Texas Heart Institute journal
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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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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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The redesigned HeartMate II, an axial-flow left ventricular assist device, is simpler, smaller, and easier to operate than are pulsatile pumps. These design characteristics should make the HeartMate II more reliable and durable and broaden the eligible population base. We implanted the HeartMate II in 43 patients (average age, 42 yr). ⋯ Of the 10 patients in whom the HeartMate II replaced a failed HeartMate I, 8 were discharged from the hospital. We have seen excellent results with use of the HeartMate II. Functional status and quality of life have greatly improved in patients who survived the perioperative period.
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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.
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Case Reports
Mesenteric oxygen desaturation in an infant with congenital heart disease and necrotizing enterocolitis.
Congenital heart disease is a risk factor for the development of necrotizing enterocolitis, although the exact mechanism of development remains unclear. Herein, we report the case of an infant with pulmonary atresia, an intact ventricular septum, and multiple aortopulmonary collateral vessels. ⋯ This case highlights the importance of impaired mesenteric oxygen delivery consequential to congenital heart disease as a possible risk factor for necrotizing enterocolitis, and the use of near-infrared spectroscopy to measure tissue perfusion noninvasively in high-risk patients. To our knowledge, this is the 1st report of mesenteric oxyhemoglobin desaturation in association with necrotizing enterocolitis in a patient who also had congenital heart disease.