ABSTRACT
Acquired muscular ventricular septal defects (MVSD) after myocardial infarction (MI) can lead to right heart failure and cardiogenic shock with high mortality. Early surgical therapy is often difficult to perform but can reduce the mortality. The closure of congenital septal defects is performed with high safety. Therefore, the interventional closure of an acquired post-MI VSD might be feasible and of potential benefit. To date, experiences with closure of post-MI MVSDs are minimal. We report on two patients with post-MI VSD.
Subject(s)
Cardiac Catheterization , Cardiomyopathies/etiology , Embolization, Therapeutic , Heart Septum , Myocardial Infarction/complications , Aged , Embolization, Therapeutic/instrumentation , Embolization, Therapeutic/methods , Equipment Design , Female , Humans , Prostheses and ImplantsABSTRACT
Heparin-induced thrombocytopenia type II (HIT type II) is the most serious complication of heparin treatment apart from bleeding, which is the most common side effect. Eleven days after coronary bypass grafting, a 71 year old patient showed a posterolateral myocardial infarction and a thrombocytopenia of 80,000/microliter. This was considered a postoperative thrombocytopenia. Coronary angiography revealed closed venous bypass grafts. The right coronary artery (RCA) was revascularized by percutaneous transluminal coronary angioplasty (PTCA) and stent placement. During both coronary angiography and PTCA, heparin was administered to the patient. The platelet number did not change. Four days later the patient showed an inferior myocardial infarction and an AV-block III degrees and a syncope. The following coronary angiography revealed RCA stent occlusion. HIT type II was presumed and recanalization was carried out using Lepirudin (Refludan) as the anticoagulant. After placing the guide wire, thrombi could be seen in the proximal RCA. Abciximab (Reo pro), a monoclonal antibody against the glycoprotein IIb/IIIa receptor was additionally administered. Coronary angiography on the next day revealed only a small remaining thrombus. The AV-block disappeared immediately after revascularization. The diagnosis of HIT type II was confirmed through heparin-induced-platelet-activation-test (Hipa-test) and immunoassay (PF 4/heparin-ELISA). This case report illustrates the complicated diagnosis of HIT type II and the successful simultaneous use of Lepirudin (Refludan) and Abciximab (Reo pro). The number of platelets should be checked daily during heparin treatment. In the case of a thrombocytopenia, the treatment should be stopped immediately, and Hipa-test and PF 4/heparin-ELISA should be carried out.
Subject(s)
Antibodies, Monoclonal/therapeutic use , Coronary Artery Bypass/adverse effects , Heparin/adverse effects , Hirudins/analogs & derivatives , Immunoglobulin Fab Fragments/therapeutic use , Thrombocytopenia/diagnosis , Thrombocytopenia/drug therapy , Abciximab , Aged , Angioplasty, Balloon, Coronary/methods , Heparin/pharmacology , Heparin/therapeutic use , Hirudin Therapy , Humans , Male , Myocardial Infarction/chemically induced , Myocardial Infarction/diagnosis , Myocardial Infarction/drug therapy , Postoperative Complications/drug therapy , Recombinant Proteins/therapeutic use , Stents/adverse effects , Thrombocytopenia/chemically induced , Thrombosis/chemically induced , Thrombosis/diagnosis , Thrombosis/drug therapyABSTRACT
Two patients with large left ventricular false aneurysms due to CABG-occlusion, myocardial infarction, and ventricular free wall rupture are reported. Colorflow cardiac Doppler showing blood flow at the site of the perforation and in the false aneurysm revealed the diagnosis noninvasively. Because of the high incidence of rupture of false aneurysms, surgical management is essential.
