Giornale italiano di cardiologia : organo ufficiale della Federazione italiana di cardiologia : organo ufficiale della Società italiana di chirurgia cardiaca
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G Ital Cardiol (Rome) · Oct 2013
Review[What cardiologists should know to manage acute complications in mechanical circulatory support recipients].
Patients with advanced heart failure refractory to optimal medical treatment have a high mortality and a poor quality of life with frequent hospital admissions. The lack of alternative treatment options has prompted the development of mechanical circulatory support (MCS) devices, first as bridge to heart transplant and subsequently as destination therapy as a valid alternative to transplant. Last generation MCS devices are mechanically reliable and their management has become increasingly less complex. ⋯ The management of general or acute problems will no longer be limited to tertiary implanting centers. A key issue to improve patient outcomes is the provision of a smooth and careful transition from the hospital environment to home care. The aim of this review is to start this process by providing basic notions and general indications through several scenarios of MCS recipients presenting to the emergency room for acute clinical problems.
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G Ital Cardiol (Rome) · Jul 2013
Review[Aortic disease in Marfan syndrome: current role of surgery and thoracic endovascular aortic repair].
Aortic disease is the most life-threatening complication of Marfan syndrome. Over the last decades, improved medical management and surgical results of prophylactic aortic interventions on the aortic root have dramatically increased expectancy of life in Marfan syndrome patients. ⋯ Nevertheless, the available literature, although restricted to small case series, indicates that endovascular repair is a feasible treatment option leading to satisfactory short-term results and may provide a bridging role to definitive open reconstruction. The aim of this paper was to review surgical and endovascular outcomes of aortic disease in Marfan syndrome.
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G Ital Cardiol (Rome) · Feb 2013
Case Reports[Combined treatment of refractory cardiac arrest by extracorporeal membrane oxygenation and therapeutic hypothermia].
A 57-year-old man underwent myocardial revascularization for unstable angina. Cardiocirculatory arrest complicated the procedure and the patient was rapidly treated with advanced cardiac life support. After 26-min long resuscitation attempts, 5 DC-shock and cardioactive drug administration, an extracorporeal system was positioned and activated (extracorporeal membrane oxygenation, ECMO). ⋯ ECMO was removed after 12h, and therapeutic hypothermia was continued for 27h without any complications. The patient was discharged with good neurological outcome. This report shows the feasibility of treatment of a dramatic event such as refractory cardiac arrest, using modern and advanced techniques in the intensive cardiac care unit.
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G Ital Cardiol (Rome) · Feb 2013
Case Reports[Optimal dose of bivalirudin in dialysis patients at high risk of heparin-induced thrombocytopenia undergoing percutaneous coronary intervention: case report].
Bivalirudin is a direct thrombin inhibitor that has been approved for use in patients with or at risk for heparin-induced thrombocytopenia undergoing percutaneous coronary intervention. The efficacy of bivalirudin has been well documented in the setting of percutaneous coronary intervention, but there are only few data on its use in chronic dialysis-dependent patients. Bivalirudin is mainly eliminated enzymatically (80%) and to a lesser extent renally (20%). ⋯ Dosing and monitoring recommendations in dialysis patients have not yet been established. We describe the case of a 77-year-old man with non-ST-elevation acute coronary syndrome complicated by heparin-induced thrombocytopenia and acute renal failure requiring dialysis treatment. During percutaneous coronary intervention, anticoagulant therapy with bivalirudin was administered at non-standard doses, though already documented in the literature.