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1.
Clin Med Insights Circ Respir Pulm Med ; 14: 1179548420957451, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32952405

RESUMEN

BACKGROUND: Novel coronavirus 2019 (COVID-19) has been the focus of the medical world since being declared a pandemic in March 2020. While the pathogenesis and heterogeneity of COVID-19 manifestations is still not fully understood, viral evasion of cellular immune responses and inflammatory dysregulation are believed to play essential roles in disease progression and severity. CASE PRESENTATION: We present the first case of a patient with COVID-19 with massive pulmonary embolism treated successfully with systemic thrombolysis, VA-ECLS, and bail out catheter directed thrombolysis. He was discharged from the hospital after an eventful hospital course on therapeutic anticoagulation with warfarin. CONCLUSIONS: We present the first case of a patient with COVID-19 with massive pulmonary embolism (PE) treated successfully with systemic thrombolysis, VA-ECLS and bail out catheter directed thrombolysis. In our experience catheter directed thrombolysis comes with an acceptable bleeding risk despite use of mechanical circulatory support, particularly with meticulous attention to vascular access and dose response monitoring.

2.
Ann Transplant ; 16(1): 5-13, 2011.
Artículo en Inglés | MEDLINE | ID: mdl-21436768

RESUMEN

BACKGROUND: Obesity is a risk factor for heart failure (HF) and associated with poor outcomes after cardiac transplantation. We assessed change in total body weight, morbidity and mortality in obese heart failure patients after implantation of a left ventricular assist device (LVAD) compared to medical management. MATERIAL/METHODS: Nineteen patients (9 females, age 51.3 ± 10 years) with a body mass index (BMI) ≥ 30.0 kg/m² and advanced HF (NYHA class III-IV, stage D) were evaluated. Thirteen (group 1) received insertion of a LVAD as bridge to transplantation. The remaining patients (group 2) were medically managed. All were advised on lifestyle modification. RESULTS: At baseline, group 1 (49.1 ± 10.7 years) had a total body weight (BW) of 246.6 ± 34.9 pounds (mean ± SD) and a BMI of 36.1 ± 4 kg/m². Group 2 (56 ± 6.7 yrs) had a BW of 238.8 ± 73.6 pounds and a BMI of 39.1 ± 9.3 kg/m2 (n.s. compared to group 1). All patients were alive at 12 months. At 6 months, BW in group 1 was reduced to 216.3 ± 20.8 pounds, and BMI to 31.8 ± 3.3 kg/m² (p < 0.05). At 6 months, BW in group 2 was 238.2 ± 84.6 pounds, and BMI was 39.1 ± 11.6 kg/m² (n.s. vs. baseline, p < 0.05 compared to group 1). The decrease in BW in group 1 was 12.3 ± 12% (30.3 ± 28.5 pounds). There was no change in BW in group 2 (0.3 ± 8.7%, 0.6 ± 21 pounds, p < 0.05 vs. group 1). At 12 months, 7 patients in group 1 (54%) underwent cardiac transplantation. CONCLUSIONS: LVAD insertion resulted in weight loss in obese patients not considered for heart transplantation compared to medically managed patients.


Asunto(s)
Insuficiencia Cardíaca/complicaciones , Insuficiencia Cardíaca/cirugía , Trasplante de Corazón , Corazón Auxiliar , Obesidad/complicaciones , Adulto , Anciano , Índice de Masa Corporal , Gasto Cardíaco , Contraindicaciones , Ingestión de Energía , Metabolismo Energético , Femenino , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Persona de Mediana Edad , Obesidad/patología , Factores de Riesgo , Resultado del Tratamiento , Pérdida de Peso
3.
J Relig Health ; 50(4): 872-9, 2011 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-20191322

RESUMEN

Deciding who should receive maximal technological treatment options and who should not represents an ethical, moral, psychological and medico-legal challenge for health care providers. Especially in patients with chronic heart failure, the ethical and medico-legal issues associated with providing maximal possible care or withholding the same are coming to the forefront. Procedures, such as cardiac transplantation, have strict criteria for adequate candidacy. These criteria for subsequent listing are based on clinical outcome data but also reflect the reality of organ shortage. Lack of compliance and non-adherence to lifestyle changes represent relative contraindications to heart transplant candidacy. Mechanical circulatory support therapy using ventricular assist devices is becoming a more prominent therapeutic option for patients with end-stage heart failure who are not candidates for transplantation, which also requires strict criteria to enable beneficial outcome for the patient. Physicians need to critically reflect that in many cases, the patient's best interest might not always mean pursuing maximal technological options available. This article reflects on the multitude of critical issues that health care providers have to face while caring for patients with end-stage heart failure.


Asunto(s)
Reanimación Cardiopulmonar/ética , Insuficiencia Cardíaca/terapia , Trasplante de Corazón/ética , Corazón Auxiliar/ética , Rol del Enfermo/ética , Reanimación Cardiopulmonar/psicología , Manejo de la Enfermedad , Humanos , Selección de Paciente , Calidad de Vida
4.
Ann Thorac Surg ; 90(5): 1630-6, 2010 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-20971278

RESUMEN

BACKGROUND: Gastroesophageal reflux and aspiration contribute to the development of bronchiolitis obliterans and accelerate graft deterioration after lung transplantation (LTx). We evaluated LTx candidates for esophageal motor abnormalities and gastroesophageal reflux. METHODS: Consecutive patients evaluated for LTx underwent 24-hour pH monitoring using a dual-channel pH probe and high-resolution esophageal manometry. High-resolution manometry was also performed in healthy control subjects. The prevalence of abnormal acid exposure was noted in the LTx candidates. RESULTS: Thirty LTx candidates and 10 control subjects were evaluated. Lung transplantation candidates had higher residual upper and lower esophageal sphincter pressures. The mean proportion of peristaltic swallows was 21% lower in LTx candidates. Both hypotensive and aperistaltic swallows were sixfold more prevalent in LTx candidates than in control subjects. All control subjects had normal high-resolution manometry whereas 23 LTx candidates (76.7%) had esophageal peristaltic dysfunction. Abnormal acid exposure time was seen in the proximal and distal esophagus in 25% and 36% of LTx candidates, respectively. Lung transplantation candidates with idiopathic pulmonary fibrosis had more aperistaltic contractions, more negative minimum intrathoracic pressure, and a higher frequency of abnormal distal esophagus acid exposure. The majority of patients with complications after LTx demonstrated motor, anatomic, or pH abnormalities. CONCLUSIONS: Disordered esophageal motor function and gastroesophageal reflux are common in LTx candidates. We believe high-resolution esophageal manometry is a valid tool to use and the abnormalities we identified may be representative of this unique patient population. The role of this study in predicting a worse outcome should be further studied in patients after LTx.


Asunto(s)
Trastornos de la Motilidad Esofágica/epidemiología , Reflujo Gastroesofágico/epidemiología , Trasplante de Pulmón/efectos adversos , Adulto , Anciano , Estudios de Casos y Controles , Esfínter Esofágico Inferior/fisiopatología , Esfínter Esofágico Superior/fisiopatología , Femenino , Humanos , Concentración de Iones de Hidrógeno , Masculino , Manometría , Persona de Mediana Edad
6.
Interact Cardiovasc Thorac Surg ; 9(5): 888-90, 2009 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-19720659

RESUMEN

We present a case report of a ruptured sinus of Valsalva aneurysm (SVA) that presented as aortic insufficiency following bacterial endocarditits in a cardiac transplant patient. Cardiac computed tomographic angiography (CCTA) including volume rendered images predicted the appearance of the fistula entrance and defined spatial relationships facilitating the surgical approach. CCTA ability to define the coronary anatomy obviated the need for invasive coronary angiography. The use of this imaging modality especially with three-dimensional spatial visualization, and multiphase cine angiography can add significant value to the care of a patient with ruptured sinus of Valsalva.


Asunto(s)
Aneurisma Falso/diagnóstico por imagen , Aneurisma de la Aorta/diagnóstico por imagen , Rotura de la Aorta/diagnóstico por imagen , Cateterismo Cardíaco , Cineangiografía , Angiografía Coronaria/métodos , Seno Aórtico/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Aneurisma Falso/etiología , Aneurisma Falso/cirugía , Aneurisma de la Aorta/etiología , Aneurisma de la Aorta/cirugía , Rotura de la Aorta/etiología , Rotura de la Aorta/cirugía , Insuficiencia de la Válvula Aórtica/diagnóstico por imagen , Insuficiencia de la Válvula Aórtica/etiología , Bioprótesis , Endocarditis Bacteriana/complicaciones , Endocarditis Bacteriana/diagnóstico por imagen , Cardiopatías/diagnóstico por imagen , Cardiopatías/etiología , Prótesis Valvulares Cardíacas , Implantación de Prótesis de Válvulas Cardíacas/instrumentación , Ventrículos Cardíacos/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Pericardio/trasplante , Valor Predictivo de las Pruebas , Seno Aórtico/cirugía , Resultado del Tratamiento , Fístula Vascular/diagnóstico por imagen , Fístula Vascular/etiología
7.
Eur J Cardiothorac Surg ; 34(4): 918-9, 2008 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-18678506

RESUMEN

We present the case of a man who underwent successful heart transplantation with an allograft that was obtained from a donor who had already received heart transplantation.


Asunto(s)
Trasplante de Corazón/métodos , Recolección de Tejidos y Órganos/métodos , Adulto , Muerte Encefálica , Hemorragia Cerebral/etiología , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias , Donantes de Tejidos
8.
Transplantation ; 81(6): 862-5, 2006 Mar 27.
Artículo en Inglés | MEDLINE | ID: mdl-16570009

RESUMEN

BACKGROUND: Controversy exists regarding the optimal use of bilateral lung transplant (BLT) in older recipients in diseases where either single or bilateral transplant is appropriate. International Society for Heart and Lung Transplant (ISHLT) guidelines suggest an upper age limit of 60 for BLT, despite limited data regarding outcomes with BLT in patients over 60. We hypothesize that BLT offers comparable, if not superior, clinical outcomes to SLT in all patients independent of recipient age. METHODS: In order to test our hypothesis, we conducted a case-control study to compare the effect of transplant operation on survival and the onset of bronchiolitis obliterans syndrome (BOS) in consecutive lung transplant recipients 61 years of age or older using Kaplan- Meier analysis and Cox proportional hazard models. RESULTS: We identified 107 consecutive lung transplant recipients 61 or older at the time of transplant. Patients received SLT (n=46) or BLT (n=61) based on donor organ availability. Comparable survival was achieved with BLT in older patients vs. SLT P=0.19). One-, two-, and five-year survival estimates in BLT were 82%, 75% and 68%, respectively, vs. in SLT 78%, 70% and 44%, respectively. A comparable onset of BOS was also observed in the patients who received BLT vs. SLT (P=0.23). CONCLUSION: Successful short- and medium-term outcomes are achieved with BLT in older recipients and are comparable to those achieved with SLT. Our results suggest that age over 60 should not exclude patients from consideration of BLT.


Asunto(s)
Trasplante de Pulmón , Factores de Edad , Anciano , Bronquiolitis Obliterante/etiología , Estudios de Casos y Controles , Femenino , Humanos , Trasplante de Pulmón/efectos adversos , Trasplante de Pulmón/mortalidad , Masculino , Persona de Mediana Edad
9.
Interact Cardiovasc Thorac Surg ; 5(3): 202-6, 2006 Jun.
Artículo en Inglés | MEDLINE | ID: mdl-17670548

RESUMEN

Microwave energy allows thoracoscopic beating-heart ablation for the treatment of atrial fibrillation. However, there is a paucity of data on the histologic effects of microwave energy on the beating human heart. This study aims to histopathologically characterize microwave lesions on the beating human atrium. Microwave energy was applied prior to cardiectomy on the beating native right atrium in eight patients undergoing heart transplantation and as a circumferential left atrial 'box' lesion in one patient undergoing heart-lung transplantation. Lesions were applied following heparinization and cannulation, but before initiation of cardiopulmonary bypass. Following cardiectomy, specimens were resected, fixed and subjected to histologic preparation. Grossly, all atrial lesions were 'comma-shaped' with an area of maximum injury on the surface. Microscopically, myocyte injury manifested as acute coagulation necrosis with hypereosinophilic myocytes with both nuclear loss and pyknosis. Contraction bands were noted at the periphery of lesions. The injury was transmural in all right atrial lesions. The left atrial sample contained a circumferential lesion ranging from 0.1 to 0.8 cm in width. The cut edge demonstrated lesion depths of 0.2-0.6 cm, maximum (transmural) in the inferior margin. Microwave ablation represents an acceptable energy source to create characteristic lesions on the beating human atrium.

10.
Ann Thorac Surg ; 80(2): 717-9, 2005 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-16039240

RESUMEN

Doxorubicin-induced cardiomyopathy is not uncommon and may progress to end-stage heart failure. Treatment of this condition with heart transplantation, however, requires that the primary malignancy be deemed "cured." We present the case of a 55- year-old woman who had doxorubicin-induced cardiomyopathy and non-Hodgkin's lymphoma. The active status of her lymphoma precluded heart transplantation. She had end-stage heart failure and underwent the insertion of a left ventricular assist device as a destination therapy.


Asunto(s)
Antibióticos Antineoplásicos/efectos adversos , Cardiomiopatías/inducido químicamente , Doxorrubicina/efectos adversos , Insuficiencia Cardíaca/cirugía , Corazón Auxiliar , Cardiomiopatías/cirugía , Femenino , Insuficiencia Cardíaca/inducido químicamente , Humanos , Linfoma no Hodgkin/tratamiento farmacológico , Persona de Mediana Edad
12.
Crit Care Med ; 31(9): 2324-31, 2003 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-14501963

RESUMEN

OBJECTIVE: To determine whether near infrared spectroscopic measurement of tissue pH and Po2 has sufficient accuracy to assess variation in tissue perfusion resulting from changes in blood pressure and metabolic demand during cardiopulmonary bypass. DESIGN: Prospective clinical study. SETTING: Academic medical center. SUBJECTS: Eighteen elective cardiac surgical patients. INTERVENTION: Cardiac surgery under cardiopulmonary bypass. MEASUREMENTS AND MAIN RESULTS: A near infrared spectroscopic fiber optic probe was placed over the hypothenar eminence. Reference Po2 and pH sensors were inserted in the abductor digiti minimi (V). Data were collected every 30 secs during surgery and for 6 hrs following cardiopulmonary bypass. Calibration equations developed from one third of the data were used with the remaining data to investigate sensitivity of the near infrared spectroscopic measurement to physiologic changes resulting from cardiopulmonary bypass. Near infrared spectroscopic and reference pH and Po2 measurements were compared for each subject using standard error of prediction. Near infrared spectroscopic pH and Po2 at baseline were compared with values during cardiopulmonary bypass just before rewarming commenced (hypotensive, hypothermic), after rewarming (hypotensive, normothermic) just before discontinuation of cardiopulmonary bypass, and at 6 hrs following cardiopulmonary bypass (normotensive, normothermic) using mixed-model analysis of variance. Near infrared spectroscopic pH and Po2 were well correlated with the invasive measurement of pH (R2 =.84) and Po2 (R 2 =.66) with an average standard error of prediction of 0.022 +/- 0.008 pH units and 6 +/- 3 mm Hg, respectively. The average difference between the invasive and near infrared spectroscopic measurement was near zero for both the pH and Po2 measurements. Near infrared spectroscopic Po2 significantly decreased 50% on initiation of cardiopulmonary bypass and remained depressed throughout the bypass and monitored intensive care period. Near infrared spectroscopic pH decreased significantly during cardiopulmonary bypass, decreased significantly during rewarming, and remained depressed 6 hrs after cardiopulmonary bypass. Diabetic patients responded differently than nondiabetic subjects to cardiopulmonary bypass, with lower muscle pH values (p =.02). CONCLUSIONS: Near infrared spectroscopic-measured muscle pH and Po2 are sensitive to changes in tissue perfusion during cardiopulmonary bypass.


Asunto(s)
Dióxido de Carbono , Puente Cardiopulmonar/métodos , Concentración de Iones de Hidrógeno , Monitoreo Intraoperatorio/métodos , Músculo Esquelético/metabolismo , Espectroscopía Infrarroja Corta , Anciano , Puente de Arteria Coronaria/métodos , Enfermedad Coronaria/cirugía , Femenino , Humanos , Masculino , Persona de Mediana Edad , Consumo de Oxígeno/fisiología , Periodo Posoperatorio , Valor Predictivo de las Pruebas , Estudios Prospectivos , Sensibilidad y Especificidad
13.
Ann Thorac Surg ; 75(5): 1635-7, 2003 May.
Artículo en Inglés | MEDLINE | ID: mdl-12735596

RESUMEN

Splenic abscess is a rare clinical entity that is most commonly associated with infective endocarditis. Valve replacement in the setting of an unaddressed splenic abscess is associated with a high incidence of prosthetic valve infection and death. We describe 2 patients with infective endocarditis and splenic abscess treated by laparoscopic splenectomy followed by valve replacement.


Asunto(s)
Absceso/cirugía , Endocarditis Bacteriana/cirugía , Implantación de Prótesis de Válvulas Cardíacas , Laparoscopía , Esplenectomía , Enfermedades del Bazo/cirugía , Absceso/complicaciones , Adulto , Anciano , Humanos , Masculino , Enfermedades del Bazo/complicaciones
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