Rescue Venoarterial Extracorporeal Membrane Oxygenation After Cardiac Arrest in COVID-19 Myopericarditis: A Case Report.

Coronavirus Disease-2019 (COVID-19) has been associated with potentially life threatening cardiovascular complications, including fulminant myocarditis and cardiac tamponade. Optimal management strategies are still unclear, including the role of immunomodulatory therapies and extracorporeal membrane oxygenation (ECMO) in the context of cardiogenic shock. We report a case of a middle-aged female with COVID-19 who developed respiratory distress and hemodynamic deterioration with elevated troponin levels on the seventh day of symptoms. Echocardiography demonstrated pericardial effusion with diastolic restriction of the right ventricle. Cardiac arrest developed during pericardiocentesis, resulting in emergency thoracotomy and pericardial drainage. Venoarterial ECMO was subsequently initiated due to refractory cardiogenic shock. Tocilizumab, immunoglobulin, methylprednisolone and convalescent plasma were added to supportive care, with progressive recovery of cardiac function and successful weaning from mechanical ventilation. This case highlights the potential role of ECMO, convalescent plasma and immunomodulatory therapies in the management of cardiogenic shock associated with COVID-19 myopericarditis.

L-carnitine supplementation in the recovery of plasma L-carnitine in patients with heart failure submitted to coronary artery bypass grafting.

Coronary artery bypass grafting reduces plasma L-carnitine and may impair the production of myocardial energy. L-carnitine supplementation may elevate plasma L-carnitine and increase cardiac mechanical efficiency. The objective of this study was to verify the recovery of preoperative plasma LC in patients with heart failure undergoing coronary artery bypass grafting supplemented with a daily oral dose of 50 mg / kg. Volunteers with ischemic heart failure who underwent surgery were randomized into a supplemented group (A-received 50 mg / kg L-carnitine) or placebo group (B) for 60 days. Supplementation was started on the third postoperative day. The spectrophotometric enzymatic method was used to quantify plasma L-carnitine. In the preoperative period, both groups had plasma L-carnitine adequate to the reference range (18.9-71.1 µM). On the second postoperative day, there was a reduction in plasma L-carnitine in groups A (17.4%) and B (14.4%). In the comparison between the groups, plasma L-carnitine was higher in group A than B in 10º (p = 0.024), 30º (p = 0.001), and 60º postoperative day (p = 0.008). Supplementation of L-carnitine at a daily oral dose of 50 mg / kg in patients with heart failure undergoing coronary artery bypass grafting may recover preoperative plasma L-carnitine within 10 days.

Predictors of permanent pacemaker requirement after transcatheter aortic valve implantation: insights from a Brazilian registry.

BACKGROUND: The aim of this study is to evaluate the predictors of permanent pacemaker (PPM) implantation after TAVI. METHODS: Between January 2008 and February 2012, 418 patients with severe aortic stenosis underwent TAVI and were enrolled in a Brazilian multicenter registry. After excluding patients who died during the procedure and those with a previous PPM, 353 patients were included in the analysis. RESULTS: At 30 days, the overall incidence of PPM implantation was 25.2%. Patients requiring PPM were more likely to be older (82.73 vs. 81.10 years, p=0.07), have pre-dilation (68.42% vs. 60.07%, p=0.15), receive CoreValve (93.68% vs. 82.55%, p=0.008), and have baseline right bundle branch block (RBBB, 25.26% vs. 6.58%, p<0.001). On multivariable analysis, CoreValve vs. Sapien XT (OR, 4.24; 95% CI, 1.56-11.49; p=0.005), baseline RBBB (OR, 4.41; 95% CI, 2.20-8.82; p<0.001), and balloon pre-dilatation (OR, 1.75; 95% CI, 1.02-3.02; p=0.04) were independent predictors of PPM implantation. CONCLUSION: PPM implantation occurred in approximately one-fourth of cases. Pre-existing RBBB, balloon pre-dilatation, and CoreValve use were independent predictors of PPM after TAVI. The type of prosthesis used and pre-balloon dilatation should be considered in TAVI candidates with baseline RBBB.

Predictors of permanent pacemaker requirement after transcatheter aortic valve implantation: Insights from a Brazilian Registry

Background: The aimof this study is to evaluate the predictors of permanent pacemaker (PPM) implantation afterTAVI.Methods: Between January 2008 and February 2012, 418 patientswith severe aortic stenosis underwent TAVI andwere enrolled in a Brazilian multicenter registry. After excluding patients who died during the procedure andthose with a previous PPM, 353 patients were included in the analysis.Results: At 30 days, the overall incidence of PPM implantation was 25.2%. Patients requiring PPM weremore likelyto be older (82.73 vs. 81.10 years, p = 0.07), have pre-dilation (68.42% vs. 60.07%, p = 0.15), receive CoreValve(93.68% vs. 82.55%, p = 0.008), and have baseline right bundle branch block (RBBB, 25.26% vs. 6.58%, p b 0.001).On multivariable analysis, CoreValve vs. Sapien XT (OR, 4.24; 95% CI, 1.56–11.49; p = 0.005), baseline RBBB (OR,4.41; 95% CI, 2.20–8.82; p b 0.001), and balloon pre-dilatation (OR, 1.75; 95% CI, 1.02–3.02; p = 0.04) were independentpredictors of PPM implantation.Conclusion: PPM implantation occurred in approximately one-fourth of cases. Pre-existing RBBB, balloon predilatation,and CoreValve use were independent predictors of PPM after TAVI. The type of prosthesis used andpre-balloon dilatation should be considered in TAVI candidates with baseline RBBB.