Journal of cardiovascular medicine
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J Cardiovasc Med (Hagerstown) · Jan 2010
Permanent pacemaker implantation after isolated aortic valve replacement: incidence, risk factors and surgical technical aspects.
Conducting system defects are common in patients with aortic valve disease. Aortic valve replacement may result in further conduction abnormalities requiring permanent pacemaker implantation. The aim of our study was to identify the incidence and predictors for postoperative 30-day permanent pacemaker implantation in patients undergoing isolated aortic valve replacement, and the effect of an accurate surgical technique in order to prevent permanent pacemaker implantation. ⋯ Need of permanent pacemaker implantation after aortic valve replacement seems to be related more to preoperative advanced aortic valve disease rather than pre-existing conducting system abnormalities. An accurate surgical technique for aortic valve replacement probably helps to prevent further impairment of conducting system function requiring early postoperative permanent pacemaker implantation.
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J Cardiovasc Med (Hagerstown) · Jan 2010
Postprocedural hyperglycemia in ST elevation myocardial infarction submitted to percutaneous coronary intervention: a prognostic indicator and a marker of metabolic derangement.
Hyperglycemia in acute coronary syndrome is associated with an increased risk of death in patients without previously known diabetes but the prognostic role of postrevascularization hyperglycemia in these patients is so far incompletely elucidated. ⋯ In ST elevation myocardial infarction patients without previously known diabetes submitted to percutaneous coronary intervention, glucose serum levels measured after mechanical revascularization were independent predictors of in-hospital mortality.
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J Cardiovasc Med (Hagerstown) · Dec 2009
Case ReportsHeparin resistance during cardiopulmonary bypass.
The hemostatic system is activated during cardiopulmonary bypass (CPB) procedures, and the use of heparin attenuates the coagulation. However, heparin resistance occurs in between 4 and 22% of patients undergoing cardiac surgery, and the preoperative use of heparin is usually responsible for this. Sometimes, critically ill patients are referred for intra-aortic balloon pump (IABP) insertion, and anticoagulation therapy with heparin is recommended to prevent thrombosis and embolization. The author experienced heparin resistance in patients who underwent percutaneous coronary intervention (PCI) and IABP insertion.
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J Cardiovasc Med (Hagerstown) · Nov 2009
Case ReportsDelayed pericarditis and cardiac tamponade associated with active-fixation lead pacemaker in the presence of mitochondrial myopathy and Ockham's razor.
A 23-year-old male patient, with a diagnosed mitochondrial myopathy, encephalopathy, lactic acidosis and stroke-like episodes, was referred for recurrent fainting. Long sinus pauses were documented, and an atrial pacemaker with an active-fixation lead was implanted. He was admitted again 4 months later because of chest pain and diffuse ST segment changes. ⋯ By a 'wait and see' strategy, the active-fixation atrial lead was eventually changed into a passive-fixation one, while continuing corticosteroids and salicylates. The patient quickly improved and is now, after 1 year, symptom free. For the explanation of any phenomenon, it is important that as few assumptions as possible are considered, eliminating those that make no difference in the observable predictions of the explanatory hypothesis or theory, according to the concept of Ockham's razor.