Texas Heart Institute journal
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Review Case Reports
AMPLATZER Septal Occluder failure resulting in paradoxical cerebral embolism.
Patent foramen ovale and atrial septal defect are risk factors for paradoxical embolism and subsequent cerebral ischemic events. The transseptal passage of emboli from the right to the left cardiac chambers appears to play an important role. The therapeutic options are medical therapy (anti-aggregation or anticoagulation), surgical closure, or transcatheter closure. ⋯ Pulmonary hypertension and resultant right ventricular failure and right atrial dilation could have contributed to the persistent shunting and paradoxical embolism. To our knowledge, the delayed dysfunction of an AMPLATZER Septal Occluder has not been reported. In addition to describing the patient's case, we review the relevant medical literature.
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Peripartum cardiomyopathy is idiopathic heart failure occurring in the absence of any determinable heart disease during the last month of pregnancy or the first 5 months postpartum. The incidence varies worldwide but is high in developing nations; the cause of the disease might be a combination of environmental and genetic factors. Diagnostic echocardiographic criteria include left ventricular ejection fraction <0.45 or M-mode fractional shortening <30% (or both) and end-diastolic dimension >2.7 cm/m(2). ⋯ Mechanical support and transplantation might be necessary in severe cases. Targeted therapies (such as intravenous immunoglobulin, pentoxifylline, and bromocriptine) have shown promise in small trials but require further evaluation. Fortunately, despite a mortality rate of up to 10% and a high risk of relapse in subsequent pregnancies, many patients with peripartum cardiomyopathy recover within 3 to 6 months of disease onset.
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Since the implantable cardioverter-defibrillator was first used clinically in 1980, several large randomized controlled trials have shown that therapy with this device can be beneficial in various patient populations. Evidence suggests that this therapy is useful in the secondary prevention of sudden cardiac death among patients who have survived arrhythmic events. ⋯ When used with cardiac resynchronization therapy, implantable cardioverter-defibrillators have improved survival rates and quality of life in patients with severe heart failure. Further research is needed to examine the potential benefits of implantable cardioverter-defibrillators in elderly, female, and hemodialysis-dependent patients, and to determine the optimal waiting period for implantation after myocardial infarction, coronary revascularization, and initial heart-failure diagnosis.
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Review Historical Article
Self-experimentation and its role in medical research.
Although experimentation involving human volunteers has attracted intense study, the matter of self-experimentation among medical researchers has received much less attention. Many questions have been answered only in part, or have been left unanswered. How common is this practice? Is it more common among certain nationalities? What have been the predominant medical fields in which self-experimentation has occurred? How dangerous an act has this proved to be? What have been the trends over time? What is the future likely to bring?From the available literature, I identified and analyzed 465 documented instances of this practice, performed over the course of the past 2 centuries. ⋯ Eight deaths were recorded. A number of the investigators enjoyed successful careers, including the receipt of Nobel Prizes. Although self-experimentation by physicians and other biological scientists appears to be in decline, the courage of those involved and the benefits to society cannot be denied.