ABSTRACT
Prophylactic use of an intraaortic balloon pump (IABP) prior to open-heart surgery in patients with impaired left ventricular function is still under debate. Patients with left ventricular ejection fraction (LVEF) < 40% were therefore compared according to time of IABP placement, viz. preoperative (n = 56), intraoperative (n = 40) or postoperative (n = 17), and also with patients who did not receive mechanical support despite LVEF < 40% (n = 78). The main indication for preoperative IABP insertion was severely impaired left ventricular function (80%), while patients with intraoperative or postoperative IABP placement mainly presented with low cardiac-output syndrome (70%/53%). Preoperative IABP was associated with a low mortality rate (8.9%), whereas patients with intraoperative or postoperative IABP placement had a high mortality risk and an increased catecholamine requirement. Of the patients scheduled for surgery without prophylactic IABP, 19% required intra- or postoperative insertion. Prophylactic placement of IABP thus reduced the mortality rate as well as the postoperative need for mechanical and catecholamine support. Need for intraoperative IABP insertion was associated with high mortality, whereas the outcome after postoperative IABP placement depended on the indication for the measure.
Subject(s)
Intra-Aortic Balloon Pumping , Ventricular Dysfunction, Left/therapy , Aged , Cardiac Output, Low/physiopathology , Cardiac Output, Low/therapy , Cardiac Surgical Procedures/mortality , Catecholamines/therapeutic use , Female , Humans , Intraoperative Period , Male , Middle Aged , Postoperative Care , Preoperative Care , Retrospective Studies , Risk Factors , Stroke Volume , Survival Rate , Ventricular Dysfunction, Left/physiopathologyABSTRACT
Hardware-related complications in implantable cardioverter/defibrillators (ICD) are still a common problem. Identifying underlying reasons becomes more and more difficult as the complexity of ICD systems increases. We report a patient with a dual chamber ICD (DDD-ICD) who suffered multiple complications. These included: ventricular oversensing causing inappropriate shocks and episodes of asystole; an insulation defect resulting in ineffective shocks as a consequence of a short circuit between the active can device and a defective high voltage cable; and device dysfunction requiring several hospitalizations and operative system revisions.
Subject(s)
Defibrillators, Implantable/adverse effects , Aged , Heart Arrest/therapy , Humans , Male , ReoperationABSTRACT
Implantable left-ventricular assist devices have been remarkably free of mechanical failures. We describe an uncommon Novacor N100 PCq LVAS malfunction caused by an internal short circuit of the device due to urine aspiration via the vent line. Device replacement was managed via a subcostal approach without sternotomy. Patient recovery was uneventful and successful transplantation was performed one month after the device exchange.
Subject(s)
Equipment Failure , Heart-Assist Devices/adverse effects , Prosthesis Implantation/methods , Shock, Cardiogenic/therapy , Adult , Cardiomyopathy, Dilated/complications , Cardiomyopathy, Dilated/therapy , Equipment Safety , Follow-Up Studies , Humans , Male , Reoperation , Shock, Cardiogenic/etiology , Sternum/surgerySubject(s)
Heart Transplantation , Heart-Assist Devices , Equipment Design , Fatal Outcome , Humans , Infant , Infant, Newborn , Treatment OutcomeABSTRACT
This study investigated the influence of chronic oral nifedipine on the hemodynamic effects of halothane or isoflurane anesthesia in dogs. Under general anesthesia with fentanyl 0.3 microgram/kg/min i.v. and 3:1 N2O/O2 inhalation mixture a left thoracotomy was performed and two needle force probes were placed in the left ventricular wall to measure myocardial force of contraction. In the halothane group (n = 12) a Hall-effect sensor was placed on the anterior surface of the left ventricle, which in combination with a magnet on the posterior surface allowed measurements of left ventricular diameter. In the isoflurane group (n = 15) a Widney gauge was placed around the left ventricle to measure left ventricular circumference changes. The dogs were also monitored with left ventricular tip manometers, pulmonary arterial thermodilution catheters, and femoral arterial and venous catheters. Prior to surgery, in the halothane group 6 dogs were pretreated with nifedipine 6 mg/kg p.o. for 10 days; the other 6 served as controls. In the isoflurane group, 8 dogs were pretreated with nifedipine in the same way and 7 served as controls. Three hours after instrumentation baseline hemodynamic measurements were performed and repeated 15 min after adding 1 MAC and then 2 MAC halothane or isoflurane. Oral pretreatment with nifedipine caused vasodilation with a significant decrease in systemic vascular resistance (SVR) and mean arterial pressure (MAP); heart rate (HR) and dp/dt max were unchanged in comparison to the control group. The cardiac output (CO) increased. Halothane (1 MAC/2 MAC) had a dose-related circulatory depressant effect. This occurred to the same extent in both groups.(ABSTRACT TRUNCATED AT 250 WORDS)