RESUMO
Low-output syndrome is one of the leading causes of death following open-heart surgery or high-risk angioplasty. Ventricular assist devices have been used to treat patients who suffer from postoperative cardiogenic shock despite use of an intraaortic balloon pump and maximum inotropic support. The Impella pump (Impella Cardiosystems AG, Aachen, Germany) is a newly introduced left ventricular assist device that has been shown to reduce infarct size and to accelerate recovery of stunned myocardium. We report our initial experience using the Impella device for the treatment of cardiogenic shock following cardiopulmonary bypass and for maintaining hemodynamic stability in high-surgical-risk patients undergoing unprotected left coronary artery angioplasty.
Assuntos
Baixo Débito Cardíaco/cirurgia , Coração Auxiliar , Choque Cardiogênico/cirurgia , Volume Sistólico , Idoso , Idoso de 80 Anos ou mais , Angioplastia , Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Vasos Coronários/cirurgia , Feminino , Ventrículos do Coração , Humanos , Masculino , Pessoa de Meia-Idade , Infarto do Miocárdio/cirurgia , Desenho de Prótese , Choque Cardiogênico/etiologiaRESUMO
Q fever is characterized by its clinical polymorphism. Cardiac involvement in acute Q fever is rare. We report a case of pleuro-pericarditis that rapidly evolved to pericardial constriction during an acute episode of Coxiella burnetii infection. Constrictive pericarditis was confirmed by hemodynamic measurements, echocardiography, and magnetic resonance. Indirect immunofluorescence assay revealed positive serology for acute Q fever. The patient underwent a successful pericardiectomy and was given antibiotics. The histopathologic study of the excised pericardium showed C. burnetii in a large cluster of organisms. After a 6-month follow-up period, the individual was asymptomatic.
Assuntos
Pericardite Constritiva/etiologia , Febre Q/complicações , Anticorpos Antibacterianos/análise , Cateterismo Cardíaco , Terapia Combinada , Coxiella burnetii/imunologia , Coxiella burnetii/isolamento & purificação , Doxiciclina/uso terapêutico , Humanos , Imunoglobulina G/análise , Imunoglobulina M/análise , Imageamento por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Pericardiectomia , Pericardite Constritiva/diagnóstico por imagem , Pericardite Constritiva/tratamento farmacológico , Pericardite Constritiva/patologia , Pericardite Constritiva/cirurgia , Pericárdio/imunologia , Pericárdio/microbiologia , Derrame Pleural/etiologia , Derrame Pleural/imunologia , Febre Q/diagnóstico , Febre Q/tratamento farmacológico , UltrassonografiaRESUMO
PURPOSE: To report endovascular repair of dual aneurysms in a patient with Behçet's disease. CASE REPORT: A 37-year-old man diagnosed 6 months prior with Behçet's disease presented with a pulsating abdominal mass. Computed tomography revealed a 70-mm-diameter pseudoaneurysm in the abdominal aorta and another (20 mm) in the celiac trunk 5 mm from the aorta. Staged endovascular repair began with the aortic aneurysm, which was excluded with a bifurcated 23 x 140-mm Excluder stent-graft. Three days later, 2 Jostent stent-grafts were placed in the celiac trunk, successfully excluding the lesion. Fifteen days later, the patient was discharged on a regimen of clopidogrel, cyclosporine, and warfarin. At 6 months, the CT scan showed good perfusion of the stent-grafts. CONCLUSIONS: Aneurysmal involvement of the celiac trunk in a patient with Behçet's disease is a rare pathology that appears amenable to stent-graft repair.