000), as well as the major adverse cardiovascular and cerebrovascular events composite outcome (6.3% vs. 7.5%; P=0.541). Mortality also did not differ (1.5% vs. 2.4%; P=0.401), and CPB support was not an independent predictor of risk for 30-day mortality (odds ratio: 2.052; 95% confidence interval: 0,609-6.913; P=0.246).ConclusionAfter matching by propensity analyses, similar rates of on- and off-pump 30-day mortality and other major outcomes were observed. In addition, the use of CPB support was not an independent predictor of risk for the occurrence of 30-day mortality.

Single-center surgical site infection rate after peripheral ECMO decannulation and surgical repair.

Objective:Extracorporeal membrane oxygenation (ECMO) is used to provide heart–lung bypass support in cases of acute respiratory and cardiac failure. The two main classifications of ECMO are venoarterial (VA) and venovenous (VV). After the patient recovers from an acute state, ECMO decannulation from the groin often requires femoral exploration and vessel repair. This study was performed to quantify the rate of surgical site infection (SSI) after ECMO decannulation.Methods:Retrospective single-institutional review of patients requiring ECMO from January 2016 to October 2019 was conducted. The study examined incidence of SSI. We evaluated preoperative risk factors, VA versus VV ECMO, Szilagyi infection score, and postoperative management.Results:Initial search began with 176 ECMO cases, of which 106 patients were deceased before development of any infection. Eighteen were eliminated because of central ECMO access, and four were lost to chart privacy. Of the 154 patients requiring femoral ECMO, 48 (31%) survived, with 22 VA and 26 VV ECMO. Twelve patients were classified as infected, resulting in an overall SSI rate of 25%. Surgical repair of the femoral arterial cannulation site was required in the 22 VA ECMO patients, and 10 of these became infected, resulting in an infection rate of 45%. The remaining two infected were VV ECMO and did not require surgery. The VV ECMO SSI rate was 7.7%. The infected group of VA ECMO consisted of eight primary surgical repairs and two patch repairs. Eight of the patients required multiple reoperations and two required antibiotics and wound care alone. There was no instance of limb loss. Statistical analysis showed intraoperative transfusion of >250 ml and blood loss of >300 ml as the only predictive factors of infection. The Szilagyi score was found to be worse in patients requiring patch angioplasty.Conclusion:Surgical repair of ECMO arterial cannulation sites had postoperative SSIs in nearly half of the patients (45%). The VV ECMO SSI rate was found to be 7.7%. Severity of infection was worse in more complicated repairs. Overall ECMO mortality was high at 69%. Although we found no clear correlation with common risk factors, transfusions >250 ml and blood loss >300 ml were found to be predictive. Vascular surgeons should be aware of high risk of SSI with repair of femoral ECMO cannulation sites.

The platelet-lymphocyte ratio is a promising predictor of early postoperative acute kidney injury following cardiac surgery: a case-control study.

BackgroundAcute kidney injury (AKI) is a common complication following cardiac surgery. This study explored the correlation between hematological biomarkers and the occurrence of postoperative AKI following cardiac surgery.MethodsThis was a retrospective case-control, single-center study. This study enrolled 91 patients who underwent cardiac surgery with cardiopulmonary bypass (CPB) support in Guangdong Provincial People’s Hospital Zhuhai Hospital between March 2019 and July 2021. The baseline serum creatinine levels of the patients was <132.6 µmol/L. The patients’ electronic medical records were retrospectively reviewed. AKI was diagnosed according to the Kidney Disease Improving Global Outcomes (KDIGO) 2012 Acute Kidney Injury Guideline criteria. Patients who sustained AKI in the 48 hours following cardiac surgery were categorized as Group A (n=48), while patients with normal serum creatinine levels postoperatively were categorized as Group B (n=43). The baseline demographic and clinical characteristics of the two groups were compared. Univariate analysis was performed to evaluate the correlation between biomarkers and postoperative AKI. Multivariate logistic regression was performed to identify the predictors of AKI following cardiac surgery.ResultsForty-eight patients were diagnosed with AKI during the first 48 hours after cardiac surgery, while 43 patients were found to have normal creatinine levels postoperatively. Multivariate logistic regression analysis revealed advanced age (P=0.007), preoperative increased creatinine (P=0.023), duration of intraoperative hypotension (P=0.027), and the platelet-lymphocyte ratio (P/LR; P=0.042) as predictors of AKI following cardiac surgery with CPB. This study was performed in a single center, which might not be generalized to whole population. Ongoing review and modification of the surgical protocols may contribute to bias of the study.ConclusionsThe P/LR can be obtained from a routine blood test, and may potentially be utilized as an independent indicator of AKI following cardiac surgery.

Kidney Replacement Therapy for Patients Requiring Cardiopulmonary Bypass Support during Cardiac Surgery.

Kidney Replacement Therapy for Patients Requiring Cardiopulmonary Bypass Support during Cardiac Surgery.

Hemodynamic evaluation of a new pulsatile blood pump during low flow cardiopulmonary bypass support.

The VentriFlo® True Pulse Pump (VentriFlo, Inc, Pelham, NH, USA) is a new pulsatile blood pump intended for use during short-term circulatory support. The purpose of this study was to evaluate the feasibility of the VentriFlo and compare it to a conventional centrifugal pump (ROTAFLOW, Getinge, Gothenberg, Sweden) in acute pig experiments. Pigs (40-45kg) were supported by cardiopulmonary bypass (CPB) with the VentriFlo (n=9) or ROTAFLOW (n=5) for 6h. Both VentriFlo and ROTAFLOW circuits utilized standard CPB components. We evaluated hemodynamics, blood chemistry, gas analysis, plasma hemoglobin, and microcirculation at the groin skin with computer-assisted video microscopy (Optilia, Sollentuna, Sweden). Pigs were successfully supported by CPB for 6h without any pump-related complications in either group. The VentriFlo delivered an average stroke volume of 29.2±4.8ml. VentriFlo delivered significantly higher pulse pressure (29.1±7.2mmHg vs. 4.4±7.0mmHg, p<0.01) as measured in the carotid artery, with mean aortic pressure and pump flow comparable with those in ROTAFLOW. In blood gas analysis, arterial pH was significantly lower after five hours support in the VentriFlo group (7.30±0.07 vs. 7.43±0.03, p=0.001). There was no significant difference in plasma hemoglobin level in both groups after six hours of CPB support. In microcirculatory assessment, VentriFlo tended to keep normal capillary flow, but it was not statistically significant. VentriFlo-supported pigs showed comparable hemodynamic parameters with significantly higher pulse pressure compared to ROTAFLOW without hemolysis.

Extracorporeal life support and cardiopulmonary bypass for central airway surgery: A systematic review.

Major airway surgery can pose a complex problem to perioperative central airway management. Adjuncts to advanced ventilation strategies have included cardiopulmonary bypass, veno-arterial, or veno-venous extracorporeal life support. We performed a systematic review to assess the existing evidence utilizing these strategies. An electronic search was conducted to identify studies written in English reporting the use of extracorporeal life support (ECLS) during central airway surgery. Thirty-six articles consisting of 78 patients were selected and patient-level data were analyzed. Median patient age was 47 [IQR: 34-53] and 59.0% (46/78) were male. Indications for surgery included central airway or mediastinal cancer in 57.7% (45/78), lesion or injury in 15.4% (12/78), and stenosis in 12.8% (10/78). Support was initiated pre-operatively in 9.9% (7/71) and at the time of induction in 55.3% (42/76). It was most commonly used at the time of tracheal resection/repair [93.2% (68/73)], intubation of the tracheal stump [94.4% (68/72)], and re-anastomosis [94.2% (65/69)]; 13.7% (10/73) patients were supported post-operatively. The most commonly performed surgery was tracheal repair or resection in 70.3% (52/74). Median hospital stay was 12 [8, 25] days and in-hospital mortality was 7.9% (6/76). There was no significant difference in survival between the three groups (p=.54). Extracorporeal membrane oxygenation offers versatility in timing, surgical approach, and ECLS runtime that makes it a viable addition to the surgical armamentarium for treating complex central airway pathologies.

Indications and outcome after lung transplantation in children under 12 years of age: A 16-year single center experience

Paediatric lung transplantation poses unique management challenges. Experience regarding indications and outcome is scarce, especially in younger children. The primary aim of this study was to investigate outcome after first lung transplantation in children <12 years of age in comparison to adolescents (12-17 years old). Records of patients <18 years who underwent first lung transplantation between 01/2005 and 01/2021 were retrospectively reviewed, and compared between children <12 years old and adolescents. Median (IQR) follow-up was 51 (23-91) months. Of the 117 patients underwent first lung transplantation at our institution, of whom 42 (35.8%) patients were <12 years and 75 (64.2%) ≥12 years old. Compared to adolescents, children were more often transplanted for interstitial lung disease (33.3% vs 12%, p=0.005) and precapillary pulmonary hypertension (28.6% vs 12%, p=0.025), and required more often intraoperative cardiopulmonary bypass (31% vs 14.7%, p=0.036) and postoperative ECMO support (47.6% vs 13.3%, p < 0.001). Postoperatively, children required longer ventilation times (78 vs 18 hours, p=0.009) and longer ICU stay (9.5 vs 3 days, p < 0.001) compared to their older counterparts. Primary graft dysfunction grade 3 at 72 hours (9.5% vs 9.3%, p=0.999), in-hospital mortality (2.4% vs 6.7%, p=0.418), graft survival (80% vs 62%, p=0.479) and freedom from chronic lung allograft dysfunction (76% vs 59%, p=0.41) at 8-year follow-up did not differ between groups. Lung transplantation in children under 12 years is challenging due to underlying medical conditions and operative complexity. Nevertheless, outcomes are comparable to those in older children.

Development of Inspired Therapeutics Pediatric VAD: Benchtop Evaluation of Impeller Performance and Torques for MagLev Motor Design.

Despite the availability of first-generation extracorporeal mechanical circulatory support (MCS) systems that are widely used throughout the world, there is a need for the next generation of smaller, more portable devices (designed without cables and a minimal number of connectors) that can be used in all in-hospital and transport settings to support patients in heart failure. Moreover, a system that can be universally used for all indications for use including cardiopulmonary bypass (CPB), uni- or biventricular support (VAD), extracorporeal membrane oxygenation (ECMO) and respiratory assist that is suitable for use for adult, neonate, and pediatric patients is desirable. Providing a single, well designed, universal technology could reduce the incidence of human errors by limiting the need for training of hospital staff on a single system for a variety of indications throughout the hospital rather than having to train on multiple complex systems. The objective of this manuscript is to describe preliminary research to develop the first prototype pump for use as a ventricular assist device for pediatric patients with the Inspired Universal MCS technology. The Inspired VAD Universal System is an innovative extracorporeal blood pumping system utilizing novel MagLev technology in a single portable integrated motor/controller unit which can power a variety of different disposable pump modules intended for neonate, pediatric, and adult ventricular and respiratory assistance. A prototype of the Inspired Pediatric VAD was constructed to determine the hemodynamic requirements for pediatric applications. The magnitude/range of hydraulic torque of the internal impeller was quantified. The hydrodynamic performance of the prototype pump was benchmarked using a static mock flow loop model containing a heated blood analogue solution to test the pump over a range of rotational speeds (500-6000 RPM), flow rates (0-3.5L/min), and pressures (0 to ~420 mmHg). The device was initially powered by a shaft-driven DC motor in lieu of a full MagLev design, which was also used to calculate the fluid torque acting on the impeller. The pediatric VAD produced flows as high as 4.27L/min against a pressure of 127 mmHg at 6000 RPM and the generated pressure and flow values fell within the desired design specifications. The empirically determined performance and torque values establish the requirements for the magnetically levitated motor design to be used in the Inspired Universal MagLev System. This next step in our research and development is to fabricate a fully integrated and functional magnetically levitated pump, motor and controller system that meets the product requirement specifications and achieves a state of readiness for acute ovine animal studies to verify safety and performance of the system.

Protective effect of soluble Klotho in pediatric patients undergoing cardiac surgery with cardiopulmonary bypass support-A pilot study.

The Klotho protein family plays important roles in several metabolic pathways. Soluble Klotho has been recently put forward as an antiaging protein, demonstrating renal and cardiovascular protective traits. Cardiopulmonary bypass (CPB) support during cardiac surgery has been implicated in several adverse outcomes in pediatric and adult patients. Our goal was to assess whether serum Klotho levels can be used to predict outcomes in children undergoing cardiac surgery with CPB due to congenital heart defects (CHDs). This prospective study was conducted on pediatric patients admitted to two Pediatric Cardiac Intensive Care Units, between 2012 and 2018. All patients were born with CHD and underwent corrective surgery with CPB. Sequential blood samples were analyzed by enzyme-linked immunosorbent assay for soluble Klotho levels at baseline, 2, 6, and 24 h after surgery. The association between Klotho levels and several demographic, intraoperative, and postoperative clinical and laboratory parameters was studied. Twenty-nine children undergoing cardiac surgery with CPB support were included. Serum Klotho levels were shown to significantly decrease 2 h after surgery and increase to baseline levels after 6 h (p < .001 and p < .05, respectively). Patients with low Klotho levels 2 h after surgery were at a 32-fold higher risk for developing postoperative complications (p = .015, odds ratio < 0.03). Moreover, Klotho levels at each of the four time points were lower in patients who developed postoperative complications. Cardiac surgery with CPB results in a significant decrease of serum Klotho levels 2 h after surgery in pediatric patients with CHDs, which can be used to predict development of postoperative complications in this patient population.

Minimal invasive temporary percutaneous right ventricular circulatory support after left ventricular assist device implantation.

Cardiogenic shock is a life-threatening situation with high mortality rates. Mechanical unloading of the left ventricle may be achieved via left ventricular assist device (LVAD) implantation. Postoperative right ventricular (RV) failure, however, has very limited therapeutic options and is associated with increased postoperative mortality. In this paper, we describe a percutaneous right heart bypass for temporary postoperative RV support. We retrospectively examined all patients receiving percutaneous RV mechanical support after LVAD implantation. All patients receiving trans-jugular mechanical right heart bypass during or after LVAD implantation in our tertiary medical centre between November 2014 and December 2019 were examined retrospectively. The venous draining cannula was placed in the femoral vein; the pulmonary cannula was placed in the pulmonary artery using fluoroscopy. In total, 14 patients received RV support using the trans-jugular technique. Mean age was 48.4 ± 14.9 years. Nine patients were treated with mechanical circulatory support before LVAD implantation. Biventricular support was done in 7 patients. All patients were treated with an Heartware HVAD . Mean postoperative intensive care unit stay was 46.3 ± 32.4 days. Mean right heart bypass support time was 10.6 ± 4.3 days. Twelve patients (86%) could be bridged to RV recovery, RV assist device implantation or heart transplantation. Percutaneous RV mechanical support is feasible, safe and shows acceptable outcome. Early implantation of RV support may contribute to successful outcome after LVAD implantation.

A case of successful surgical treatment of a patient with a cement embolism of the right heart chambers after vertebroplasty

Cement embolism of the right chambers of the heart after vertebral surgery is an extremely rare complication and occurs in 4 % of cases. The strategies for choosing the treatment of this complication are open-heart surgery under conditions of cardiopulmonary bypass, conservative treatment, or endovascular support. In the case of a fatal complication of embolism, such as perforation of the heart with the development of tamponade or life-threatening arrhythmias, the patient is shown an open operation with infrared. According to the literature, only 14 such operations are described, performed to save the patient’s life. We performed a successful operation of embolectomy from the right heart chambers in a 69‑year-old patient who had previously undergone vertebroplasty of the thoracic vertebrae.

Giant coronary sinus aneurysm misdiagnosed as an extracardiac mediastinal tumor

Coronary sinus aneurysm is a rare heart anomaly. Herein, we report a rare case with giant coronary sinus aneurysm misdiagnosed as an extracardiac mediastinal tumor. The preoperative diagnostic imaging failed to diagnose the correct location of the tumor and a simple resection was planned. It turned out to be coronary sinus aneurysm intraoperatively and required cardiopulmonary bypass support for the resection.

Development of the Left Atrial Assist Device for Patients with Heart Failure with Preserved Ejection Fraction: First In Vivo Results

<h3>Purpose</h3> The Left Atrial Assist Device (LAAD) is a novel device in development for mechanical circulatory assistance in patients who have heart failure with preserved ejection fraction (HFpEF). The device is implantable in the mitral position and delivers blood from the left atrium to the left ventricle. We report our results of the first LAAD <i>in vivo</i> implantation to assess the operational performance. <h3>Methods</h3> The LAAD was implanted in calves (<i>n</i>=4; mean weight 78.9 kg) using cardiopulmonary bypass (CPB) support through a left atrial incision. Horizontal mattress sutures were placed circumferentially around the mitral annulus and through the LAAD sewing ring (diameter 29 mm, Fig. 1a). Various pump-operating conditions, including mean pump speeds ranging from 3,600 to 6,000 rpm, were evaluated after the CPB was weaned, and the hemodynamics for each pump setting were recorded. <h3>Results</h3> The LAAD responded to all control inputs and ran as expected during the experiment. The cardiac output and mean aortic pressure increased (from 5.3 to 6.0 L/min, and from 69 to 77 mm Hg, respectively) by increasing the pump speed from 3,600 to 4,400 rpm, while the mean left atrial pressure decreased (from 15.1 to 8.3 mm Hg). These parameters stayed the same at pump speeds of 4,400 to 5,200 rpm. The left ventricular end-diastolic pressure, central venous pressure and heart rate remained stable at speeds ranging from 3,600 to 5,200 rpm. Suction events were occasionally observed at speeds over 4,400 rpm, mainly because of the small size of the left atrium. The epicardial echocardiography showed good positioning of the LAADs, with no evidence of obstruction of the left ventricular outflow tracts (Fig. 1b). <h3>Conclusion</h3> The implantation of the LAADs in calves was successful, and the pump showed intended improvement of the hemodynamics in the normal calf hearts. Additional studies are underway to evaluate the pump performance under diastolic heart failure conditions.

Pulmonary mucormycosis causing a mycotic pulmonary artery aneurysm

Mycotic pulmonary artery aneurysms requiring pneumonectomy are extremely rare. We present a severely breathless immunocompromised diabetic middle-aged female patient. CT pulmonary angiogram revealed a giant pulmonary artery aneurysm with impending rupture in the right lung. We did an emergency right pneumonectomy under cardiopulmonary bypass support. Histopathology report of the lung specimen confirmed mucormycosis. She received amphotericin B after the procedure. The patient had a prolonged postoperative hospital stay and succumbed to sepsis. Mycotic pulmonary artery aneurysm portends very high morbidity and mortality in immunocompromised patients.