RESUMO
UNLABELLED: The mortality of cardiogenic shock (CS) after an acute myocardial infarction (AMI) still remains high. Thrombolysis, PTCA or CABG, when possible, can improve the results, but when all the treatments fail death is almost certain. OBJECTIVE: We investigate the use of the mechanical circulatory assistance (MCA) and heart transplantation (HT) to improve the adverse results in this irreversible situation. METHODS: Among 11 patients with irreversible CS after an AMI we used a MCA (Abiomed BVS-5000). After improvement and hemodynamic stabilization, we performed heart transplantation in 7 patients of mean age 52 years (35-60) including two women. The MCA was univentricular in 7 patients and biventricular in 4. Mean duration of the MCA was 5 days (1-12). RESULTS: Three patients died during the MCA: two due to cerebrovascular accidents and one multiorgan failure. Weaning was possible in one patient. Among Seven transplanted patients one died due to sepsis. Seven (64%) patients are long-term survivors. CONCLUSION: When all the treatments have failed for CS after an AMI, MCA may be used as a bridge to heart transplantation in a select group of patients where the procedure is not contraindicated. The long-term results of 64% survivors in our experience is satisfactory.
Assuntos
Transplante de Coração/fisiologia , Coração Auxiliar , Infarto do Miocárdio/complicações , Choque Cardiogênico/terapia , Adulto , Feminino , Transplante de Coração/mortalidade , Humanos , Masculino , Pessoa de Meia-Idade , Choque Cardiogênico/cirurgia , Análise de SobrevidaAssuntos
Aorta Torácica/cirurgia , Aorta Torácica/transplante , Transplante de Coração/métodos , Doadores de Tecidos , Adolescente , Adulto , Idoso , Aorta Torácica/anatomia & histologia , Cardiomiopatia Dilatada/cirurgia , Doença das Coronárias/cirurgia , Feminino , Humanos , Masculino , Pessoa de Meia-IdadeRESUMO
From July 1991 to September 1992 the authors treated twenty-eight patients with proven adult respiratory distress syndrome (ARDS). In this paper five patients with ARDS accompanying septicaemia are presented. In this group of patients, elevated pulmonary artery pressure or pulmonary hypertension (PAH) could not have been caused by LV failure, as it was possible in remaining twenty-three patients with ARDS after open heart surgery, so the effect of prostaglandin E1 (PGE1) on pulmonary hypertension could be followed accurately. Moreover, ARDS after septicaemia carries the worst prognosis. All patients were admitted from other hospitals, they were intubated and mechanically ventilated. ARDS was diagnosed 4 to 7 days after the primary injury.
Assuntos
Síndrome do Desconforto Respiratório/terapia , Humanos , Síndrome do Desconforto Respiratório/diagnóstico , Síndrome do Desconforto Respiratório/etiologiaRESUMO
The presence of an iron-containing complex (FSC, ferric sorbitol citrate) in medium inhibited proliferation of malignant (KB. GHC) cells: but did not appreciably alter the proliferation of normal (HBS, Vero) cells. Flow cytometric analysis showed considerable differences of malignant and normal cell growth kinetics. With addition of 200 microM Fe in FSC, malignant cell proliferation was suppressed. An increased number of cells in G1 and early S phase suggested that iron excess blocked the cell cycle before beginning of DNA synthesis.