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1.
In. Soeiro, Alexandre de Matos; Leal, Tatiana de Carvalho Andreucci Torres; Accorsi, Tarso Augusto Duenhas; Gualandro, Danielle Menosi; Oliveira Junior, Múcio Tavares de; Caramelli, Bruno; Kalil Filho, Roberto. Manual da residência em cardiologia / Manual residence in cardiology. Santana de Parnaíba, Manole, 2 ed; 2022. p.436-441, tab, ilus.
Monography in Portuguese | LILACS | ID: biblio-1352663
2.
Medicina (B.Aires) ; 81(5): 761-766, oct. 2021. graf
Article in Spanish | LILACS | ID: biblio-1351048

ABSTRACT

Resumen El shock cardiogénico (SC) presenta una elevada mortalidad y puede requerir de terapéuticas avanzadas como la asistencia circulatoria mecánica (ACM) y el trasplante cardíaco (TC). Se analizaron en forma retrospectiva, en un único centro, aquellos pacientes que presentaron un infarto agudo de miocardio (IAM), SC y requirieron ACM puente al TC. Entre enero 1997 y junio 2020, 524 pacientes recibieron un TC, 203 por cardiopatía isquémica, 103 en lista de emergencia. Se incluyeron once pacientes con los criterios mencionados (edad media 53 ± 11 años; hombres 73%). Se realizaron 5 angioplastias primarias y 2 cirugías de revascularización miocárdica de urgencia. Cuatro pacientes presentaban anatomía coronaria no pasible de revascularización. Todos recibieron tratamiento inotrópico y vasopresor y requirieron soporte con balón de contrapulsación intra aórtico (BCIA). Dos requirieron el implante de bomba centrífuga univentricular izquierda (BioMedicus®, Medtronic) y 2 de oxigenador de membrana extracorpóreo veno-arterial (ECMO-VA) periférico (Maquet®, Getinge Group). La mediana entre IAM y TC fue 15 días (rango 7-21) y la edad de los donantes 28 ± 11 años. Todos presentaron un IAM extenso (monto necrótico 35 ± 5%) con signos histopatológicos de necrosis transmural e injuria de reperfusión. La mediana de seguimiento fue 9 años (rango 1-15). Ninguno falleció en la internación ni durante el primer año post trasplante. La supervivencia a los 5 y 10 años fue 73% y 55%. El TC en situación de emergencia ha demostrado ser, en nuestro medio, la mejor opción en aquellos pacientes con IAM y SC refractario a la terapia convencional.


Abstract Cardiogenic shock (CS) has a high mortality rate and often requires advanced therapies such as mechanical circulatory support (MCS) and heart transplantation (HT). Those patients who presented an acute myocardial infarction (AMI) with CS and required support through MCS as bridge to HT were retrospectively analyzed in a single Center. Between January 1997 and June 2020, 524 patients received HT, 203 for ischemic-cardiomyopathy, 103 were in emergency waiting list. Eleven patients met the inclusion criteria (mean age 53 ± 11 years old; men 73%). Five primary angioplasties and 2 emergency myocardial revasculariza tion surgeries were performed. Four patients had coronary anatomy not subject to revascularization. All received inotropic and vasopressor treatment and required intra-aortic balloon pump (IABP). Subsequently, two required support with a left univentricular centrifugal pump (BioMedicus®, Medtronic) and two with peripheral veno-arterial extracorporeal membrane oxygenator (VA-ECMO) (Maquet®, Getinge Group). The median between AMI and HT was 15 days (range 7-21) and the mean age of the donors 28 ± 11 years. All had extensive AMI (necrotic amount 35 ± 5%) with histopathological signs of transmural necrosis and reperfusion injury. The median follow-up was 9 years (range 1-15). None died in hospitalization or during the first year after transplantation. Survival at 5 and 10 years was 73% and 55%. Emergency HT may be the best option for selected patients with acute myocardial infarction and cardiogenic shock refractory to conventional therapy.


Subject(s)
Humans , Male , Adolescent , Adult , Middle Aged , Young Adult , Heart-Assist Devices , Myocardial Infarction , Shock, Cardiogenic/etiology , Shock, Cardiogenic/therapy , Retrospective Studies , Intra-Aortic Balloon Pumping
3.
Rev. colomb. cardiol ; 28(4): 334-344, jul.-ago. 2021. tab
Article in Spanish | LILACS | ID: biblio-1351930

ABSTRACT

Resumen Introducción: La falla cardiaca (FC) es un problema de salud pública mundial. En Latinoamérica, la incidencia es de 199/100.000 personas-año y la prevalencia de ≈1%. En Colombia, pocos estudios han descrito el comportamiento sociodemográfico y clínico de los pacientes con FC agudamente descompensada (FCAD) y FC crónica (FCC). Método: Se implementó un registro multicéntrico para identificar características que puedan ayudar en la planeación y desarrollo de estrategias de prevención secundaria y tratamiento de esta población. Resultados: Se incluyeron 2528 pacientes. 57.59% hombres, edad promedio 69 años. La principal comorbilidad fue hipertensión arterial (72.04%). Las principales causas de descompensación de la FC fueron la progresión de la enfermedad (35.00%) y el tratamiento insuficiente (19.09%). La etiología más frecuente fue isquémica (43.99%). Al momento del ingreso, 86.95% de pacientes recibían betabloqueador, 67.25% recibían diuréticos, 55.66% recibían ARM, 42.41% recibían ARA-II, 33.66% recibían IECA y 9.73% recibían ARNI. Conclusiones: Los pacientes con FC en Colombia son similares a los descritos por otros registros de FC en el mundo occidental, destacando el uso de terapias basadas en la evidencia. Se documentó una proporción menor de fibrilación auricular, con mayor frecuencia de disfunción sistólica moderada-grave y un aparente uso subóptimo de dispositivos implantables.


Abstract Introduction: Heart failure (HF) is a public health problem worldwide. In Latin America, incidence is 199 / 100,000 person-year and prevalence is ≈1%. In Colombia, few studies have described the sociodemographic and clinical behavior of patients with acutely decompensated HF (ADHF) and chronic HF (CHF). Method: A multicenter registry was implemented to identify characteristics that can help in the planning and development of secondary prevention and treatment strategies for this population. Results: 2528 patients were included. 57.59% men, average age 69 years. The main comorbidity was arterial hypertension (72.04%). The main causes of HF decompensation were disease progression (35.00%) and insufficient treatment (19.09%). The most frequent etiology was ischemic (43.99%). At the time of admission, 86.95% of patients received beta-blocker, 67.25% received diuretics, 55.66% received MRA, 42.41% received ARB-II, 33.66% received ACEI, and 9.73% received ARNI. Conclusions: Patients with HF in Colombia are similar to those described by other HF registries in the western world, highlighting the use of evidence-based therapies. A lower proportion of atrial fibrillation was documented, with a higher frequency of moderate-severe systolic dysfunction and an apparent suboptimal use of implantable devices.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Cardiovascular Diseases , Heart-Assist Devices , Therapeutics , Mortality , Colombia , Hospitalization
4.
Article in Chinese | WPRIM | ID: wpr-879251

ABSTRACT

Right ventricular (RV) failure has become a deadly complication of left ventricular assist device (LVAD) implantation, for which desynchrony in bi-ventricular pulse resulting from a LVAD is among the important factor. This paper investigated how different control modes affect the synchronization of pulse between LV (left ventricular) and RV by numerical method. The numerical results showed that the systolic duration between LV and RV did not significantly differ at baseline (LVAD off and cannula clamped) (48.52%


Subject(s)
Heart Failure/therapy , Heart-Assist Devices , Humans , Systole , Ventricular Dysfunction, Right , Ventricular Function, Right
5.
Article in Chinese | WPRIM | ID: wpr-888211

ABSTRACT

The subpulmonary ventricular exclusion (Fontan) could effectively improve the living quality for the children patients with a functional single ventricle in clinical. However, postoperative Fontan circulation failure can easily occur, causing obvious limitations while clinically implementing Fontan. The cavopulmonary assist devices (CPAD) is currently an effective means to solve such limitations. Therefore, in this paper the


Subject(s)
Algorithms , Child , Feedback , Heart-Assist Devices , Hemodynamics , Humans , Models, Cardiovascular
6.
Rev. bras. cir. cardiovasc ; 35(6): 986-989, Nov.-Dec. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1143987

ABSTRACT

Abstract Since Barnard's first heterotopic heart transplant in 1974, Copeland's method has been the greatest contribution to heterotopic transplants but has the drawback of donor's right ventricular atrophy. This new method proposes a modification in the anastomosis of the superior vena cava aiming to pre-serve donor's right ventricular function by decompressing the pulmonary territory and reducing the pulmonary arterial pressure, as a biological ventricular assist device. Finally, a second intervention is proposed, where a "twist" is performed to place the donor's heart in an orthotopic position after re-moval of the native heart. A pioneering research on this method received approval from the ethics committee of the Heart Institute of São Paulo. We believe that this method has the potential to im-prove quality of life in a selected group of patients.


Subject(s)
Humans , Heart-Assist Devices , Heart Transplantation , Quality of Life , Vena Cava, Superior , Transplantation, Heterotopic
10.
Rev. bras. cir. cardiovasc ; 35(4): 477-483, July-Aug. 2020. tab, graf
Article in English | SES-SP, LILACS, SES-SP | ID: biblio-1137312

ABSTRACT

Abstract Objective: Left ventricular assist device (LVAD) implantation with concomitant Dor plasty is only reported anecdotally. We herein aimed to describe our experience with LVAD and concomitant Dor procedures and describe long-term outcomes of this special subset of heart failure patients. Methods: Between January/2010 and December/2018, 144 patients received LVAD therapy at our institution. Of those, five patients (80% male, 60.4±7.2 years) presented with an apical aneurysm and received concomitant Dor plasty. Apical aneurysms presented diameter between 75 and 98 mm, with one impending rupture. Results: Procedural success was achieved in all patients. No unplanned right ventricular assist device implantation occurred. Furthermore, no acute 30-day mortality was seen. In follow-up, one patient was lost due to intentional disconnection of the driveline. One patient underwent heart transplantation on postoperative day 630. The remaining three patients are still on device with sufficient flow; pump thromboses were successfully managed by lysis therapy in one patient. Conclusion: LVAD implantation with concomitant Dor procedure is feasible, safe, and occasionally performed in patients with ischemic cardiomyopathy. Major advantages are prevention of thromboembolism and facilitation of LVAD placement by improving pump stability and warranting midventricular, coaxial alignment of the inflow cannula. In long-term follow-up, no adverse event associated with Dor plasty was observed.


Subject(s)
Humans , Male , Female , Middle Aged , Aged , Heart-Assist Devices , Thromboembolism , Retrospective Studies , Heart Transplantation , Percutaneous Coronary Intervention , Heart Failure/surgery
12.
Rev. colomb. anestesiol ; 48(1): 40-44, Jan.-Mar. 2020. tab, graf
Article in English | LILACS, COLNAL | ID: biblio-1092918

ABSTRACT

Abstract Introduction: Heart failure represents a public health problem involving high morbidity and mortality. For advanced stages of the disease the use of ventricular assist devices (VADs) has been implemented as destination therapy. The perioperative management of patients with VADs may result in multiple challenges, with optimal pain management being one of those challenges. Objective: To describe the use of erector spinae plain (ESP) block as a rescue analgesia technique in a patient undergoing HeartMate 3 type VAD implantat. Methods: Case report and subject review. Results: The case discussed is a patient with ischemic cardiomyopathy and severe ventricular dysfunction, undergoing a HeartMate 3 type VAD implant as destination therapy, under general anesthesia and postoperative analgesia protocol with fentanyl and acetaminophen. During the postoperative period the patient developed acute pain of severe intensity (visual analogue scale [VAS]: 8-10/10), that led to the use of a regional rescue technique-ESP block-that showed satisfactory results with optimal analgesia control (VAS: 1-3/10). Conclusion: The ESP block was a safe and effective option as part of a postoperative analgesia strategy for a patient with a HeartMate 3 type VAD implant.


Resumen Introducción: la insuficiencia cardiaca representa un problema de salud pública con alta morbimortalidad. En estadios avanzados se ha implementado el uso de dispositivos de asistencia ventricular (DAV) como terapia destino. El manejo perioperatorio de pacientes con DAV puede generar múltiples retos, dentro de los cuales se destaca el manejo óptimo del dolor. Objetivo: describir el uso del bloqueo del plano del musculo erector de la espina (ESP) como técnica analgésica de rescate en un paciente llevado a implante de DAV tipo HeartMate 3. Métodos: reporte de caso y revisión de tema. Resultados: se presenta el caso de un paciente con cardiopatía isquémica y disfunción ventricular severa, que fue llevado a un implante de DAV tipo HeartMate 3 como terapia destino, bajo anestesia general y protocolo de analgesia postoperatoria con fentanil y acetaminofén. Durante el posoperatorio presentó dolor agudo de intensidad severa (Escala Visual Análoga: 8-10/10), por lo que se aplicó una técnica regional de rescate: bloqueo ESP, la cual mostró resultados satisfactorios con control analgésico óptimo (Escala Visual Análoga: 1-3/10). Conclusiones: el bloqueo ESP fue una opción segura y efectiva como parte de una estrategia analgésica postoperatoria para un paciente con implante de un DAV tipo HeartMate 3.


Subject(s)
Humans , Male , Aged , Postoperative Period , Heart-Assist Devices , Equipment and Supplies , Analgesia , Anesthesia, General , Indicators of Morbidity and Mortality , Myocardial Ischemia , Ventricular Dysfunction , Acute Pain , Acetaminophen , Cardiomyopathies
13.
Rev. méd. Chile ; 148(3): 409-413, mar. 2020. graf
Article in Spanish | LILACS | ID: biblio-1115807

ABSTRACT

We report a 55-year-old woman with a history of hypothyroidism and type 2 diabetes mellitus who consulted at the emergency room because of intermittent oppressive chest discomfort. At admission, electrocardiogram showed a complete atrioventricular block. A transthoracic echocardiogram disclosed severe left ventricular dysfunction. The patient developed cardiogenic shock that required the installation of the Impella system. An emergency coronary angiography showed an ostial occlusion of the anterior descending artery. Despite successful primary angioplasty, she persisted with refractory shock and progressive hypoxemia. A concomitant connection to the extracorporeal membrane oxygenation system (ECMO) was decided. The support of both devices allowed the stabilization of the patient and the improvement of perfusion parameters.


Subject(s)
Humans , Female , Middle Aged , Shock, Cardiogenic/therapy , Heart-Assist Devices , Ventricular Dysfunction, Left , Extracorporeal Membrane Oxygenation , Diabetes Mellitus, Type 2
14.
Horiz. enferm ; 31(3): 340-357, 2020. tab
Article in Spanish | LILACS, BDENF | ID: biblio-1224102

ABSTRACT

A lo largo de los últimos años la implantación de Dispositivos de Asistencia Ventricular (DAV) está tomando un papel más relevante en el tratamiento de la Insuficiencia Cardíaca (IC). El uso de los DAV también está cambiando hacia la Terapia Definitiva (TD), conformándose como alternativa clara al trasplante cardíaco. La implantación de un DAV, en ocasiones, requiere previamente tratamiento emergente con otros dispositivos de Asistencia Circulatoria Mecánica (ACM) como Circulación Extracorpórea con Membrana de Oxigenación (ECMO) o Asistencia Ventricular paracorpórea Izquierda o Derecha. Por tanto, es necesario el ingreso en Unidades de Cuidados Intensivos (UCI) especializadas en estas terapias hasta la estabilización del paciente y toma de la decisión correcta. Se expone un caso clínico reciente de una persona que requiere asistencia inicial con ECMO V-A emergente en el hospital de origen y su traslado al centro de referencia para posterior asistencia biventricular paracorpórea e implantación definitiva de un DAVI (Dispositivo de Asistencia Ventricular Izquierda). Se exponen la secuencia de decisiones, complicaciones y el plan de cuidados de enfermería inicial en UCI con taxonomía NANDA. Es el primer implante de un DAVI, realizado en nuestro hospital. En él ha intervenido un enorme equipo multidisciplinar.


Over the past few years, the Ventricular Assist Devices (VADs) implementation is taking a relevant role in the Heart Failure (HF) treatment. VADs ́s use is also shifting towards Definitive Therapy (TD), being a clear alternative to heart transplantation. The implantation of a VAD, sometimes, requires a previous emergent treatment with other Mechanical Circulatory Assistance (ACM) devices such as Extracorporeal Circulation with Oxygenation Membrane (ECMO) or Left or Right Paracorporeal Ventricular Assistance. So is necessary of a mobile team for emergency assistance with ECMO and transfer to Intensive Care Units (ICU) which is specialized in these therapies until the patient stabilizes and doctors takes the right decision. A recent clinical case of a patient is exposed. This person required assistance with emergent ECMO V-A (Venous-Arterial) in the hospital of origin and his transfer to the reference center for subsequent biventricular paracorporeal assistance and to the definitive implantation of LVAD (Left Ventricular Assist Device). The sequence of decisions, complications and the initial nursing care plan at ICU with NANDA taxonomy, are presented here. This is the first implant of a LVAD in our hospital. A huge multidisciplinary team has been involved in the project.


Subject(s)
Humans , Male , Adult , Assisted Circulation/methods , Heart-Assist Devices , Heart Failure/drug therapy , Intensive Care Units , Nursing Care , Patient Care Planning , Heart Transplantation/methods , Critical Care
15.
Journal of Biomedical Engineering ; (6): 1000-1011, 2020.
Article in Chinese | WPRIM | ID: wpr-879230

ABSTRACT

Heart failure is one kind of cardiovascular disease with high risk and high incidence. As an effective treatment of heart failure, artificial heart is gradually used in clinical treatment. Blood compatibility is an important parameter or index of artificial heart, and how to evaluate it through hemodynamic design and


Subject(s)
Heart Failure , Heart, Artificial , Heart-Assist Devices , Hemodynamics , Hemolysis , Humans
16.
Article in Chinese | WPRIM | ID: wpr-828167

ABSTRACT

The high rotational speed of the axial flow blood pump and flow separation of the centrifugal blood pump are the main causes for blood damage in blood pump. The mixed flow blood pump can effectively alleviate the high rotational speed and the flow separation. Based on this, the purpose of this study is to explore the performance of the mixed blood pump with a closed impeller. A mixed flow blood pump with closed impeller was studied by numerical simulation in this paper. The flow field characteristics and the pressure distribution of this type of blood pump were analyzed. The hydraulic performance of the blood pump and the possible damages to red blood cells were also discussed. At last, pump performance was compared with the mixed flow blood pump with semi-open impeller. The results show that the mixed flow blood pump with close impeller studied in this paper can operate safely and efficiently with a good performance. The pump can reach the pressure head of 100 mmHg at 5 L/min mass flow rate. Flow in the blood pump is uniform and no obvious separation or vortex occurs. Pressure distribution in and on the impeller is uniform and reasonable, which can effectively avoid the thrombosis of blood. The average mean value of hemolysis index is 4.99 × 10 . The pump has a good biocompatibility. Compared with the mixed flow blood pump with semi-open impeller, the mixed flow blood pump with closed impeller has higher head and efficiency, a smaller mean value of hemolysis index prediction, a better hydraulic performance and the ability to avoid blood damage. The results of this study may provide a basis for the performance evaluation of the closed impeller mixed flow blood pump.


Subject(s)
Computer Simulation , Equipment Design , Heart-Assist Devices , Hemolysis , Humans , Thrombosis
17.
Med. infant ; 26(2): 189-196, Junio 2019. Tab, ilus
Article in Spanish | LILACS | ID: biblio-1021542

ABSTRACT

La Insuficiencia Cardíaca (IC) es un síndrome clínico que epresenta una de las mayores causas de mobi-mortalidad en pacientes pediátricos. Refleja la incapacidad del corazón para satisfacer las necesidades metabólicas del organismo, incluido el crecimiento y el ejercicio. En el niño la causa más frecuente es la cardiopatía congénita. Otras causas las miocardiopatía, las miocarditis, las arritmias y las causas no cardíacas como: insuficiencia renal, hipertensión arterial, enfermedades pulmonares crónicas, anemia, sepsis, hiper e hipotiroidismo, cardiotoxicidad, etc. Clásicamente el tratamiento estaba dirigido a mejorar la contractilidad y evitar la retención hidrosalina con digital y diuréticos. En la actualidad, dado a la mejor comprensión del mecanismo fisiopatológico, en los últimos años, el tratamiento se centra en el control de los sistemas renina-angiotensina (SRAA) y nervioso simpático. En los casos de IC descompensada que presentan síndrome de bajo gasto cardíaco que no responde a la terapia médica, previo al trasplante cardíaco, está indicado el soporte mecánico (AU)


Heart failure (HF) reflects the inability of the heart to meet the metabolic needs of the body, including growth and exercise. In the child, the most common cause is congenital heart disease. Other causes are cardiomyopathy, myocarditis, arrhythmias, and non-cardiac causes, such as renal failure, high blood pressure, chronic pulmonary diseases, anemia, sepsis, hyper- and hypothyroidism, cardiotoxicity. Classically, the treatment aimed at improving contractility and avoiding salt and fluid retention using digitalis and diuretics. Given the current better understanding of the pathophysiological mechanism, over the past years treatment has focused on the control of renin-angiotensin (RAAS) and sympathetic nervous systems. In cases of decompensated HF with low cardiac output syndrome not responding to medical therapy, prior to cardiac transplantation mechanical support is indicated (AU)


Subject(s)
Humans , Infant, Newborn , Infant , Child, Preschool , Child , Adolescent , Heart Failure/etiology , Heart Failure/physiopathology , Heart Failure/drug therapy , Heart Failure/therapy , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Cardiotonic Agents/therapeutic use , Heart-Assist Devices , Adrenergic beta-Agonists/therapeutic use , Diuretics/therapeutic use
18.
Rev. bras. cir. cardiovasc ; 34(2): 233-236, Mar.-Apr. 2019. tab, graf
Article in English | LILACS | ID: biblio-990577

ABSTRACT

Abstract Ventricular assist devices (VADs) are an important technological development for patients with end-stage heart failure, and approximately 50% of these patients require various additional cardiac procedures. Here we presente the case of a patient suffering from severe aortic insufficiency, aortic root dilatation, and an ascending aortic aneurysm with end-stage decompensated heart failure. We performed the Bentall procedure combined with a left VAD implantation during the same session. The postoperative period was uneventful for this patient, and he was discharged on the 32nd postoperative day. The heart failure symptoms of the patient are reasonable, and he is still on the heart transplantation waiting list.


Subject(s)
Humans , Male , Middle Aged , Heart-Assist Devices , Heart Valve Prosthesis Implantation/methods , Heart Failure/surgery , Aortic Diseases/surgery , Radiography, Thoracic , Tomography, X-Ray Computed , Treatment Outcome
19.
Gac. méd. Méx ; 155(2): 196-198, mar.-abr. 2019. graf
Article in English, Spanish | LILACS | ID: biblio-1286483

ABSTRACT

Resumen El tratamiento de la falla cardiaca terminal avanzada ha sido el trasplante de corazón, sin embargo, hay limitantes en cuanto a las características del receptor y disponibilidad de donadores, por lo que se ha utilizado alternativamente el soporte ventricular como tratamiento de destino. Se describe a una paciente con falla cardiaca terminal por cardiomiopatía isquémica en quien se implantó exitosamente un sistema de soporte ventricular izquierdo y a ocho meses del procedimiento se encontraba en clase funcional I, sin complicaciones.


Abstract The treatment of refractory terminal heart failure has been heart transplantation. However, there are limitations with regard to clinical conditions of the recipient and availability of donors, and ventricular support has therefore been alternatively used as destination therapy. We describe the case is of a female patient with ischemic cardiomyopathy-associated heart failure who had a left ventricular assist device successfully implanted and at eight months of the procedure was at functional class I, with no complications.


Subject(s)
Humans , Female , Aged , Heart-Assist Devices , Myocardial Ischemia/surgery , Heart Failure/surgery , Follow-Up Studies , Myocardial Ischemia/complications , Prosthesis Implantation/methods
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