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1.
Am J Cardiol ; 117(10): 1622-1628, 2016 05 15.
Artigo em Inglês | MEDLINE | ID: mdl-27061705

RESUMO

Many patients with end-stage heart failure require mechanical circulatory support as a temporizing measure to enable multidisciplinary assessment for the most suitable therapeutic strategy. Impella 5.0 can be used as a bridge to decision to evaluate patients for potential recovery or bridge to next therapy (bridge to heart transplantation [BTHT] or bridge to durable left ventricular assist device or VAD [BLVAD]. Our goal was to examine single-center outcomes with the Impella 5.0 device as a bridge to next therapy (BTHT or BTLVAD). Forty patients underwent Impella 5.0 support from December 2009 to December 2015 with the intent of BTHT (n = 20) or BTLVAD (n = 20). The primary end point was survival to next therapy. Secondary end points included hemodynamic assessments and in-hospital/30-day complications. All patients were inotrope-dependent, with severely depressed left ventricular ejection fraction (12%) and renal insufficiency (creatinine 2.0 mg/dl). Most were Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) 2 (66%) with biventricular failure (65%). Thirty patients (75%) survived to next therapy, including transplant (n = 13), durable LVAD (n = 15), and recovery of native heart function (n = 2). No strokes or major bleeding events requiring surgery were observed. Acute renal dysfunction, bleeding requiring transfusion, hemolysis, device malfunction, limb ischemia occurred in 13 (33%), 11 (28%), 3 (8%), 4 (10%), and 1 (3%) patients, respectively. Survival rate to discharge and/or 30 days was 68% (27 of 40). Temporary support with the Impella 5.0 allows for an effective bridge to decision strategy for hemodynamic stabilization and multidisciplinary heart team assessment of critically ill patients with heart failure. In conclusion, many of these patients can be subsequently bridged to the next therapy with favorable outcomes.


Assuntos
Insuficiência Cardíaca/terapia , Transplante de Coração , Coração Auxiliar , Sistema de Registros , Função Ventricular Esquerda/fisiologia , Feminino , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Desenho de Prótese , Estudos Retrospectivos , Taxa de Sobrevida/tendências , Texas/epidemiologia , Resultado do Tratamento
2.
Proc (Bayl Univ Med Cent) ; 27(3): 231-2, 2014 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-24982572

RESUMO

Described herein is a 68-year-old man who underwent cardiac transplantation for severe chronic heart failure resulting from ischemic cardiomyopathy. Examination of the excised heart showed not only extensive left ventricular scarring but also a huge collection of adipose tissue in the subepicardial region and surprisingly also in the ventricular septum. The finding of fat in the ventricular septum is extremely rare and prompted this report.

3.
Am J Cardiol ; 113(8): 1442-6, 2014 Apr 15.
Artigo em Inglês | MEDLINE | ID: mdl-24576543

RESUMO

Described herein are clinical and necropsy findings in a 61-year-old woman with fatal left ventricular diastolic failure secondary to massive calcific deposits primarily within the left ventricular cavity. At age 3, an isthmic aortic coarctation was resected, and at age 44, a stenotic congenitally bicuspid aortic valve was replaced. The cause of the intracavitary calcific deposits remains unclear, but surgical resection of the deposits has been an effective form of therapy.


Assuntos
Calcinose/complicações , Cardiomiopatias/complicações , Insuficiência Cardíaca/etiologia , Ventrículos do Coração , Disfunção Ventricular Esquerda/complicações , Calcinose/diagnóstico , Cardiomiopatias/diagnóstico , Diagnóstico Diferencial , Ecocardiografia , Evolução Fatal , Feminino , Insuficiência Cardíaca/diagnóstico , Humanos , Pessoa de Meia-Idade , Radiografia Torácica , Índice de Gravidade de Doença , Tomografia Computadorizada por Raios X , Disfunção Ventricular Esquerda/diagnóstico
4.
Am J Cardiol ; 111(12): 1818-22, 2013 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-23540544

RESUMO

Described herein are certain findings in 2 male cousins who underwent cardiac transplantation for severe heart failure (HF), one of the diastolic type (ejection fraction ≈65%), and one of the systolic type (ejection fraction ≈20%), both the consequence of hypertrophic cardiomyopathy (HC), and each had identical disease-causing gene mutations. The implanted heart in one had normal-sized ventricular cavities and no grossly visible ventricular wall lesions (except in one papillary muscle) and the other patient had severely dilated ventricular cavities and multiple extensive ventricular wall scars. The heart mass and the age of onset of symptoms was similar in each patient. A number of other family members had evidence of HC.


Assuntos
Cardiomiopatia Hipertrófica Familiar/genética , Cardiomiopatia Hipertrófica Familiar/cirurgia , Insuficiência Cardíaca Diastólica/genética , Insuficiência Cardíaca Diastólica/cirurgia , Insuficiência Cardíaca Sistólica/genética , Insuficiência Cardíaca Sistólica/cirurgia , Transplante de Coração , Mutação , Cardiomiopatia Hipertrófica Familiar/complicações , Cardiomiopatia Hipertrófica Familiar/diagnóstico , Insuficiência Cardíaca Diastólica/diagnóstico , Insuficiência Cardíaca Diastólica/etiologia , Insuficiência Cardíaca Sistólica/diagnóstico , Insuficiência Cardíaca Sistólica/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Linhagem , Fenótipo , Troponina I/genética
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