The Journal of invasive cardiology
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Extracorporeal membrane oxygenation (ECMO) is an effective rescue method for severe respiratory and cardiac failure. Right ventricular (RV) failure with cardiogenic shock is a critical condition with generally poor prognosis unless aggressive therapeutical measures are undertaken. Authors report on their initial experience with ECMO support in severe RV failure with cardiogenic shock caused by an obstructive hemodynamic pattern. ⋯ Bleeding complications were the main complications observed. As per initial experience, veno-arterial ECMO allows bypassing of the pulmonary bed, therefore, relieves the RV pressure overload and does not cause further elevation of the pulmonary pressures in contrary to RV assist devices. This aggressive management approach requires further clinical evaluation in order to establish its definite role in critical RV failure.
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Case Reports
Transcatheter aortic valve implantation with preexisting mechanical mitral prosthesis - use of CT angiography.
A 72-year-old Chinese female with prior mitral valve replacement with a mechanical prosthesis 13 years before was diagnosed with severe symptomatic aortic stenosis. She was considered a high-risk surgical candidate and was considered for transcatheter aortic valve implantation using a balloon-expandable device. ⋯ Gated cardiac computed tomographic angiography was used to assess the distance between the mitral prosthesis and the aortic annulus. Transcatheter aortic valve implantation using the transapical approach was subsequently performed successfully.
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The intra-aortic balloon pump (IABP) is a tool to help improve myocardial perfusion, reduce afterload, and decrease myocardial demand by reducing cardiac work. We describe a unique case of an IABP placement in a pregnant woman in her third trimester with a non-ST elevation myocardial infarction. The IABP allowed safe delivery of the fetus by cesarean section prior to a successful percutaneous intervention for complex two-vessel coronary artery disease. This case report also describes the first-time use of an IABP during cesarean section.
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This was a retrospective study of 144 patients with retrievable inferior vena cava (IVC) filters inserted between 2004 and 2008 at a community/teaching hospital. The purpose was to evaluate the incidence of complications and the rate and success of retrieval. Retrieval of IVC filters was attempted in 14 of 144 (10%) patients at an average of 4.6 months. ⋯ In conclusion, retrieval was attempted in only a small proportion of patients at a community/teaching hospital. Formalized guidelines for follow up may increase the proportion of patients in whom retrieval is attempted. Half of the complications of IVC filters could have been avoided with retrieval within 3 months.