Texas Heart Institute journal
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Case Reports
Aortic valve noncoronary cusp thrombosis after implantation of a nonpulsatile, continuous-flow pump.
Different institutions have different strategies for managing both native and prosthetic aortic valves in recipients of left ventricular assist devices (LVADs). Anticoagulation protocols and pump-flow algorithms remain nonstandardized. ⋯ We report the cases of 4 HeartMate II LVAD recipients in whom, despite an anticoagulative regimen, thrombus formed on the noncoronary cusp of the aortic valve. The management of the closed aortic valve in LVAD-supported patients remains problematic.
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Case Reports
Percutaneous thrombin injection of common carotid artery pseudoaneurysm without cerebral protection.
An 83-year-old man with sepsis sustained right common carotid artery injury during attempted central-line placement. A computed tomographic scan showed a large hematoma in the patient's neck and a carotid pseudoaneurysm. His clinical condition was such that transfer to the interventional suite was judged unsafe. ⋯ The procedure was successful, with no neurologic complications. At follow-up ultrasonographic evaluation, there was complete and sustained occlusion of the pseudoaneurysm. Emergent percutaneous treatment of common carotid artery pseudoaneurysm can be performed without temporary balloon occlusion for cerebral protection-in extreme circumstances, and at unknown risk.
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Peripartum cardiomyopathy is idiopathic heart failure occurring in the absence of any determinable heart disease during the last month of pregnancy or the first 5 months postpartum. The incidence varies worldwide but is high in developing nations; the cause of the disease might be a combination of environmental and genetic factors. Diagnostic echocardiographic criteria include left ventricular ejection fraction <0.45 or M-mode fractional shortening <30% (or both) and end-diastolic dimension >2.7 cm/m(2). ⋯ Mechanical support and transplantation might be necessary in severe cases. Targeted therapies (such as intravenous immunoglobulin, pentoxifylline, and bromocriptine) have shown promise in small trials but require further evaluation. Fortunately, despite a mortality rate of up to 10% and a high risk of relapse in subsequent pregnancies, many patients with peripartum cardiomyopathy recover within 3 to 6 months of disease onset.