RESUMO
We report the case of a 64-year old Caucasian male patient with a tear of the left ventricular driveline just above the driveline-air tube junction. We describe the repair technique and the necessary set of tools.
Assuntos
Insuficiência Cardíaca/cirurgia , Coração Auxiliar/efeitos adversos , Ventrículos do Coração , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Falha de Prótese , ReoperaçãoRESUMO
A 68-year-old man was admitted to the hospital 4 months after HeartMate II ventricular assist device implantation, because his clinical status had deteriorated and his levels of lactate dehydrogenase and free hemoglobin had increased. Transthoracic echocardiography performed at admission revealed decreased basic diastolic continuous flow velocity with a pulsatile increase in flow velocity during ventricular contraction in both inflow and outflow cannulas. Twelve hours after beginning lytic therapy, basal diastolic continuous flow velocity had increased, and the amplitude between diastolic and systolic flow velocity had decreased. The clinical status of the patient improved, and his lactate dehydrogenase decreased. A decrease in basal diastolic flow may be a valuable marker of flow disturbance in continuous flow ventricular assist devices.
Assuntos
Ecocardiografia/métodos , Coração Auxiliar/efeitos adversos , Trombose/diagnóstico por imagem , Trombose/etiologia , Disfunção Ventricular Esquerda/diagnóstico por imagem , Disfunção Ventricular Esquerda/etiologia , Idoso , Humanos , Masculino , Trombose/terapia , Disfunção Ventricular Esquerda/prevenção & controleRESUMO
OBJECTIVE: To evaluate the effect of a miniaturized extracorporeal circulation system (MECC System) compared to conventional extracorporeal circulation (ECC) regarding liver function in cardiac surgical patients. METHODS: Double indicator dilution measurements were achieved by bolus injection of indocyanine green (ICG) for assessment of cardiac index (CI) and plasma disappearance rate of ICG (PDRig). Measurements were simultaneously performed preoperatively after induction of anaesthesia (T1), following admission on the ICU (T2) and 6 h postoperatively (T3). RESULTS: CI and PDRig were markedly increased after cardiac surgery without significant differences between groups. The percentage increase in CI was significantly correlated to the percentage increase in PDRig in both groups. CONCLUSION: Liver function improved after cardiac surgery in both groups of patients, which may partly be explained by an increase in CI under mild inotrope support. Differences between the extracorporeal circuits with respect to PDRig appear to be minimal in a group of patients without pre-existing liver injury.
