Texas Heart Institute journal
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Air embolism is a rare and usually fatal complication of major cardiac surgery. We present a case in which a 45-year-old man supported by a HeartMate(R) XVE left ventricular assist device required a pump exchange due to failure of the device motor. During pump dissection, a massive amount of air entered the systemic circulation. ⋯ Forty-four days after the pump exchange operation, the patient was discharged from the hospital with only mild left hemiparesis. Exposure of the left ventricular assist device or its external components requires careful monitoring, because air can enter the pump-particularly in a hypovolemic patient. Rapid response after massive air entry into the left ventricular assist device system, as in our patient, can result in a successful outcome.
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Comparative Study
Left ventricular aneurysmal repair within 30 days after acute myocardial infarction: early and mid-term outcomes.
For safe resection, left ventricular aneurysmal repair after acute myocardial infarction is usually delayed. However, delaying surgery may not be possible or prudent in some patients who are clinically unstable after acute myocardial infarction. We retrospectively reviewed the early and mid-term outcomes of left ventricular aneurysmal repair in patients who had experienced acute myocardial infarction <30 days before the repair. ⋯ Postoperative New York Heart Association functional class improved similarly in both groups. We infer that left ventricular aneurysmal repair with coronary revascularization < 30 days after a recent myocardial infarction is a feasible procedure, with acceptable morbidity and mortality rates. Our mid-term results were comparable with those for patients who underwent this surgery > or = 30 days after acute myocardial infarction.
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Case Reports
Systemic venous thrombosis after recombinant factor VIIa in the control of bleeding after cardiac surgery.
Recombinant factor VIIa has been licensed in the United Kingdom since 1996 for the control of bleeding in hemophilic patients who are actively bleeding or are about to undergo surgery. Medical practitioners are also applying recombinant factor VIIa toward the control of bleeding in patients without hemophilia. ⋯ Herein, we report the case of a 73-year-old woman who underwent major coronary surgery and developed fatal systemic venous thrombosis after recombinant factor VIIa was used in an attempt to control her severe postoperative bleeding. We review the medical literature and discuss the risks of using recombinant factor VIIa to control severe bleeding after cardiac surgery.
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Case Reports
High-pressure pulmonary artery aneurysm and unilateral pulmonary artery agenesis in an adult.
The presence of a pulmonary artery aneurysm, major aortopulmonary and coronary-pulmonary collateral vessels, and severe pulmonary hypertension in an adult with unilateral pulmonary artery agenesis and previous patent ductus arteriosus ligation is very rare. A 34-year-old man experienced these conditions. When he was 10 years old, catheterization and angiography revealed right pulmonary artery agenesis, dilation of the main pulmonary artery, multiple collateral vessels extending from the aorta to the right pulmonary system, and a patent ductus arteriosus (shunt ratio, 3.57) that was then ligated; the other conditions were not corrected. ⋯ We concluded that irreversible pulmonary hypertension had developed (delayed by the patent ductus arteriosus ligation in childhood) and that the patient's only chance for survival was heart-lung transplantation. To sustain the patient until surgery, we administered sildenafil. Herein, we describe the vascular conditions that accompany unilateral absence of the pulmonary artery, and therapeutic methods.
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Cardiogenic shock after acute myocardial infarction is associated with a high mortality rate despite modern reperfusion methods and intra-aortic balloon pump support. For myocardial infarction patients in cardiogenic shock that is refractory to intra-aortic ballon pump counterpulsation and pressors (severe refractory cardiogenic shock), there are limited means to rapidly provide additional hemodynamic support. We present the case of a 49-year-old man who presented with an anterior wall acute myocardial infarction complicated by cardiogenic shock. ⋯ Cardiopulmonary resuscitation was started, and the patient underwent urgent placement of a TandemHeart percutaneous ventricular assist device. The device enabled the reversal of terminal hemodynamic collapse during active cardiopulmonary resuscitation, subsequent stabilization of the patient, and discharge of the patient from the hospital after device removal. In this patient, the percutaneous ventricular assist device was successful in the treatment of severe refractory cardiogenic shock after acute myocardial infarction.