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Vriz O, Arshi F, Ahmed M, Alhumaid M, Galzerano D, Emmanual S, Kinsara AJ, Aladmawi M, Alamro B, Alshahid M, Pedrizzettid G. Cavitation phenomenon in mechanical prosthetic valves: Not only microbubbles. Echocardiography 2020; 37:876-882. [PMID: 32416011 DOI: 10.1111/echo.14692] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2020] [Accepted: 04/26/2020] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Microbubbles (MBs) or cavitation is high-velocity, echo-bright findings present during the closing or opening of a mechanical valve (MVP). Cavitation bubble growth or gas emboli are less frequently described. We evaluated the hemodynamic parameters involved in the formation of gas emboli and the impact of gas emboli on requests for additional investigations. METHODS AND RESULTS Transthoracic echocardiographic studies (TTE) of 57 patients (31 males, mean age 46.8 ± 13.8 years) with gas emboli were evaluated after heart valve replacement surgery. The majority (72%, n = 42) had a mitral or combined mitral/aortic MVP, with 28% (n = 16) an aortic MVP. The last TTE with and without gas emboli were considered for the same patient and the no emboli group was the control group (42 patients). The patient's blood pressure (BP) and heart rate (HR) were available for each TTE. Comparing the two TTEs, the systolic and diastolic BP, transmitral and aortic gradients, and left ventricular ejection fraction were similar but the HR (80.9 ± 18.7 vs 72.5 ± 13.9 bpm, P = .02) was significantly higher in the group with gas emboli. A TEE was performed 52 times in 27 patients, due to gas emboli, with one case positive for thrombus/vegetation. For 19 patients, a brain CT was requested. In two patients, the indication for the brain CT was gas emboli but the result was negative. CONCLUSION Gas emboli are frequently present and associated to an increased HR. They can cause the misdiagnosis of endocarditis or thrombus formation with significant additional requests for diagnostic examinations.
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Affiliation(s)
- Olga Vriz
- Cardiac Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Fatma Arshi
- Cardiac Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mawada Ahmed
- Cardiac Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Mohammed Alhumaid
- Cardiac Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Domenico Galzerano
- Cardiac Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia.,College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Shisamma Emmanual
- Cardiac Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdulhalim J Kinsara
- Ministry of National Guard Health Affair, COM-WR, King Abdullah International Research Center, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, Saudi Arabia
| | - Mohammed Aladmawi
- Cardiac Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Bandar Alamro
- Cardiac Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Maie Alshahid
- Cardiac Centre, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Gianni Pedrizzettid
- Dipartimento Ingegneria e Architettura, University of Trieste, Trieste, Italy
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Jenks CL, Zia A, Venkataraman R, Raman L. High Hemoglobin Is an Independent Risk Factor for the Development of Hemolysis During Pediatric Extracorporeal Life Support. J Intensive Care Med 2017; 34:259-264. [PMID: 28486865 DOI: 10.1177/0885066617708992] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate risk factors for hemolysis in pediatric extracorporeal life support. DESIGN Retrospective, single-center study. SETTING Pediatric intensive care unit. PATIENTS Two hundred thirty-six children who received extracorporeal membrane oxygenation. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Risk factors for hemolysis were retrospectively analyzed from a single center in a total of 236 neonatal and pediatric patients who received extracorporeal membrane oxygenation support (ECMO). There was no difference in the incidence of hemolysis between centrifugal (127 patients) and roller head (109 patients) pump type or between venoarterial and venovenous ECMO. High hemoglobin (Hb) was found to be an independent risk factor for hemolysis in both pump types. The Hb level >12 g/dL was significant in the roller group and the Hb level >13 g/dL was significant in the centrifugal group for the development of hemolysis for the cumulative ECMO run. The presence of high Hb levels on any given day increased the risk of hemolysis for that day of the ECMO run regardless of ECMO pump type. Higher revolutions per minute (RPMs) and higher inlet pressures on any given day increased the risk for the development of hemolysis in the centrifugal pump. Lower inlet venous pressures and RPMs were not associated with hemolysis in the roller group. CONCLUSIONS An Hb level greater than 13 g/dL was associated with an increased risk of hemolysis, and a high Hb on a given day was associated with a significantly higher risk of hemolysis on the same day. Higher RPMs and lower inlet venous pressures were associated with an increased risk of hemolysis in the centrifugal pump only.
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Affiliation(s)
- Christopher L Jenks
- Department of Pediatrics, Baylor College of Medicine, Houston, TX, USA.,Department of Pediatrics, Texas Children's Hospital, Houston, TX, USA
| | - Ayesha Zia
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA.,Children's Medical Center of Dallas, Dallas, TX, USA
| | - Ramgopal Venkataraman
- Department of Accounting, University of Texas at Arlington, Arlington, TX, USA.,*Joint senior authors
| | - Lakshmi Raman
- Department of Pediatrics, University of Texas Southwestern Medical Center at Dallas, Dallas, TX, USA.,Children's Medical Center of Dallas, Dallas, TX, USA.,*Joint senior authors
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Pohlmann JR, Toomasian JM, Hampton CE, Cook KE, Annich GM, Bartlett RH. The relationships between air exposure, negative pressure, and hemolysis. ASAIO J 2009; 55:469-73. [PMID: 19730004 DOI: 10.1097/mat.0b013e3181b28a5a] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The purpose of this study was to describe the hemolytic effects of both negative pressure and an air-blood interface independently and in combination in an in vitro static blood model. Samples of fresh ovine or human blood (5 ml) were subjected to a bubbling air interface (0-100 ml/min) or negative pressure (0-600 mm Hg) separately, or in combination, for controlled periods of time and analyzed for hemolysis. Neither negative pressure nor an air interface alone increased hemolysis. However, when air and negative pressure were combined, hemolysis increased as a function of negative pressure, the air interface, and time. Moreover, when blood samples were exposed to air before initiating the test, hemolysis was four to five times greater than samples not preexposed to air. When these experiments were repeated using freshly drawn human blood, the same phenomena were observed, but the hemolysis was significantly higher than that observed in sheep blood. In this model, hemolysis is caused by combined air and negative pressure and is unrelated to either factor alone.
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Affiliation(s)
- Joshua R Pohlmann
- Department of Surgery, Division of Critical Care, University of Michigan Medical School, Ann Arbor, Michigan 48109, USA
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Lippi G, Salvagno GL, Montagnana M, Brocco G, Cesare Guidi G. Influence of the needle bore size used for collecting venous blood samples on routine clinical chemistry testing. Clin Chem Lab Med 2006; 44:1009-14. [PMID: 16879070 DOI: 10.1515/cclm.2006.172] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AbstractClin Chem Lab Med 2006;44:1009–14.
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Affiliation(s)
- Giuseppe Lippi
- Istituto di Chimica e Microscopia Clinica, Dipartimento di Scienze Morfologico-Biomediche, Università degli Studi di Verona, Piazzale, Scuro, Verona, Italy.
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