RESUMO
AIMS: Currently, there is limited data on prognostic indicators after insertion of percutaneous ventricular assist device (PVAD) in the treatment of cardiogenic shock (CS). This study evaluated the prognostic role of cardiac power output (CPO) ratio, defined as CPO at 24 h divided by early CPO (30 min to 2 h), in CS patients after PVAD. METHODS AND RESULTS: Consecutive CS patients from the QEH-PVAD Registry were followed up for survival at 90 days after PVAD. Among 121 consecutive patients, 98 underwent right heart catheterization after PVAD, with CPO ratio available in 68 patients. The CPO ratio and 24-h CPO, but not the early CPO post PVAD, were significantly associated with 90-day survival, with corresponding area under curve in ROC analysis of 0.816, 0.740, and 0.469, respectively. In multivariate analysis, only the CPO ratio and lactate level at 24 h remained as independent survival predictors. The CPO ratio was not associated with age, sex, and body size. Patients with lower CPO ratio had significantly lower coronary perfusion pressure, worse right heart indices, and higher pulmonary vascular resistance. A lower CPO ratio was also significantly associated with mechanical ventilation and higher creatine kinase levels in myocardial infarction patients. CONCLUSION: In post-PVAD patients, the CPO ratio outperformed the absolute CPO values and other haemodynamic metrics in predicting survival at 90 days. Such a proportional change of CPO over time, likely reflecting native heart function recovery, may help to guide management of CS patients post-PVAD.
RESUMO
A 63-year-old man presented with delayed inferior ST-elevation myocardial infarction complicated with ventricular septal rupture (VSR). He developed cardiogenic shock and respiratory failure requiring intubation and Impella (Abiomed) support.
Assuntos
Anemia Hemolítica , Próteses Valvulares Cardíacas , Falha de Prótese , Idoso , Humanos , Masculino , Anemia Hemolítica/etiologia , Ecocardiografia Transesofagiana/métodos , Próteses Valvulares Cardíacas/efeitos adversos , Implante de Prótese de Valva Cardíaca/efeitos adversos , Reoperação , Deiscência da Ferida Operatória/diagnóstico por imagem , Deiscência da Ferida Operatória/cirurgia , Resultado do TratamentoAssuntos
Estenose da Valva Aórtica , Próteses Valvulares Cardíacas , Substituição da Valva Aórtica Transcateter , Humanos , Substituição da Valva Aórtica Transcateter/efeitos adversos , Substituição da Valva Aórtica Transcateter/métodos , Valor Preditivo dos Testes , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/diagnóstico por imagem , Estenose da Valva Aórtica/cirurgia , Modelagem Computacional Específica para o Paciente , Resultado do Tratamento , Fatores de RiscoRESUMO
Traditionally, percutaneous mitral commissurotomy (PMC) is performed under fluoroscopy only. In difficult cases, general anesthesia with transesophageal echocardiography (TEE) guidance is needed. Intracardiac echocardiography (ICE) enables operators to perform PMC under local anesthesia while providing intra-procedural imaging guidance, as in TEE. Hereby, we describe a case of PMC guided by ICE to allow early detection of complications.
Assuntos
Apêndice Atrial , Ecocardiografia Transesofagiana , Humanos , Resultado do Tratamento , Ecocardiografia Transesofagiana/métodos , Fluoroscopia , Ultrassonografia de Intervenção/métodos , Apêndice Atrial/diagnóstico por imagem , Cateterismo Cardíaco/métodosRESUMO
A 70-year-old man with history of transcatheter aortic valve-in-valve implantation was admitted because of suspected infective endocarditis (IE). Transesophageal echocardiogram did not reveal any vegetations, as the metallic stent frames caused significant artifacts. Position emission tomography was also negative. Intracardiac echocardiogram (ICE) was performed retrogradely through the ascending aorta, which showed clear vegetations over the stent frame of the transcatheter heart valve. Endocarditis after transcatheter aortic valve implantation was not uncommon. With increasing use of valve-in-valve procedures, echocardiographic diagnosis of IE would be more challenging. This case demonstrated the advantage of ICE over conventional echocardiography in visualizing the neo-aortic valve complex for diagnosing IE.
Assuntos
Endocardite Bacteriana , Endocardite , Infecções Relacionadas à Prótese , Substituição da Valva Aórtica Transcateter , Masculino , Humanos , Idoso , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Infecções Relacionadas à Prótese/diagnóstico por imagem , Infecções Relacionadas à Prótese/etiologia , Infecções Relacionadas à Prótese/terapia , Resultado do Tratamento , Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/etiologia , Endocardite Bacteriana/cirurgia , Endocardite/etiologia , Endocardite/complicações , Substituição da Valva Aórtica Transcateter/efeitos adversos , Ecocardiografia/efeitos adversosRESUMO
A 68-year old lady present with left ventricular free wall rupture and cardiac arrest post-myocardial infarction. This article illustrates a strategy combining pericardiocentesis with autologous transfusion together with VA-ECMO as a bridge to definitive surgical repair.