ABSTRACT
Low-output syndrome is one of the leading causes of death following open-heart surgery or high-risk angioplasty. Ventricular assist devices have been used to treat patients who suffer from postoperative cardiogenic shock despite use of an intraaortic balloon pump and maximum inotropic support. The Impella pump (Impella Cardiosystems AG, Aachen, Germany) is a newly introduced left ventricular assist device that has been shown to reduce infarct size and to accelerate recovery of stunned myocardium. We report our initial experience using the Impella device for the treatment of cardiogenic shock following cardiopulmonary bypass and for maintaining hemodynamic stability in high-surgical-risk patients undergoing unprotected left coronary artery angioplasty.
Subject(s)
Cardiac Output, Low/surgery , Heart-Assist Devices , Shock, Cardiogenic/surgery , Stroke Volume , Aged , Aged, 80 and over , Angioplasty , Cardiac Surgical Procedures/adverse effects , Coronary Vessels/surgery , Female , Heart Ventricles , Humans , Male , Middle Aged , Myocardial Infarction/surgery , Prosthesis Design , Shock, Cardiogenic/etiologyABSTRACT
El síndrome de bajo gasto es una de las principales causas de muerte tras la cirugía cardiaca y la angioplastia de alto riesgo. Los dispositivos de asistencia ventricular se han utilizado para tratar a pacientes con bajo gasto postoperatorio a pesar del balón de contrapulsación intraaórtico y el apoyo inotrópico máximo. El Impella (Impella Cardiosystems AG, Aachen, Alemania) es un dispositivo de asistencia ventricular de reciente introducción que ha demostrado reducir el tamaño del infarto, así como acelerar la recuperación del miocardio aturdido. Describimos nuestra experiencia inicial con el Impella para el tratamiento del shock cardiogénico tras el bypass cardiopulmonar y para el mantenimiento de la estabilidad hemodinámica en pacientes con tronco coronario izquierdo no protegido de alto riesgo quirúrgico tratados con angioplastia (AU)
Low-output syndrome is one of the leading causes of death following open-heart surgery or high-risk angioplasty. Ventricular assist devices have been used to treat patients who suffer from postoperative cardiogenic shock despite use of an intraaortic balloon pump and maximum inotropic support. The Impella pump (Impella Cardiosystems AG, Aachen, Germany) is a newly introduced left ventricular assist device that has been shown to reduce infarct size and to accelerate recovery of stunned myocardium. We report our initial experience using the Impella device for the treatment of cardiogenic shock following cardiopulmonary bypass and for maintaining hemodynamic stability in high-surgical-risk patients undergoing unprotected left coronary artery angioplasty (AU)
Subject(s)
Male , Female , Middle Aged , Aged , Humans , Shock, Cardiogenic/therapy , Ventricular Dysfunction, Left/therapy , Angioplasty, Balloon, Coronary/methods , Intra-Aortic Balloon Pumping/methods , Coronary Angiography , Postoperative Complications/therapyABSTRACT
Q fever is characterized by its clinical polymorphism. Cardiac involvement in acute Q fever is rare. We report a case of pleuro-pericarditis that rapidly evolved to pericardial constriction during an acute episode of Coxiella burnetii infection. Constrictive pericarditis was confirmed by hemodynamic measurements, echocardiography, and magnetic resonance. Indirect immunofluorescence assay revealed positive serology for acute Q fever. The patient underwent a successful pericardiectomy and was given antibiotics. The histopathologic study of the excised pericardium showed C. burnetii in a large cluster of organisms. After a 6-month follow-up period, the individual was asymptomatic.
Subject(s)
Pericarditis, Constrictive/etiology , Q Fever/complications , Antibodies, Bacterial/analysis , Cardiac Catheterization , Combined Modality Therapy , Coxiella burnetii/immunology , Coxiella burnetii/isolation & purification , Doxycycline/therapeutic use , Humans , Immunoglobulin G/analysis , Immunoglobulin M/analysis , Magnetic Resonance Imaging , Male , Middle Aged , Pericardiectomy , Pericarditis, Constrictive/diagnostic imaging , Pericarditis, Constrictive/drug therapy , Pericarditis, Constrictive/pathology , Pericarditis, Constrictive/surgery , Pericardium/immunology , Pericardium/microbiology , Pleural Effusion/etiology , Pleural Effusion/immunology , Q Fever/diagnosis , Q Fever/drug therapy , UltrasonographyABSTRACT
PURPOSE: To report endovascular repair of dual aneurysms in a patient with Behçet's disease. CASE REPORT: A 37-year-old man diagnosed 6 months prior with Behçet's disease presented with a pulsating abdominal mass. Computed tomography revealed a 70-mm-diameter pseudoaneurysm in the abdominal aorta and another (20 mm) in the celiac trunk 5 mm from the aorta. Staged endovascular repair began with the aortic aneurysm, which was excluded with a bifurcated 23 x 140-mm Excluder stent-graft. Three days later, 2 Jostent stent-grafts were placed in the celiac trunk, successfully excluding the lesion. Fifteen days later, the patient was discharged on a regimen of clopidogrel, cyclosporine, and warfarin. At 6 months, the CT scan showed good perfusion of the stent-grafts. CONCLUSIONS: Aneurysmal involvement of the celiac trunk in a patient with Behçet's disease is a rare pathology that appears amenable to stent-graft repair.
