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1.
Intern Med J ; 47(9): 1068-1071, 2017 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-28891183

RESUMO

A 63-year-old man with an ischaemic cardiomyopathy, supported by the HeartWare left ventricular assist device (LVAD), presented with ventricular tachycardia and inferior ST-elevation myocardial infarction (STEMI) with associated acute right ventricular (RV) dysfunction. He underwent primary percutaneous coronary intervention with balloon angioplasty and placement of three drug-eluting stents in the proximal-to-mid right coronary artery. Post-procedure, ventricular arrhythmias abated, RV systolic dysfunction resolved and RV size normalised. Percutaneous coronary intervention (PCI) facilitated by the use of miniaturised percutaneous LVAD has become an increasingly available treatment option for high-risk patients. PCI in patients on established full mechanical circulatory support is not a common occurrence. Indeed, to our knowledge, this is the first case of primary percutaneous coronary intervention on an LVAD-supported heart reported in the medical literature. The case raises several specific issues that are of peculiar interest to clinicians involved in the care of patients supported by mechanical assist devices who experience an acute coronary syndrome requiring emergent revascularisation.


Assuntos
Coração Auxiliar , Intervenção Coronária Percutânea/métodos , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico por imagem , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Ventrículos do Coração/diagnóstico por imagem , Ventrículos do Coração/cirurgia , Coração Auxiliar/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Resultado do Tratamento
2.
Pacing Clin Electrophysiol ; 38(8): 925-33, 2015 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-25940215

RESUMO

BACKGROUND: Both implantable cardioverter defibrillators (ICDs) and left ventricular assist devices (LVADs) have a positive impact on survival in the heart failure population. We sought to determine whether these positive effects on survival are additive or whether LVAD therapy supersedes ICD therapy. METHOD: We analyzed survival data of patients implanted with nonpulsatile LVADs between October 2004 and March 2013. Survival in patients with ICDs (n = 64) was compared to those without ICDs (n = 36). Patients exited the study at the time of heart transplantation or death. RESULTS: A total of 100 patients underwent LVAD implantation during this time. Patients had a mean follow-up time of 364 ± 295 days. Death occurred in 15 (38%) patients in the no ICD group versus 18 (30%) in the ICD group. Univariate analysis demonstrated a marginal early survival benefit at up to 1 year post-LVAD implant in the ICD cohort; however, at time points greater than 1 year there was no statistically significant benefit in ICD therapy in LVAD patients (P = 0.56). Multivariate analysis did not show any significant predictor of survival. There were no patients who died of sudden cardiac death. There was no significant difference in the time to heart transplantation (443 days ± 251 no ICD vs 372 days ± 277 ICD, P = 0.37). CONCLUSION: The benefit of ICD therapy in the setting of continuous flow LVAD therapy is uncertain. Although prolonged ventricular arrhythmias (VAs) may potentially impact on patient survival, LVAD therapy is beneficial in prevention of sudden cardiac death due to VAs.


Assuntos
Desfibriladores Implantáveis , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Coração Auxiliar , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Taxa de Sobrevida
3.
Pacing Clin Electrophysiol ; 32(7): 879-87, 2009 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-19572863

RESUMO

BACKGROUND: Nonpulsatile left ventricular assist devices (LVADs) are increasingly used for treatment of refractory heart failure. A majority of such patients have implanted cardiac devices, namely implantable cardioverter-defibrillators (ICDs) or cardiac resynchronization therapy-pacemaker (CRT-P) or cardiac resynchronization therapy-defibrillator (CRT-D) devices. However, potential interactions between LVADs and cardiac devices in this category of patients remain unknown. METHODS: We reviewed case records and device logs of 15 patients with ICDs or CRT-P or CRT-D devices who subsequently had implantation of a VentrAssist LVAD (Ventracor Ltd., Chatswood, Australia) as destination therapy or bridge to heart transplantation. Pacemaker and ICD lead parameters before and after LVAD implant were compared. In addition, ventricular tachyarrhythmia event logs and potential electromagnetic interference reports were evaluated. RESULTS: Right ventricular (RV) sensing decreased in the first 6 months post-LVAD. Mean R-wave amplitude preimplant was 10.9 +/- 5.25 mV compared with 7.2 +/- 3.4 mV during follow-up (P = 0.02). RV impedance also decreased from 642 +/- 240 ohms at baseline to 580 +/- 212 ohms at follow-up (P = 0.007). There was a significant increase in RV stimulation threshold following implantation of the LVAD from 0.8 +/- 0.6 V at baseline to 1.4 +/- 1.0 V in the first 6 months postimplant (P = 0.01). A marked increase in ventricular tachyarrhythmia burden was observed in three patients. One patient displayed electromagnetic interference between the LVAD and defibrillator, resulting in inappropriate defibrillation therapy. CONCLUSIONS: LVADs have a definite impact on cardiac devices in respect with alteration of lead parameters, ventricular tachyarrhythmias, and electromagnetic interference.


Assuntos
Desfibriladores Implantáveis/efeitos adversos , Coração Auxiliar/efeitos adversos , Marca-Passo Artificial/efeitos adversos , Fibrilação Ventricular/diagnóstico , Fibrilação Ventricular/etiologia , Adolescente , Adulto , Idoso , Falha de Equipamento , Análise de Falha de Equipamento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento , Adulto Jovem
4.
Surg Today ; 33(4): 282-4, 2003.
Artigo em Inglês | MEDLINE | ID: mdl-12707823

RESUMO

We report the case of a 35-year-old man in whom an acute pulmonary vein thrombosis developed following bilateral sequential lung transplantation for cystic fibrosis. The thrombus was detected by transesophageal echocardiography 12 h after transplantation and an emergency thrombectomy was successfully performed.


Assuntos
Veias Pulmonares , Trombectomia , Trombose Venosa/cirurgia , Adulto , Ecocardiografia Transesofagiana , Humanos , Masculino , Trombose Venosa/diagnóstico por imagem
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