The Journal of invasive cardiology
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We sought to investigate the outcomes for different treatments of pericardial effusions. ⋯ There is no significant difference in overall mortality between open surgical drainage and percutaneous pericardiocentesis for symptomatic pericardial effusions. There may be more procedural complications following surgical drainage of a pericardial effusion, and a greater need for repeat procedures if the effusion is drained using pericardiocentesis.
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Comparative Study
Intra-aortic counterpulsation for hemodynamic support in patients with acute ischemic versus non-ischemic heart failure.
Intra-aortic counterpulsation (IABP) is frequently applied to provide hemodynamic support in patients with refractory cardiogenic shock (CS) of ischemic and non-ischemic cause. However, clinical data comparing outcomes are lacking for both indications. The purpose of this analysis was to evaluate outcome and safety of IABP support in patients with ischemic and non-ischemic CS and to identify predictors of early mortality in this severely ill patient population. ⋯ IABP represents a safe technology for hemodynamic support and is associated with low complication rates. Parameters relating to early mortality include age >70 years, respiratory failure requiring mechanical ventilation, and left ventricular function <40%, which represent an additional risk of death. However, the etiology of CS had no effect on mortality in this analysis. This observation should encourage physicians to apply IABP for hemodynamic support in patients with nonischemic left ventricular failure.
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Accidental introduction of air into veins can occur during a variety of surgical operations or diagnostic procedures. High mortality rate results without early diagnosis and appropriate treatment. This is due to "air lock" at the right ventricular outflow tract, compromising the left ventricular filling. We describe a 2-year-old male with Tetralogy of Fallot who developed air embolism due to unexpected rupture of Swan-Gang catheter during a cardiac catheterization study, which was managed successfully by intracardiac aspiration.
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Fistulas between coronary artery and bronchial artery may be present from birth, with few hemodynamic consequences, and may remain closed due to similarity of the filling pressures at these 2 sites. They can also be secondary to pulmonary artery occlusive disease or chronic pulmonary inflammation. These pulmonary changes may cause a dilation of the fistula and make it functional, causing angina pectoris by coronary steal syndrome, which is the most common symptom. ⋯ However, most patients remain asymptomatic. The ones that need treatment may not have a good response to the medical management, requiring an intervention. This can be done using embolization coils, stents grafts, and performing surgical ligation of the fistulas.