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4 results on '"Ray Guo"'

1. Extracorporeal membrane oxygenation in the acute treatment of cardiovascular collapse immediately post-partum

Author

W. Robert Leeper, Robert Arntfield, Matthew Valdis, and L. Ray Guo

Subjects
Pulmonary and Respiratory Medicine, Adult, Resuscitation, medicine.medical_specialty, Time Factors, medicine.medical_treatment, Pregnancy Complications, Cardiovascular, Case Reports, law.invention, Extracorporeal Membrane Oxygenation, law, Pregnancy, Extracorporeal membrane oxygenation, medicine, Humans, Caesarean section, Thrombolytic Therapy, Cardiopulmonary resuscitation, business.industry, Cesarean Section, Postpartum Period, Hemodynamics, Infant, Newborn, Shock, Oxygenation, medicine.disease, Intensive care unit, Cardiopulmonary Resuscitation, Pulmonary embolism, Surgery, surgical procedures, operative, Treatment Outcome, Acute Disease, Female, Emergencies, Cardiology and Cardiovascular Medicine, business, Pulmonary Embolism, Postpartum period
Abstract

We describe the use of extracorporeal membrane oxygenation (ECMO) in a 30-year old woman at 37 weeks’ gestation, following cardiac arrest from pulmonary embolism immediately post-partum from an emergent Caesarean section. In this case, ECMO was initiated though modified techniques with only the equipment available in a delivery room as a last resort to save a new mother after a significant downtime of 83 min. The patient received tissue plasminogen activator during the resuscitation resulting in significant blood loss. However, the patient was stabilized on ECMO and after 5 weeks in the intensive care unit achieved complete physical and neurologic recovery. To our knowledge, this is the first reported case where ECMO has been used in a resuscitation from massive pulmonary embolism immediately post-partum, after thombolytics were administered. Here, we discuss our strategies for emergent cannulation in a suboptimal environment, management of profound bleeding and oxygenation strategies in this hostile setting. Given the potential for success and the significant life-years gained, aggressive measures, such as ECMO, should be considered in such extreme life-threatening cases.

Published
2013

2. Biatrial reduction plasty with reef imbricate technique as an adjunct to maze procedure for permanent atrial fibrillation associated with giant left atria

Author

Xiao-Dong Feng, Xi Qing Feng, William Wang, Anne Marie O. Martland, L. Ray Guo, and Jie Ma

Subjects
Pulmonary and Respiratory Medicine, Aortic valve, Adult, Male, medicine.medical_specialty, China, Time Factors, medicine.medical_treatment, Heart Valve Diseases, Preoperative care, Aortic valve replacement, Internal medicine, Mitral valve, Atrial Fibrillation, medicine, Humans, Sinus rhythm, cardiovascular diseases, Heart Atria, Hospital Mortality, Heart Valve Prosthesis Implantation, Atrium (architecture), business.industry, Suture Techniques, Mitral valve replacement, Atrial fibrillation, Middle Aged, medicine.disease, Surgery, medicine.anatomical_structure, Treatment Outcome, Aortic Valve, cardiovascular system, Cardiology, Catheter Ablation, Mitral Valve, Female, Cardiology and Cardiovascular Medicine, business, Echocardiography, Transesophageal
Abstract

Success of the modified maze procedure after valvular operation with giant atria and permanent atrial fibrillation (AF) remains suboptimal. We report an aggressive approach for these patients utilizing biatrial reduction plasty with a reef imbricate suture technique concomitantly with valvular and maze procedure for AF. From January 1999 to December 2006, 122 consecutive Chinese patients with permanent AF and biatrial enlargement who required mitral valve+/-tricuspid valve (TV) surgery underwent aggressive left atrial reduction combined with radiofrequency bipolar full maze procedure. Left atrial dimensions were measured by TTE or TEE. There were 71 women (58.1%) and 51 men (41.9%) and their mean age was 45+/-9.5 years. Mean duration of AF was 48.4+/-21.4 months. All patients underwent left atrial reduction plasty with reef imbricate suture technique and full maze procedure. Their preoperative left atria measured 64+/-12 mm in the enlarged left atria (ELA) group and 86+/-17 mm in the giant left atria (GLA). Mitral valve replacement (MVR) combined with TV repair was performed in 102 patients (83%) while 21 patients underwent MVRs combined with aortic valve replacements (17%). Sixty-six (54%) patients required additional procedures and 61 (50%) of the patients also underwent left atrial appendage clot evacuation. Postoperative left atrial size was reduced to 49+/-8 mm (ELA) and 51+/-11 mm (GLA), respectively (P

Published
2010

4. Extracorporeal membrane oxygenation in the acute treatment of cardiovascular collapse immediately post-partum.

Author

Leeper WR, Valdis M, Arntfield R, and Ray Guo L

Subjects
Acute Disease, Adult, Cardiopulmonary Resuscitation, Cesarean Section, Emergencies, Female, Hemodynamics, Humans, Infant, Newborn, Postpartum Period, Pregnancy, Pregnancy Complications, Cardiovascular diagnosis, Pregnancy Complications, Cardiovascular physiopathology, Pulmonary Embolism diagnosis, Pulmonary Embolism physiopathology, Shock diagnosis, Shock physiopathology, Thrombolytic Therapy, Time Factors, Treatment Outcome, Extracorporeal Membrane Oxygenation, Pregnancy Complications, Cardiovascular surgery, Pulmonary Embolism surgery, Shock surgery
Abstract

We describe the use of extracorporeal membrane oxygenation (ECMO) in a 30-year old woman at 37 weeks' gestation, following cardiac arrest from pulmonary embolism immediately post-partum from an emergent Caesarean section. In this case, ECMO was initiated though modified techniques with only the equipment available in a delivery room as a last resort to save a new mother after a significant downtime of 83 min. The patient received tissue plasminogen activator during the resuscitation resulting in significant blood loss. However, the patient was stabilized on ECMO and after 5 weeks in the intensive care unit achieved complete physical and neurologic recovery. To our knowledge, this is the first reported case where ECMO has been used in a resuscitation from massive pulmonary embolism immediately post-partum, after thombolytics were administered. Here, we discuss our strategies for emergent cannulation in a suboptimal environment, management of profound bleeding and oxygenation strategies in this hostile setting. Given the potential for success and the significant life-years gained, aggressive measures, such as ECMO, should be considered in such extreme life-threatening cases.

Published
2013
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