The Usefulness of Microcirculatory Assessment After Cardiac Surgery: Illustrative Case Report

Fernandes, Marcos; Lorenzo, Andrea De; Tibiriçá, Eduardo

doi:10.21470/1678-9741-2023-0383

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CASE REPORT • Braz. J. Cardiovasc. Surg. 39 (6) • 2024 • https://doi.org/10.21470/1678-9741-2023-0383 linkcopy

The Usefulness of Microcirculatory Assessment After Cardiac Surgery: Illustrative Case Report

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Cardiac surgery causes a series of disturbances in human physiology. The correction of systemic hemodynamic variables is frequently ineffective in improving microcirculatory perfusion and delivering oxygen to the tissues. We present the case of a 52-year-old male submitted to mitral valve replacement (metallic valve) and subaortic membrane resection. Sublingual microcirculatory density and perfusion were evaluated using a handheld CytoCam camera before surgery and in the early postoperative period. In this case, systemic hemodynamic variables were compromised despite an actual improvement in the microcirculatory parameters in comparison to the preoperative evaluation, possibly due to the correction of the structural cardiac defects.

Keywords: Microcirculation; MitralValve; Cardiac Surgical Procedures; Hemodynamics; Perfusion; Oxygen

Authorship

Marcos Fernandes

conception and design of the work

and the analysis and interpretation of data for the work

drafting the work and revising it

agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved. final approval of the version to be published

Instituto Nacional de Cardiologia, Ministry of Health, Rio de Janeiro, Rio de Janeiro, BrazilMinistry of HealthBrazilRio de Janeiro, Rio de Janeiro, BrazilInstituto Nacional de Cardiologia, Ministry of Health, Rio de Janeiro, Rio de Janeiro, Brazil

Andrea De Lorenzo

conception and design of the work

and the analysis and interpretation of data for the work

drafting the work and revising it

agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved

final approval of the version to be published

Eduardo Tibiriçá Correspondence Address: Eduardo Tibiriçá https://orcid.org/0000-0002-3406-930C Instituto Nacional de Cardiologia, Rua das Laranjeiras, 374, Rio de Janeiro, RJ, Brazil, Zip Code: 22240-006, E-mail: etibi@uol.com.br

conception and design of the work

and the analysis and interpretation of data for the work

drafting the work and revising it

agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved

final approval of the version to be published

https://orcid.org/0000-0002-3406-9300

No conflict of interest.

Correspondence Address: Eduardo Tibiriçá https://orcid.org/0000-0002-3406-930C Instituto Nacional de Cardiologia, Rua das Laranjeiras, 374, Rio de Janeiro, RJ, Brazil, Zip Code: 22240-006, E-mail: etibi@uol.com.br

SCIMAGO INSTITUTIONS RANKINGS

Figures

Figures (4)

Thumbnail

Fig. 1
CytoCam-IDF handheld video microscope used for visualization of microcirculatory parameters in our department, based on IDF technology. The CytoCam is a pen-like device and is held as such. The low weight of the device (120 g) minimizes pressure artifact problems that were present in the earlier heavy devices. The camera is connected to a device controller based on a medical grade computer or a suitable portable device such as laptop or tablet, which is used for image storage (from https://braedius-medical.com/products/). IDF=incident dark field.

Thumbnail

Fig. 2
Representative example of the report of the offline image analysis performed using CytoCamTools 3.1.4 software (Braedius Medical, Huizen, The Netherlands).

Thumbnail

Fig. 3
CytoCam-incident dark field imaging of the sublingual area of the patient using a handheld camera the day before heart valve surgery (A) and during the early postoperative period (B). The blue lines indicate capillary vessels (diameter range between 6 µm and 16 µm). Offline image analysis was performed using CytoCamTools 3.1.4 software (Braedius Medical, Huizen, The Netherlands). The number of capillary vessels increased after surgery, as shown in Figure 4.

Thumbnail

Fig. 4
Bar graphs showing the analysis of the main microvascular parameters, including (A) total number of capillary vessels, (B) capillary vessel density, (C) total number of non-capillary vessels, (D) non-capillary vessel density, (E) total vessel number, and (F) microvascular flow index in the sublingual area, assessed using a handheld camera based on incident dark-field imaging before and after heart valve surgery.

imageFig. 1 CytoCam-IDF handheld video microscope used for visualization of microcirculatory parameters in our department, based on IDF technology. The CytoCam is a pen-like device and is held as such. The low weight of the device (120 g) minimizes pressure artifact problems that were present in the earlier heavy devices. The camera is connected to a device controller based on a medical grade computer or a suitable portable device such as laptop or tablet, which is used for image storage (from https://braedius-medical.com/products/). IDF=incident dark field. open_in_new

imageFig. 2 Representative example of the report of the offline image analysis performed using CytoCamTools 3.1.4 software (Braedius Medical, Huizen, The Netherlands). open_in_new

imageFig. 3 CytoCam-incident dark field imaging of the sublingual area of the patient using a handheld camera the day before heart valve surgery (A) and during the early postoperative period (B). The blue lines indicate capillary vessels (diameter range between 6 µm and 16 µm). Offline image analysis was performed using CytoCamTools 3.1.4 software (Braedius Medical, Huizen, The Netherlands). The number of capillary vessels increased after surgery, as shown in Figure 4. open_in_new

imageFig. 4 Bar graphs showing the analysis of the main microvascular parameters, including (A) total number of capillary vessels, (B) capillary vessel density, (C) total number of non-capillary vessels, (D) non-capillary vessel density, (E) total vessel number, and (F) microvascular flow index in the sublingual area, assessed using a handheld camera based on incident dark-field imaging before and after heart valve surgery. open_in_new

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Sociedade Brasileira de Cirurgia Cardiovascular Rua Afonso Celso, 1178 Vila Mariana, CEP: 04119-061 - São Paulo/SP Brazil, Tel +55 (11) 3849-0341, Tel +55 (11) 5096-0079 - São Paulo - SP - Brazil
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