RESUMO
The new percutaneous Impella CP (Cardiac Power; Abiomed, Inc., Danvers, MA) was designed to provide a higher level of support than Impella 2.5 (Abiomed, Inc.). We present the first documented case of a patient that was transitioned from the Impella 2.5 to Impella CP. A 48-year-old male patient with no medical history was transferred to our institution with a one day history of worsening shortness of breath. The patient was unstable and found to have monomorphic ventricular tachycardia at 220 beats/min that was cardioverted to normal sinus rhythm. An emergent right and left heart catheterization was performed showing nonobstructive coronary artery disease, biventricular failure with a left ventricular ejection fraction (LVEF) of 5 to 10%, high pulmonary capillary wedge pressure (PCWP) 22 mm Hg, right atrial (RA) pressure 22 mm Hg, and a very low cardiac index of 1.0 L/min/m2. Because of severe cardiogenic shock, Impella 2.5 was inserted providing flow up to 2.1 L/min; however, the patient remained unstable and critically ill with severe multiorgan failure. To provide better mechanical support, the device was upgraded to the new Impella CP that can provide up to 3.5 L/min of cardiac output. Over the course of the next 72 hours, the patient showed significant improvement in hemodynamics and cardiac function (LVEF 45%), with recovery of liver function. The Impella CP was removed with no complications. The new Impella CP was shown to be safe and effective for prolonged use in critically ill patients and may significantly improve their prognosis.
RESUMO
The treatment of aortic stenosis (AS) has reached an exciting stage with the introduction of transcatheter aortic valve replacement (TAVR). It is the treatment of choice in patients with severe AS who are considered very high risk for surgical valve replacement. Multimodality imaging (MMI) plays a crucial role in TAVR patient selection, intra-procedure guidance, and follow-up. With the ever-increasing scope for TAVR, a better understanding of MMI is essential to improve outcomes and prevent complications.
Assuntos
Estenose da Valva Aórtica/diagnóstico , Estenose da Valva Aórtica/cirurgia , Imagem Multimodal/métodos , Cirurgia Assistida por Computador/métodos , Substituição da Valva Aórtica Transcateter/métodos , HumanosRESUMO
BACKGROUND: Cell therapy (CTh) is a promising novel therapy for myocardial infarction (MI) and ischemic cardiomyopathy (iCMP). Recognizing adverse events (AE) is important for safety evaluation, harm prevention and may aid in the design of future trials. OBJECTIVE: To define the prevalence of periprocedural AE in CTh trials in MI and iCMP. METHODS: A literature search was conducted using the MEDLINE database from January 1990 to October 2010. Controlled clinical trials that compared CTh with standard treatment in the setting of MI and/or iCMP were selected. AE related to CTh were analyzed. RESULTS: A total of 2,472 patients from 35 trials were included. There were 26 trials including 1,796 patients that used CTh in MI and 9 trials including 676 patients that used CTh in iCMP. Periprocedural arrhythmia monitoring protocols were heterogeneous and follow-up was short in most of the trials. In MI trials, the incidence of periprocedural adverse events (AE) related to intracoronary cell transplantation was 7.5 % (95 % CI 6.04-8.96 %). AE related to granulocyte colony-stimulating factor (GCS-F) used for cell mobilization for peripheral apheresis was 16 % (95 % CI 9.44-22.56 %). During intracoronary transplantation in iCMP, the incidence of periprocedural AE incidence was 2.6 % (95 % CI 0.53-4.67 %). There were no AE reported during transepicardial transplantation and AE were rare during transendocardial transplantation. CONCLUSIONS: The majority of periprocedural AE in CTh trials in MI occurred during intracoronary transplantation and GCS-F administration. In iCMP, periprocedural AE were uncommon. Avoiding intracoronary route for CTh implantation may decrease the burden of periprocedural AE. Standardization of AE definition in CTh trials is needed.
Assuntos
Cardiomiopatias/cirurgia , Terapia Baseada em Transplante de Células e Tecidos/efeitos adversos , Infarto do Miocárdio/cirurgia , Miocárdio/patologia , Complicações Pós-Operatórias/epidemiologia , Regeneração , Cardiomiopatias/patologia , Cardiomiopatias/fisiopatologia , Humanos , Incidência , Infarto do Miocárdio/patologia , Infarto do Miocárdio/fisiopatologia , Razão de Chances , Complicações Pós-Operatórias/diagnóstico , Prevalência , Medição de Risco , Fatores de Risco , Resultado do TratamentoRESUMO
Arrhythmias play a significant role in the mortality and morbidity as well as hospitalizations of patients who carry a diagnosis of congestive heart failure. With improving survival in a world of novel medications and devices, an understanding of the pathophysiology and management of these arrhythmias is crucial. Majority of the basic heart failure medications such as beta- -blockers, angiotensin converting enzyme inhibitors/aldosterone receptor blockers and aldosterone antagonists play a pivotal role in prevention of sudden cardiac deaths which can be a direct/indirect result of these arrhythmias. Anti-arrhythmic drugs and implantable cardioverter-defibrillators were also beneficial in selected patients. Innovative electrophysiological techniques need to be considered in special situations.
Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Antiarrítmicos/uso terapêutico , Arritmias Cardíacas/tratamento farmacológico , Arritmias Cardíacas/etiologia , Medicina Geral , Insuficiência Cardíaca/complicações , Antagonistas de Receptores de Mineralocorticoides/uso terapêutico , Arritmias Cardíacas/fisiopatologia , Arritmias Cardíacas/terapia , Morte Súbita Cardíaca/prevenção & controle , Desfibriladores Implantáveis , Medicina Baseada em Evidências , Humanos , Guias de Prática Clínica como Assunto , Resultado do TratamentoRESUMO
Use of biological glue during cardiovascular surgery is a common practice, rarely associated with immediate or long-term complications. We present a patient with a right atrial mass as a long-term complication associated with the use of biological glue. Surgical exploration revealed the mass to be an unabsorbed and infected aggregate of biological glue used to stop bleeding from a friable right atrium during previous surgery.
Assuntos
Granuloma de Corpo Estranho/diagnóstico , Átrios do Coração/patologia , Hemostasia Cirúrgica/instrumentação , Proteínas/efeitos adversos , Adesivos Teciduais/efeitos adversos , Insuficiência da Valva Tricúspide/etiologia , Idoso de 80 Anos ou mais , Feminino , Granuloma de Corpo Estranho/complicações , Implante de Prótese de Valva Cardíaca , Humanos , Insuficiência da Valva Tricúspide/diagnósticoRESUMO
BACKGROUND: The incidence of Myocardial Infarction (MI) in patients under the age of 30 has been rarely addressed. Moreover, it is not understood why these patients develop symptomatic Coronary Artery Disease (CAD) at such an early age. Traditional risk factor assessment has not been successful in identifying these patients before they present with MI. METHODS: Retrospective, single cohort, observational study of 14,704 cardiac catheterizations performed in a community hospital between January 2006-January 2010 identified 12 cases age <30 with MI secondary to a fixed atherosclerotic lesion requiring angioplasty and stenting. The angiograms and charts were reviewed to assess the incidence and frequency of traditional risk factors such as smoking, dyslipidemia and diabetes and family history. RESULTS: All the patients had single vessel disease. Many of the patients were noted to have traditional CAD risk factors. 2 patients had an intervention and then months later sustained another acute MI secondary to a new culprit lesion despite aggressive risk factor modification. CONCLUSION: Evaluating patients for premature CAD by screening for traditional risk factors has not effectively identified at risk patients prior to presentation with MI. There is a role for studies evaluating new and novel risk factors and imaging modalities so that these patients can be identified prior to experiencing MI.
Assuntos
Doença da Artéria Coronariana/epidemiologia , Adulto , Angioplastia , Doença da Artéria Coronariana/complicações , Doença da Artéria Coronariana/terapia , Feminino , Florida/epidemiologia , Humanos , Masculino , Infarto do Miocárdio/complicações , Estudos Retrospectivos , Fatores de Risco , Stents , Adulto JovemRESUMO
The midterm clinical and functional benefits of percutaneous coronary intervention in patients aged ≥90 years have not been clearly defined. From January 2005 to June 2009, 173 patients aged ≥90 years underwent diagnostic cardiac catheterization, of whom 90 underwent percutaneous coronary intervention. There were 45 men (50%) and 45 women (50%), with a mean age of 92 years (range 90 to 101). Of these, 24 patients (27%) presented with ST-segment elevation myocardial infarction, 31 (34%) with non-ST-segment elevation myocardial infarction, 28 (31%) with unstable angina pectoris, and 2 (2%) with stable angina pectoris; 5 patients (6%) were studied for preoperative risk assessment. A total of 127 lesions were successfully treated using 102 drug-eluting stents and 37 bare-metal stents, with a mean of 1.5 stents per patient. Postprocedural complications included renal insufficiency in 5 patients (5.6%), heart failure in 6 patients (6.7%), and cardiogenic shock in 2 patients (2.2%). Seventy-seven patients (85.6%) experienced no postprocedural complications. In-hospital mortality was 7.8%, and actuarial survival was 61.5 ± 5.2% at 24 months and 31.6 ± 6.1% at 48 months. The SF-36 Health Survey was administered at follow-up, and results demonstrated a quality of life similar to that of the general population corrected for age and gender. In conclusion, this study demonstrates that percutaneous coronary intervention in nonagenarians can be accomplished with low mortality and morbidity and excellent midterm results. Moreover, functional improvement in nonagenarians supports enhanced quality of life comparable to that of the general population.
Assuntos
Angioplastia Coronária com Balão/mortalidade , Qualidade de Vida , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Estudos Retrospectivos , Medição de Risco , Fatores de Risco , Resultado do TratamentoRESUMO
Peripartum myocardial infarction is uncommon but devastating in young women. Although it is generally associated with arterial dissection, pregnancy-induced hypercoagulable state can also be a major contributor. Association of patent foramen ovale (PFO) adds to this potential risk. A 29-year-old postpartum female presented with worsening chest pressure, shortness of breath and syncope. She was hypotensive and tachycardic. A ventilation perfusion imaging displayed high probability for pulmonary emboli. With elevated cardiac enzymes and echocardiogram showing wall motion abnormalities, patient underwent percutaneous coronary angioplasty for a midvessel thrombus in the left anterior descending artery. Further workup showed a thrombus straddling into the left atrium via a PFO and a deep venous thrombus in the right iliac vein. Hormonal changes in pregnancy are noted to place young women in a hypercoagulable state. Screening for PFO in this group of patients with timely intervention might prevent a major systemic event caused by paradoxical embolus.
Assuntos
Embolia Paradoxal/etiologia , Forame Oval Patente/complicações , Infarto do Miocárdio/etiologia , Transtornos Puerperais/etiologia , Embolia Pulmonar/etiologia , Adulto , Angiografia Coronária , Ecocardiografia Transesofagiana , Embolia Paradoxal/diagnóstico , Embolia Paradoxal/terapia , Feminino , Forame Oval Patente/diagnóstico , Forame Oval Patente/cirurgia , Humanos , Infarto do Miocárdio/diagnóstico , Infarto do Miocárdio/terapia , Gravidez , Transtornos Puerperais/diagnóstico , Transtornos Puerperais/terapia , Embolia Pulmonar/diagnóstico , Embolia Pulmonar/terapia , Fatores de RiscoRESUMO
Aortic dissection (AD) is a life-threatening medical urgency with autosomal-dominant polycystic kidney disease (ADPKD) being one of its major risk factors. Even though endovascular stentgraft repair has better outcomes in complicated Type B AD, its use in a patient with ADPKD has not been reported previously. This case involves a 44-year-old female with a history of ADPKD, hypertension and chronic low back pain presented with severe pain in the interscapular region. She was diagnosed with Type B AD by a computed tomographic (CT) scan of her chest and was managed medically. She was readmitted 9 days after discharge with worsening pain due to the proximal extension of AD. She was treated, with endovascular stentgraft repair sealing the dissection flap with significant subsequent reduction of the false lumen index and symptoms. We are reporting the first case of a complicated Type B AD in a patient with ADPKD managed with endovascular stent-graft repair.
Assuntos
Aneurisma da Aorta Abdominal , Dissecção Aórtica , Rim Policístico Autossômico Dominante/complicações , Stents , Enxerto Vascular/métodos , Adulto , Dissecção Aórtica/complicações , Dissecção Aórtica/diagnóstico por imagem , Dissecção Aórtica/terapia , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aneurisma da Aorta Abdominal/complicações , Aneurisma da Aorta Abdominal/diagnóstico por imagem , Aneurisma da Aorta Abdominal/cirurgia , Aortografia , Feminino , HumanosRESUMO
Noncompaction of ventricular myocardium (NVM), a relatively new diagnostic entity, is described as an arrest in the process of compaction of myocardial fibers, which results in a prominent trabecular network and deep intertrabecular recesses. Its coexistence with other cardiac anomalies like hypertrophic obstructive cardiomyopathy (HOCM) or polycystic kidney disease (PKD) had been reported in the past. We report the first case with all 3 different inherent conditions (NVM, HOCM, and PKD) manifesting in 1 patient. A 37-year-old man was referred for evaluation of a heart murmur. His medical history was positive for paroxysmal atrial fibrillation. Physical examination revealed a grade 3/6 systolic murmur loudest along the left sternal border accentuating on Valsalva maneuver. Echocardiography revealed HOCM. Cardiac magnetic resonance confirmed the presence of HOCM with the incidental finding of NVM and PKD. This case raises the possibility of genetic mutation common to these 3 clinical entities or 2 different gene mutations existing in the same individual.