Texas Heart Institute journal
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Early mobilization and aggressive physical therapy are essential in patients who receive left ventricular assist devices (LVADs) due to long-term, end-stage heart failure. Some of these patients remain ventilator dependent for quite some time after device implantation. We report our regimen of mobilization with the aid of a portable ventilator, in patients with cardiac cachexia and LVAD implantation. ⋯ There were significant functional gains during the period of prolonged mechanical ventilation. The patient was able to walk up to 600 feet by the time he was weaned from the ventilator and transferred out of the intensive care unit. He underwent successful heart transplantation 6 weeks after being weaned from the ventilator We believe that improving the mobility of LVAD patients who require mechanical ventilation has the potential both to facilitate ventilator weaning and to improve the outcomes of transplantation.
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Few reported cases document injury to the circumflex coronary artery secondary to repair of the mitral valve annulus. This potentially life-threatening sequela must be considered during mitral valve repair. In an effort to increase awareness of this sequela, we present the case of a patient who experienced a perioperative myocardial infarction secondary to injury of the circumflex coronary artery after mitral valve repair.