RESUMEN
BACKGROUND: Displacement of Impella 5.0 secondary to patient movement or transportation is a well-known complication. Typically, repositioning of an Impella across the aortic valve is attempted over a guidewire. We present the first case, to our knowledge, of repositioning a dislodged Impella 5.0 without a guidewire under transesophageal echocardiography (TEE) guidance, by inducing rapid ventricular pacing to cross the aortic valve. CASE PRESENTATION: A 70-year-old man with low left ventricular ejection fraction underwent off-pump coronary artery bypass grafting. On 2nd postoperative day a low cardiac output state developed with increasing lactate levels and consequently the patient was taken to the cardiac catheterization laboratory for insertion of an Impella 5.0. Suddenly the Impella system failed with a rapid hemodynamic deterioration and it was successfully bedside repositioned inducing rapid ventricular pacing. CONCLUSIONS: In case of accidental Impella dislodgement and fast deterioration of the patient's hemodynamic status, rapid pacing may be an option to "open" the aortic valve thus aiding quick replacement of Impella 5.0 through the aortic valve into the left ventricle under TEE guidance.
Asunto(s)
Válvula Aórtica/cirugía , Estimulación Cardíaca Artificial/métodos , Corazón Auxiliar/efectos adversos , Falla de Prótesis , Implantación de Prótesis/métodos , Cirugía Asistida por Computador/métodos , Anciano , Puente de Arteria Coronaria Off-Pump , Ecocardiografía Transesofágica , Ventrículos Cardíacos/cirugía , Hemodinámica , Humanos , Masculino , ReoperaciónRESUMEN
An ontology-supported e-knowledge base aimed to the evaluation of obesity and related co-morbidities is presented. The main goal of such a clinical profiling tool is to help determine the health status of a subject, supporting the knowledge transfer between medical researchers and general practitioners.
