1,721,020 research outputs found
ECMO SUPPORT TO TREAT CARDIOGENIC SHOCK DUE TO LEFT VENTRICULAR FREE WALL RUPTURE: A CASE REPORT
No full textObjective: Preoperative management of post-infarction left ventricular free wall rupture (LVFWR) is not clearly standardized. Surgical repair is the only therapeutic option. Crucial is to choose which mechanical device should be used in case of a very unstable haemodynamic status of the patient. In this case, before proceeding with any surgical repair rescue act becomes an essential step. We report a case of LVFWR with tamponade and cardiogenic shock in which cardiopulmonary support with portable ECMO was used to rescue the patient before the operation.
Methods: A 67 old man with a recent history of myocardial infarction was admitted in emergency department by collapse. Diagnosis of LVFWR was done by 2D- echocardiogram which showed pericardial effusion around the heart. Emergent pericardiocentesis was done. Due to a very critical status an ECMO was installed percutaneously via femoral vein and artery. Centrifugal pump (Jostra-Rota Floww) was used. The pump flow was maintained at 2.5 l/min/m2 obtaining a mean systemic pressure of 50-60 mmHg. In this way diastolic perfusion was improved and cardiac workload reduced. So, we could obtain a better haemodynamic stabilization and reduced pericardial effusion. At the moment of the operation, after conversion of ECMO in standard cardiopulmonary bypass, surgical repair consisted in visualization of the site of rupture, infartectomy of inferior wall and closure of the area with large Teflon strips sutures. ECMO was then maintained for two days in order to reduce the workload of the heart and to avoid re-rupture and it was weaned off uneventfully. Results: The patient was estubated at 5th postoperative day. The course was complicated by lung infection treated with antibiotic therapy. He was discharged at the 12th postoperative day
Conclusions: Free wall rupture occurs in 4% to 25% of patient with AMI between 1-7 days after infarction. The rupture is usually a gradual process that begins with a small endocardial tears which soon dissects resulting in sudden pericardial tamponade often fatal. Use of aortic counter pulsation is described but it is not always useful to avoid further complications in very critical ill patients and in those situations in which the death of patient is imminent. In this latter case, the role of portable ECMO implanted in emergency department, could stabilize the haemodynamic status and improve the postoperative course, reducing the mortality rate of this pathology
ECMO SUPPORT TO TREAT CARDIOGENIC SHOCK DUE TO LEFT VENTRICULAR FREE WALL RUPTURE: A CASE REPORT
No full textObjective: Preoperative management of post-infarction left ventricular free wall rupture (LVFWR) is not clearly standardized. Surgical repair is the only therapeutic option. Crucial is to choose which mechanical device should be used in case of a very unstable haemodynamic status of the patient. In this case, before proceeding with any surgical repair rescue act becomes an essential step. We report a case of LVFWR with tamponade and cardiogenic shock in which cardiopulmonary support with portable ECMO was used to rescue the patient before the operation.
Methods: A 67 old man with a recent history of myocardial infarction was admitted in emergency department by collapse. Diagnosis of LVFWR was done by 2D- echocardiogram which showed pericardial effusion around the heart. Emergent pericardiocentesis was done. Due to a very critical status an ECMO was installed percutaneously via femoral vein and artery. Centrifugal pump (Jostra-Rota Floww) was used. The pump flow was maintained at 2.5 l/min/m2 obtaining a mean systemic pressure of 50-60 mmHg. In this way diastolic perfusion was improved and cardiac workload reduced. So, we could obtain a better haemodynamic stabilization and reduced pericardial effusion. At the moment of the operation, after conversion of ECMO in standard cardiopulmonary bypass, surgical repair consisted in visualization of the site of rupture, infartectomy of inferior wall and closure of the area with large Teflon strips sutures. ECMO was then maintained for two days in order to reduce the workload of the heart and to avoid re-rupture and it was weaned off uneventfully. Results: The patient was estubated at 5th postoperative day. The course was complicated by lung infection treated with antibiotic therapy. He was discharged at the 12th postoperative day
Conclusions: Free wall rupture occurs in 4% to 25% of patient with AMI between 1-7 days after infarction. The rupture is usually a gradual process that begins with a small endocardial tears which soon dissects resulting in sudden pericardial tamponade often fatal. Use of aortic counter pulsation is described but it is not always useful to avoid further complications in very critical ill patients and in those situations in which the death of patient is imminent. In this latter case, the role of portable ECMO implanted in emergency department, could stabilize the haemodynamic status and improve the postoperative course, reducing the mortality rate of this pathology
Quadricuspid aortic valve as a cause of severe aortic regurgitation
No full textQuadricuspid aortic valves (QAVs) constitute a rare congenital malformation, with
an incidence ranging from 0.008 to 0.048%. We report a case of severe aortic
regurgitation associated with a QAV, which was diagnosed intraoperatively using
transesophageal echocardiography. Since the first case described in 1862, 186
QAVs have been reported. In most cases, QAVs are associated with valve
regurgitation, with a concurrent stenosis in some patients, while only a small
number of QAVs are functionally normal. Once the diagnosis has been made,
echocardiographic follow-up is recommended, as progression to severe valve
regurgitation is common. Antibiotic prophylaxis is advisable for dental, and
"dirty" surgical procedures, to minimize the risk of infective endocarditis
ECMO support for the treatment of cardiogenic shock due to left ventricular free wall rupture
No full textLeft ventricular free wall rupture (LVFWR) is still an uncommon catastrophic
complication after acute myocardial infarction (MI), and it is one of the most
frequent causes of sudden cardiac death. Immediate surgical repair is the
treatment of choice. When LVFWR presents acutely with tamponade and cardiogenic
shock in emergency department, salvage with a good outcome is still possible by
timely pericardiocentesis and extracorporeal membrane oxygenation (ECMO) support.
We report a case of cardiac rupture with tamponade and cardiogenic shock in which
cardiopulmonary support with portable ECMO was used to rescue the patient before
the operation
Interhospital stabilization of adult patients with refractory cardiogenic shock by veno-arterial extracorporeal membrane oxygenation
No full textQuadricuspid aortic valve as a cause of severe aortic regurgitation
No full textQuadricuspid aortic valves (QAVs) constitute a rare congenital malformation, with
an incidence ranging from 0.008 to 0.048%. We report a case of severe aortic
regurgitation associated with a QAV, which was diagnosed intraoperatively using
transesophageal echocardiography. Since the first case described in 1862, 186
QAVs have been reported. In most cases, QAVs are associated with valve
regurgitation, with a concurrent stenosis in some patients, while only a small
number of QAVs are functionally normal. Once the diagnosis has been made,
echocardiographic follow-up is recommended, as progression to severe valve
regurgitation is common. Antibiotic prophylaxis is advisable for dental, and
"dirty" surgical procedures, to minimize the risk of infective endocarditis
Is the Impella Device Really Useful to Unload the Left Ventricle During Extracorporeal Life Support?
No full text
Regional Thrombolysis with Tenecteplase During Extracorporeal Membrane Oxygenation: A New Approach for Left Ventricular Thrombosis
No full textWe present the case of a woman assisted with veno-arterial extracorporeal membrane oxygenation (v-a ECMO) for postischemic cardiogenic shock, who developed left ventricular thrombosis despite systemic anticoagulation and left ventricular apical venting. We successfully achieved local thrombolysis with tenecteplase administered through the venting cannula to obtain local thrombolysis while reducing systemic effects to a minimum. The procedure was effective with mild systemic bleeding and the patient was successfully weaned off the extracorporeal support a few days thereafter
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