RESUMO
Ventricular assist devices continue to play a significant role in the surgical management of advanced heart failure. Left ventricular assist devices in particular have seen a rapid evolution in design, technology, implantation, and outcomes. This concise review focuses on the key data that have been published in the past 5 years that have demonstrated this rapid evolution in left-sided mechanical circulatory support from principally bridge to transplantation to destination therapy, with an increasing emphasis on quality-of-life measures and durability.
Assuntos
Insuficiência Cardíaca , Transplante de Coração , Coração Auxiliar , Insuficiência Cardíaca/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Humanos , Qualidade de VidaRESUMO
THIS SPECIAL article is the 13th in an annual series for the Journal of Cardiothoracic and Vascular Anesthesia. The authors thank the editor-in-chief, Dr Kaplan, and the editorial board for the opportunity to continue this series; namely, the research highlights of the past year in the specialty of cardiothoracic and vascular anesthesiology.1 The major themes selected for 2020 are outlined in this introduction, and each highlight is reviewed in detail in the main body of the article. The literature highlights in the specialty for 2020 begin with an update on valvular disease, with a focus on updates in management of aortic and mitral valve disorders. The second major theme is an update on coronary artery disease, with discussion of both medical and surgical management. The third major theme is focused on the perioperative management of patients with coronavirus disease 2019 (COVID-19), with the authors highlighting literature discussing medical, surgical, and anesthetic considerations for their cardiac care. The fourth major theme is an update in heart failure, with discussion of medical, psychosocial, and procedural aspects of this complicated disease process. The fifth and final theme focuses on the latest analyses regarding survival in heart transplantation. The themes selected for this 13th special article are only a few of the diverse advances in the specialty during 2020. These highlights will inform the reader of key updates on a variety of topics, leading to improvement of perioperative outcomes for patients with cardiothoracic and vascular disease.
Assuntos
Anestesia em Procedimentos Cardíacos/tendências , Anestesiologia/tendências , COVID-19 , Procedimentos Cirúrgicos Cardíacos/tendências , Doenças das Valvas Cardíacas , Implante de Prótese de Valva Cardíaca/tendências , Procedimentos Cirúrgicos Vasculares/tendências , Anestesia em Procedimentos Cardíacos/métodos , Procedimentos Cirúrgicos Cardíacos/métodos , Transplante de Coração , Doenças das Valvas Cardíacas/cirurgia , Doenças das Valvas Cardíacas/terapia , Implante de Prótese de Valva Cardíaca/métodos , Coração Auxiliar , Humanos , SARS-CoV-2 , Substituição da Valva Aórtica Transcateter , Procedimentos Cirúrgicos Vasculares/métodosRESUMO
Spontaneous intraperitoneal hemorrhage (SIPH), or abdominal apoplexy, is a rare complication of protracted vomiting. Although usually seen later in life, increased alcohol consumption may be contributory to the accelerated incidence of SIPH among younger populations. We describe a 22-year-old male who presented with abdominal pain after prolonged retching in the setting of binge drinking. A CT scan identified a highly attenuated intraperitoneal collection measuring 7.6 cm x 11.6 cm x 15.9 cm adjacent to the stomach. Due to hemodynamic instability, exploratory laparotomy was emergently performed and 1600 mL of blood was evacuated. A diagnosis of SIPH was made with bleeding visualized from a short gastric artery. Ultimately, vessel ligation failed to achieve hemostasis at the splenic hilum and a splenectomy was required. Given that a delay in identification may prove fatal, this case highlights the importance of recognizing SIPH as a differential diagnosis for unexplained abdominal pain and shock after persistent vomiting.
Assuntos
Abdome Agudo , Consumo Excessivo de Bebidas Alcoólicas/complicações , Hemoperitônio , Hemostasia Cirúrgica/métodos , Esplenectomia/métodos , Estômago/irrigação sanguínea , Vômito/complicações , Abdome Agudo/diagnóstico , Abdome Agudo/etiologia , Artérias/diagnóstico por imagem , Artérias/patologia , Artérias/cirurgia , Diagnóstico Diferencial , Hemoperitônio/diagnóstico , Hemoperitônio/etiologia , Hemoperitônio/fisiopatologia , Hemoperitônio/cirurgia , Humanos , Laparotomia/métodos , Ligadura/métodos , Masculino , Tomografia Computadorizada por Raios X/métodos , Resultado do Tratamento , Adulto JovemAssuntos
Insuficiência Cardíaca/diagnóstico , Sistema de Registros , Cardiotônicos/uso terapêutico , Insuficiência Cardíaca/terapia , Coração Auxiliar , Humanos , Estudos Observacionais como Assunto/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Medição de Risco/métodos , Índice de Gravidade de DoençaAssuntos
Doenças Cardiovasculares/diagnóstico por imagem , Desfibriladores Implantáveis/normas , Prova Pericial/normas , Imagem Cinética por Ressonância Magnética/normas , Assistência Perioperatória/normas , Médicos/normas , Tomografia Computadorizada por Raios X/normas , Doenças Cardiovasculares/cirurgia , Análise de Dados , Prova Pericial/métodos , Humanos , Imagem Cinética por Ressonância Magnética/métodos , Assistência Perioperatória/métodos , Tomografia Computadorizada por Raios X/métodosRESUMO
The burden of morbidity and mortality from SARS-CoV-2 infection is especially significant in heart transplant patients who are at higher risk for poor outcomes owing to immunosuppression, blunted response to vaccination, and multiple comorbid conditions. Over the last 3 years the therapeutic landscape for COVID-19 has evolved and our drug armamentaria continues to expand. With these advancements comes a time of great hope to mitigate significant illness from SARS - CoV - 2 infection. However, as with many emerging frontiers, the administration of novel therapeutics to a complex patient population remains challenging. We present a patient case encountered at our institution that highlights the need for increased awareness of nuances while managing COVID-19 infection in a heart transplant recipient.
Assuntos
COVID-19 , Transplante de Coração , Humanos , SARS-CoV-2 , Ritonavir , TransplantadosRESUMO
COVID-19 induces a hypercoagulable state with early case reports of death from undetected venous thromboembolism. Various protocols and consensus statements have been proposed to address the optimal prophylaxis strategy for hospitalized patients. We offer our single institution experience with a d-dimer driven prophylaxis model with no deep vein thrombosis identified on discharge lower extremity ultrasounds.
Assuntos
COVID-19 , Trombose Venosa , Produtos de Degradação da Fibrina e do Fibrinogênio , Humanos , SARS-CoV-2 , Trombose Venosa/prevenção & controleRESUMO
Congenital cardiac abnormalities are not always found in isolation. We describe a case of a giant right coronary sinus of Valsalva aneurysm with anomalous left circumflex artery in a 46-year-old male with bicuspid aortic valve and prior ventricular septal defect repair.
RESUMO
Multiple myeloma (MM) poses inherent risk of thrombosis that can be amplified by the use of immunomodulator therapy. We present a patient with MM who was being treated with lenalidomide and dexamethasone when he developed progressive dyspnea on exertion consistent with a left lower pulmonary vein thrombosis (PVT) despite use of prophylactic aspirin. The PVT was not initially seen on standard computed tomography angiogram pulmonary embolism protocol but was seen on 192-slice multidetector computed tomography angiogram for assessment of coronary calcifications 8 months later. Subsequent treatment with full dose rivaroxaban resulted in full clot resolution and symptom improvement. PVT has not been previously reported with lenalidomide therapy and may not be a forefront differential diagnosis. In such cases, a multi-modality diagnostic approach may be beneficial. Consideration should be given to escalating venous thromboembolism prophylaxis to full dose anticoagulation during increased prothrombotic windows, such as the time of treatment initiation or dose adjustments, in low bleeding risk patients.