RESUMO
BACKGROUND: Left ventricular assist devices (LVADs) have been a significant development in the treatment of patients with advanced heart failure supporting circulation as a bridge to transplant, recovery, or long-term destination therapy. When ventricular recovery occurs, there are multiple described ways of proceeding. HM2 decommissions are well described with varying degrees of explant operations, less so in HM3 due to the novelty of the device. In certain situations, invasive surgery can carry high risk and so a minimally invasive decommission, leaving the LVAD essentially intact in situ can be considered. CASE REPORT: In this report, we describe the case of a 35-year-old male diagnosed with an idiopathic dilated cardiomyopathy requiring an LVAD with subsequent identification of cardiac recovery with the asymptomatic thrombosis of the second HM3 device. Investigations demonstrated absent flow through the pump whilst the patient-reported NYHA I functional class symptoms. The Driveline was cut with the remaining internal pump components decommissioned and left in situ. At 1 year, the patient continues to do well with continued features of cardiac recovery with an LVEF of over 40%. CONCLUSION: LV recovery is well recognized with typical management being LVAD explant surgeries performed. Each case should be analyzed for risks and benefits to the patient and future research showed be directed towards levels of decommissioning surgery and management post-LVAD decommission patient care.
Assuntos
Cardiomiopatia Dilatada , Insuficiência Cardíaca , Coração Auxiliar , Masculino , Humanos , Adulto , Insuficiência Cardíaca/cirurgia , Estudos Retrospectivos , Cardiomiopatia Dilatada/complicações , Cardiomiopatia Dilatada/cirurgia , Ventrículos do Coração/cirurgia , Coração Auxiliar/efeitos adversosAssuntos
Aorta/cirurgia , Oclusão de Enxerto Vascular/diagnóstico por imagem , Insuficiência Cardíaca/terapia , Coração Auxiliar , Implantação de Prótese/instrumentação , Trombose/diagnóstico por imagem , Ultrassonografia de Intervenção , Idoso , Aorta/diagnóstico por imagem , Aorta/fisiopatologia , Cateterismo Cardíaco , Angiografia por Tomografia Computadorizada , Remoção de Dispositivo , Feminino , Oclusão de Enxerto Vascular/etiologia , Oclusão de Enxerto Vascular/fisiopatologia , Oclusão de Enxerto Vascular/cirurgia , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Hemodinâmica , Hemólise , Humanos , Valor Preditivo dos Testes , Desenho de Prótese , Falha de Prótese , Implantação de Prótese/efeitos adversos , Trombose/etiologia , Trombose/fisiopatologia , Trombose/cirurgia , Resultado do Tratamento , Função VentricularRESUMO
A 59-year-old woman with stroke and thromboembolic aortoiliac disease in the setting of profound stress was found to have severe left ventricular (LV) systolic dysfunction and large mobile clot on focused cardiac ultrasonography (FCU). Marked recovery of LV function and thrombus resolution within 4 days suggested resolving Takotsubo cardiomyopathy. The role of FCU in early diagnosis and treatment is outlined here.
Assuntos
Diagnóstico Precoce , Ecocardiografia/métodos , Sistemas Automatizados de Assistência Junto ao Leito , Cardiomiopatia de Takotsubo/complicações , Tromboembolia/diagnóstico , Aorta Abdominal , Diagnóstico Diferencial , Feminino , Humanos , Artéria Ilíaca , Pessoa de Meia-Idade , Cardiomiopatia de Takotsubo/diagnóstico , Tromboembolia/etiologia , Tomografia Computadorizada por Raios XRESUMO
Central sleep apnea is common in patients with advanced heart failure. Apneic episodes are associated with hypoxemia, hypercapnia, and neurohumoral activation resulting in a rise in pulmonary vascular resistance. This case report describes a patient with a left ventricular assist device implanted for severe heart failure in whom unrecognized central sleep apnea resulted in under-filling of the left ventricle and a reduction in left ventricular assist device inflow.
Assuntos
Falha de Equipamento , Coração Auxiliar/efeitos adversos , Apneia do Sono Tipo Central/diagnóstico , Disfunção Ventricular Esquerda/diagnóstico , Disfunção Ventricular Esquerda/cirurgia , Adulto , Seguimentos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/cirurgia , Humanos , Masculino , Medição de Risco , Índice de Gravidade de Doença , Apneia do Sono Tipo Central/complicações , Resultado do Tratamento , Resistência Vascular/fisiologia , Disfunção Ventricular Esquerda/complicaçõesRESUMO
IMPORTANCE OF THE FIELD: Prognosis after cardiac transplantation continues to improve with long-term outcomes limited by malignancy and coronary allograft vasculopathy (CAV). Everolimus may potentially reduce these late term complications, while maintaining the low cellular rejection rates seen with standard therapy. AREAS COVERED IN THIS REVIEW: Multiple studies have demonstrated the efficacy of everolimus in reducing acute rejection in heart transplant patients, progression and development of CAV, and the prevention and treatment of common malignancies, including skin cancer and Kaposi sarcoma. This review re-examines these studies with a focus on patient tolerability and safety. WHAT THE READER WILL GAIN: Tolerability and safety of everolimus remain a concern with pneumonitis, effusions, mouth ulcers, edema and impaired wound healing associated with morbidity and mortality. Studies have repeatedly demonstrated renal function deterioration with concomitant everolimus and a standard dose calcineurin inhibitor (CNI). This impact can be partly reduced with CNI dose reduction without an increase in the rate of rejection. TAKE HOME MESSAGE: If future studies confirm reduced CAV and malignancy rates, everolimus will become an important agent in de novo and maintenance immunotherapy in cardiac transplantation. Patient centered immunotherapy is preferred to protocol-based immunotherapy as it allows tailoring of immune therapy to each individual patient's rejection risk and side profile.