The Journal of invasive cardiology
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Case Reports
Massive pulmonary embolism with shock: role of thrombolysis using central venous access.
Massive pulmonary embolism (PE) complicated with shock has an extremely high mortality rate with medical treatment. Since access to emergency vascular surgery or endovascular specialists is not readily available in most centers, patients are frequently treated with thrombolytic agents delivered via a peripheral venous access. Patients with shock, however, have poor peripheral perfusion, and peripheral administration of thrombolytic agents may thus not reliably deliver the agent to the embolus, reducing treatment efficacy. ⋯ This report describes the case of a 46-year-old man presenting with new-onset atrial fibrillation, right bundle branch block, and shock from a massive PE. In view of shock, thrombolytics were given via a subclavian central venous catheter. He improved dramatically within 1 hour, with prompt resolution of the shock and the dysrhythmia.
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Case Reports
Transfemoral aortic valve implantation in a renal transplant patient with a Dacron aorto-bi-iliac bypass.
Transcatheter aortic valve implantation (TAVI) is becoming the standard of care for inoperable patients with symptomatic severe aortic stenosis and the transfemoral approach is generally the first option chosen. However, transfemoral aortic valve replacement is contraindicated in patients with a Dacron aorto-bi-iliac bypass. To the best of our knowledge, we present the first case report of transfemoral aortic valve implantation in a kidney transplant patient with a history of aorto-bi-iliac bypass. ⋯ This case highlights the importance of a detailed anatomic vascular assessment combined with a multidisciplinary evaluation of the access site in patients evaluated for TAVI. We used multi-slice computed tomography scans of the iliofemoral arteries, the aorto-bi-iliac bypass and the thoraco-abdominal aorta to predict the potential pitfalls of a fully percutaneous transfemoral aortic valve implantation. The transfemoral approach was finally chosen in this case after considering the patient's suitable aorto-iliofemoral vasculature, his patent coronary artery bypass grafts and his predisposition for severe acute kidney injury.
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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.