RESUMO
Coronary angioplasty in patients with a right-sided heart may be difficult due to challenges in engaging the coronary arteries, interpreting angiogram, and further delivering intracoronary therapies. We present our experience of percutaneous coronary intervention in two cases and propose a practical algorithm to approach cardiac catheterization in these patients.
Assuntos
Angioplastia Coronária com Balão , Dextrocardia , Intervenção Coronária Percutânea , Humanos , Resultado do Tratamento , Intervenção Coronária Percutânea/efeitos adversos , Angiografia CoronáriaRESUMO
Although pregnancy is generally contraindicated in advanced heart failure (AHF), successful pregnancies have been observed in patients with left ventricular assist devices (LVADs). The number of pregnancies in patients with LVADs is increasing, yet optimal management strategies remain undefined. Additionally, no successful pregnancies have been reported with the HeartMate 3 (HM3) (Abbott) LVAD. A systematic review of pregnancy in patients with LVADs was prepared utilizing 3 major scientific databases. We also present the first reported case of successful pregnancy and delivery in a patient supported by an HM3 LVAD. The systematic search yielded 95 results. After filtering to include only relevant citations, eight unique cases were identified. Cases were compared on the basis of several clinical factors. Although pregnancies supported by LVADs are medically complex, several cases of successful deliveries have been observed. Clinical management between cases, however, did vary significantly. Several areas requiring further study were identified.
Assuntos
Insuficiência Cardíaca , Coração Auxiliar , Humanos , Gravidez , Feminino , Insuficiência Cardíaca/terapiaRESUMO
Older women with cardiovascular disease experience lower referral, participation, and completion rates of cardiac rehabilitation (CR), despite its well-established benefits (improved morbidity, mortality, quality of life, and functional capacity). Multiple social and health care system barriers affect participation of this population, including limitations in accessibility and transportation, competing responsibilities as caregivers, and lack of insight among patients and provider regarding the value of CR. With continued advances in technology and the ubiquity of smartphones, alternative CR programs may be able to better overcome barriers that affect older women.