Browsing by Subject "INFERIOR VENA-CAVA"

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  • European Soc Cardiology ESC; Konstantinides, Stavros V.; Meyer, Guy; Harjola, Veli-Pekka; Luis Zamorano, Jose (2019)
  • Lantto, Juulia; Erkinaro, Tiina; Haapsamo, Mervi; Huhta, Heikki; Voipio, Hanna-Marja; Hohimer, A. Roger; Davis, Lowell E.; Acharya, Ganesh; Räsänen, Juha (2019)
    The foramen ovale (FO) accounts for the majority of fetal left ventricular (LV) output. Increased right ventricular afterload can cause a redistribution of combined cardiac output between the ventricles. To understand the capability of the FO to increase its volume blood flow and thus LV output, we mechanically occluded the main pulmonary artery in seven chronically instrumented near-term sheep fetuses. We hypothesized that FO volume blood flow and LV output would increase during main pulmonary artery occlusion. Fetal cardiac function and haemodynamics were assessed by pulsed and tissue Doppler at baseline, 15 and 60 min after occlusion of the main pulmonary artery and 15 min after occlusion was released. Fetal ascending aorta and central venous pressures and blood gas values were monitored. Main pulmonary artery occlusion initially increased fetal heart rate (P <0.05) from [mean (SD)] 158 (7) to 188 (23) beats min(-1) and LV cardiac output (P <0.0001) from 629 (198) to 776 (283) ml min(-1). Combined cardiac output fell (P <0.0001) from 1524 (341) to 720 (273) ml min(-1). During main pulmonary artery occlusion, FO volume blood flow increased (P <0.001) from 507 (181) to 776 (283) ml min(-1). This increase was related to fetal tachycardia, because LV stroke volume did not change. Fetal ascending aortic blood pressure remained stable. Central venous pressure was higher (P <0.05) during the occlusion than after it was released. During the occlusion, fetal pH decreased and PCO2 increased. Left ventricular systolic dysfunction developed while LV diastolic function was preserved. Right ventricular systolic and diastolic function deteriorated after the occlusion. In conclusion, the FO has a limited capacity to increase its volume blood flow at near-term gestation.
  • Homsy, Pauliina; Blomqvist, Carl; Heiskanen, Ilkka; Vikatmaa, Leena; Tukiainen, Erkki; Numminen, Kirsti; Sampo, Mika; Leppäniemi, Ari; Albäck, Anders; Kantonen, Ilkka; Vikatmaa, Pirkka (2020)
    Objective: Radical excision of retroperitoneal or intra-abdominal soft tissue sarcomas may necessitate vessel resection and reconstruction. The aim of this study was to assess surgical results of retroperitoneal or intra-abdominal sarcomas involving major blood vessels. Methods: This was a retrospective single centre cohort study and a comprehensive review of literature. Patients with retroperitoneal or intra-abdominal sarcomas treated by the oncovascular team in Helsinki University Hospital from 2010 to 2018 were reviewed for vascular and oncological outcomes. A comprehensive literature review of vascular reconstructions in patients with retroperitoneal sarcoma was performed. Results: Vascular reconstruction was performed in 17 patients, 11 of whom required arterial reconstructions. Sixteen of the operations were sarcoma resections; the post-operative diagnosis for one patient was thrombosis instead of the presumed recurrent leiomyosarcoma. Early graft thrombosis occurred in two venous and one arterial reconstruction. Late thrombosis was detected in three (18%). The median follow up was 27 (range 0-82) months. Of the patients with sarcoma resections 5 (31%) died of sarcoma and further 4 (25%) developed local recurrence or new distant metastases. The comprehensive review of literature identified 37 articles with 110 patients, 89 of whom had inferior vena cava reconstruction only. Eight arterial reconstructions were described. Late graft thrombosis occurred in 14%. The follow up was 0-181 months, during which 57% remained disease free and 7% died of sarcoma. Conclusion: Vascular reconstructions enable radical resection of retroperitoneal and intra-abdominal sarcomas in patients with advanced disease. The complex operations are associated with an acceptable rate of serious perioperative complications and symptomatic thrombosis of the repaired vessel is rare. However, further studies are needed to assess the performance of the vascular reconstructions in the long term.