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Multimodality Diagnosis of Mesenteric Ischemia
Published on: July 21, 2023
Acute mesenteric ischemia after heart surgery
Introduction:
Acute mesenteric ischemia (AMI) is a rare but very severe complication of heart surgery, due especially to the delay in setting the correct diagnosis and choosing the appropriate treatment. There are 4 types, but the most frequent is nonocclusive mesenteric ischemia (NOMI). The main mechanism is represented by great decrease or maldistribution of the splenic blood flow, with negative impact on the integrity of the intestinal mucosa, bacterial translocation and multiorganic failure.
Material And Method:
We present a retrospective study conducted on patients who underwent open heart surgery with cardiopulmonary bypass with non-pulsatile flow. 4 cases of angiographically confirmed NOMI (non-occlusive mesenteric ischemia) were identified. When, based on clinical examination and laboratory findings, acute mesenteric ischemia was suspicioned, superior mesenteric artery angiography was performed via the femoral artery.
Results:
The main risk factors were represented by: age over 70 years old, left ventricle ejection fraction (LVEF) 35%,aortic clamping time 100 min., chronic kidney failure,counter-pulsation balloon implant, inotropic medication use,like levosimendan, use of blood components 1 unit of erythrocyte mass. Clinical signs were nonspecific. All patients presented hypoventilation, arterial hypotension, oliguria and,from a biological standpoint, metabolic acidosis and leucocytosis. Superior mesenteric artery angiography was the investigation method of choice. Treatment approach was initially medical, followed by resection of the intestine.Mortality was 100%.
Conclusions:
Acute mesenteric ischemia is a rare but very severe complication in cardiac surgery. It is primordial that the main risk factors be known, and in case of diagnosis suspicion, that it be set as early as possible, along with immediate initiation of an appropriate course of treatment.
Insights
Acute mesenteric ischemia (AMI) is a severe heart surgery complication. Non-occlusive mesenteric ischemia (NOMI) is frequent, with risk factors including age and low ejection fraction, leading to 100% mortality in this study.
Area of Science:
- Cardiovascular Surgery
- Gastrointestinal Surgery
- Critical Care Medicine
Background:
- Acute mesenteric ischemia (AMI) is a rare but severe complication following cardiac surgery.
- Non-occlusive mesenteric ischemia (NOMI) is the most frequent type, often caused by reduced splenic blood flow, leading to intestinal damage and multi-organ failure.
Purpose of the Study:
- To identify risk factors and outcomes of non-occlusive mesenteric ischemia (NOMI) in patients undergoing open heart surgery with cardiopulmonary bypass.
- To highlight the importance of early diagnosis and treatment of AMI in cardiac surgery patients.
Main Methods:
- Retrospective study of patients who underwent open heart surgery with non-pulsatile flow cardiopulmonary bypass.
- Identified 4 cases of angiographically confirmed NOMI.
- Superior mesenteric artery angiography was used for diagnosis when AMI was suspected based on clinical and laboratory findings.
Main Results:
- Key risk factors included age over 70, LVEF < 35%, aortic clamping > 100 min, chronic kidney failure, and specific medications/interventions.
- Clinical signs were nonspecific (hypoventilation, hypotension, oliguria, acidosis, leucocytosis).
- All identified patients experienced 100% mortality despite medical treatment and intestinal resection.
Conclusions:
- AMI is a critical complication in cardiac surgery, necessitating awareness of risk factors.
- Early suspicion, diagnosis, and prompt treatment are crucial for managing AMI.
- The high mortality rate underscores the severity and challenges in treating NOMI post-cardiac surgery.
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