Texas Heart Institute journal
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Pulsatile ventricular assist devices have successfully provided circulatory support for many patients throughout the past quarter century; however, persistent complications have hindered expanded clinical application of this technology. Although the use of smaller, continuous-flow ventricular assist device pumps has reduced the frequency and severity of some adverse events, design enhancement may further improve outcomes for patients who require long-term left ventricular support. One new product, the HeartWare, Inc., miniature ventricular assist device, features a wide-bladed rotor design in an axial-flow pump with a strong, passively suspended magnetic rotor. ⋯ The potential benefits of this miniature ventricular assist device are its increased availability to a broader patient population, a lower risk of infection, simplified implantation procedures, and improved durability. Further in vivo testing is planned. Herein, we discuss the unique design of the HeartWare miniature ventricular assist device, our feasibility study of its performance, and the possibilities for its use in human beings.
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Multicenter Study
Progesterone levels and carotid intima-media thickness: a negative association in older northern Chinese men.
In experimental research, progesterone has been found to be beneficial to the central nervous and cardiovascular systems; however, its potential role in preventing atherosclerosis in elderly men remains unclear. In this prospective study, we analyzed data in 385 older men and women from 6 communities in Beijing, China, in order to discover whether progesterone is associated with carotid intima-media thickness and plaque occurrence. Intima-media thickness and atherosclerotic plaques were determined by use of ultrasonography. ⋯ However, no such association was found in women (P = 0.304 and P = 0.247, respectively). In the logistic regression model that was adjusted for the confounding factors of atherosclerosis, men with progesterone levels in the lowest quartile (<1.87 nmol/L) had more risk of higher intima-media thickness (odds ratio, 2.15; P = 0.042). Although further experimental and prospective studies are warranted in order to determine the mechanism of progesterone's function in atherosclerosis prevention, we conclude that progesterone concentrations are negatively associated with carotid artery atherosclerosis in northern Chinese men 60 years of age or older.
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Diagnostic evaluation of embolic neurologic events requires the consideration of cardiac causes. We recently encountered a case that emphasizes the importance of cardiac tumor as a source of embolic events. We present herein the case of a 42-year-old woman who suffered a transient ischemic attack caused by a papillary fibroelastoma that originated from the aortic valve.
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We describe the initial--and successful--use of the TandemHeart System's catheters to provide extracorporeal membrane oxygenation (ECMO), in 2 patients. In 1 patient, who was experiencing severe primary respiratory failure, the catheters provided a standard venovenous ECMO circuit. In the other patient, who had severe, acute pulmonary hypertension and right-heart failure, the catheters enabled a novel right atrial-to-left atrial circuit for ECMO. We discuss the potential of the TandemHeart System's catheters to provide novel and possibly superior vascular routes for the delivery of ECMO in different types of cardiopulmonary failure.
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The Starfish Heart Positioner aids off-pump coronary artery surgery in adult patients by providing posterior cardiac exposure without incurring hemodynamic instability. Herein, we describe its use in a 17-month-old girl who had a right coronary artery fistula that drained to the right ventricle. ⋯ The patient was discharged from the hospital 2 days postoperatively. Six weeks later, she was well, and echocardiography showed no residual fistulous flow.