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New Publication: Cesarean section in the setting of severe pulmonary hypertension requiring extracorporeal life support.

Gen Thorac Cardiovasc Surg. 2016 Nov 25. [Epub ahead of print]

Cesarean section in the setting of severe pulmonary hypertension requiring extracorporeal life support.

Author information

1. Division of Cardiac Surgery, The Johns Hopkins Hospital, Zayed 7107, 1800 Orleans St, Baltimore, MD, 21287, USA.
2. Division of Cardiac Surgery, The Johns Hopkins Hospital, Zayed 7107, 1800 Orleans St, Baltimore, MD, 21287, USA. nhibino1@jhmi.edu.

Abstract

We describe the use of veno-arterial extracorporeal membrane oxygenation (ECMO) in a 35-year-old female with severe fixed pulmonary hypertension who went into cardiogenic shock during a Cesarean section. Pregnancy in the presence of severe pulmonary hypertension is typically contraindicated due to high maternal mortality rates. This patient visited our hospital at 37 weeks of gestation after experiencing dyspnea and chest pain. Clinical evaluation revealed severe fixed pulmonary hypertension. At the time of the planned delivery, femoral lines were placed; in case of emergency, ECMO became necessary during the delivery. During delivery, the patient developed sudden hemodynamic collapse necessitating rapid cannulation and initiation of ECMO. She was stabilized pharmacologically and separated from ECMO after 2 days. The baby was delivered uneventfully, and the mother and child were discharged 1 month after delivery.

KEYWORDS:

Cesarean section; ECMO; Pulmonary hypertension

New Publication Featured on the Cover Page of the Sept 2016 issue of WJPCHS: Single-Stage Total Arch Replacement Including Resection of Kommerell Diverticulum in a Patient With Loeys-Dietz Syndrome.

World J Pediatr Congenit Heart Surg. 2016 Sep;7(5):651-4. doi: 10.1177/2150135116656979. Epub 2016 Aug 12.

Single-Stage Total Arch Replacement Including Resection of Kommerell Diverticulum in a Patient With Loeys-Dietz Syndrome.

Author information

1. Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA.
2. Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA, visiting student from The Jikei University School of Medicine, Tokyo, Japan.
3. Division of Cardiac Surgery, The Johns Hopkins Hospital, Baltimore, MD, USA nhibino1@jhmi.edu.

Abstract

Loeys-Dietz syndrome (LDS) is an autosomal dominant genetic connective tissue disorder associated with aortic aneurysmal disease. Kommerell diverticulum (KD) is a rare aortic diverticulum, for which the indication for surgery and the surgical techniques remain subjects of debate. We describe our experience with a successful total aortic arch replacement including KD resection through a median sternotomy for a pediatric patient with LDS.

KEYWORDS:

Kommerell diverticulum; Loeys-Dietz syndrome; aberrant right subclavian artery; congenital heart disease

DOI: 10.1177/2150135116656979

Featured on the Cover Page of the Sept 2016 issue of WJPCHS.

Single-Stage Total Arch Replacement Including Resection of Kommerell Diverticulum in a Patient With Loeys-Dietz Syndrome - World J Cover 1200px.jpg

New Publication: Tissue-Engineered Small Diameter Arterial Vascular Grafts from Cell-Free Nanofiber PCL/Chitosan Scaffolds in a Sheep Model.

PLoS One. 2016 Jul 28;11(7):e0158555. doi: 10.1371/journal.pone.0158555. eCollection 2016.

Tissue-Engineered Small Diameter Arterial Vascular Grafts from Cell-Free Nanofiber PCL/Chitosan Scaffolds in a Sheep Model.

Author information

1. Department of Cardiac Surgery, Johns Hopkins University, Baltimore, MD, United States of America.
2. Tissue Engineering and Center for Cardiovascular and Pulmonary Research, Nationwide Children’s Hospital, Columbus, OH, United States of America.
3. Yale University School of Medicine, New Haven, CT, United States of America.
4. Nanofiber Solutions Inc, Columbus, OH, United States of America.

Abstract

Tissue engineered vascular grafts (TEVGs) have the potential to overcome the issues faced by existing small diameter prosthetic grafts by providing a biodegradable scaffold where the patient’s own cells can engraft and form functional neotissue. However, applying classical approaches to create arterial TEVGs using slow degrading materials with supraphysiological mechanical properties, typically results in limited host cell infiltration, poor remodeling, stenosis, and calcification. The purpose of this study is to evaluate the feasibility of novel small diameter arterial TEVGs created using fast degrading material. A 1.0mm and 5.0mm diameter TEVGs were fabricated with electrospun polycaprolactone (PCL) and chitosan (CS) blend nanofibers. The 1.0mm TEVGs were implanted in mice (n = 3) as an unseeded infrarenal abdominal aorta interposition conduit., The 5.0mm TEVGs were implanted in sheep (n = 6) as an unseeded carotid artery (CA) interposition conduit. Mice were followed with ultrasound and sacrificed at 6 months. All 1.0mm TEVGs remained patent without evidence of thrombosis or aneurysm formation. Based on small animal outcomes, sheep were followed with ultrasound and sacrificed at 6 months for histological and mechanical analysis. There was no aneurysm formation or calcification in the TEVGs. 4 out of 6 grafts (67%) were patent. After 6 months in vivo, 9.1 ± 5.4% remained of the original scaffold. Histological analysis of patent grafts demonstrated deposition of extracellular matrix constituents including elastin and collagen production, as well as endothelialization and organized contractile smooth muscle cells, similar to that of native CA. The mechanical properties of TEVGs were comparable to native CA. There was a significant positive correlation between TEVG wall thickness and CD68+ macrophage infiltration into the scaffold (R2 = 0.95, p = 0.001). The fast degradation of CS in our novel TEVG promoted excellent cellular infiltration and neotissue formation without calcification or aneurysm. Modulating host macrophage infiltration into the scaffold is a key to reducing excessive neotissue formation and stenosis.

PMID:
27467821
PMCID:
PMC4965077
DOI:
10.1371/journal.pone.0158555
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