1/19. Intramural anomalous left coronary artery from the right sinus of valsalva supported with venoarterial extracorporeal membrane oxygenation.We report the case of a 14-month-old girl with a wide complex dysrhythmia and cardiogenic shock due to abnormal coronary anatomy. She was kept alive for 20 days by full cardiocirculatory support, using venoarterial extracorporeal membrane oxygenation (VA ECMO). While she was on VA ECMO, a diagnosis was made of extensive myocardial infarction and an anomalous left main coronary artery. The patient was listed for heart transplantation and received a donor heart 20 days after beginning VA ECMO. We discuss the unusual presentation and course of the coronary arteries and the use of VA ECMO to support this patient before heart transplantation.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
2/19. Viral myocarditis presenting with seizure and electrocardiographic findings of acute myocardial infarction in a 14-month-old child.Acute viral myocarditis is an uncommon but potentially fatal illness in children. patients with myocarditis may present with nonspecific symptoms or atypical findings that make diagnosis in the emergency department difficult. We describe a previously healthy 14-month-old child with difficulty breathing and a tonic-clonic seizure who was subsequently found to have ECG changes and cardiac marker elevation consistent with acute myocardial infarction. The patient was immediately transferred from our community hospital ED to our tertiary care children's hospital. Shortly after admission, the patient developed intractable nonperfusing ventricular arrhythmias necessitating extracorporeal membrane oxygenation. Cardiac function did not recover, and the patient required heart transplantation before cessation of bypass. serology and anatomic pathology confirmed coxsackievirus B myocarditis. This case illustrates (1) the nonspecific presentation of myocarditis as dyspnea and seizure, (2) the manner in which myocarditis can mimic myocardial infarction, and (3) the importance of early diagnosis in the ED and transfer to a tertiary care facility.- - - - - - - - - - ranking = 0.2keywords = membrane (Clic here for more details about this article) |
3/19. Surgical revascularization for acute total occlusion of left main coronary artery.We report our experience with emergency surgical revascularization in 3 patients who were in cardiogenic shock as a result of acute total occlusion of the left main coronary artery. Because they were in profound shock, 2 patients required mechanical support with extracorporeal membrane oxygenation before the operation. Another patient was given moderate inotropic support and treated with an intraaortic balloon pump before surgery, because he had a dominant right coronary artery with extensive collateral circulation to the left coronary artery. All 3 patients underwent surgical revascularization within 20 hours of acute occlusion. Two patients survived, although 1 of them required extracorporeal membrane oxygenation support for 5 days postoperatively. The 3rd patient, despite successful weaning from extracorporeal membrane oxygenation immediately after coronary revascularization, died of hypoxic encephalopathy due to prolonged preoperative resuscitation. Immediate surgical revascularization was an effective treatment in our 3 patients who were in cardiogenic shock due to acute total occlusion of the left main coronary artery. Such factors as abundant collateral vessels from the right coronary artery to the left coronary artery, complete surgical revascularization within 20 hours of acute occlusion, and mechanical circulatory support were deemed important to recovery of left ventricular function. Two of our 3 patients survived.- - - - - - - - - - ranking = 0.6keywords = membrane (Clic here for more details about this article) |
4/19. Cardiogenic shock due to metastatic cardiac lymphoma: still a diagnostic and therapeutic challenge.Myocardial involvement by metastatic lymphoma progressively leads to severe contractile impairment and fatal outcome. Correct diagnosis is often late due to misleading presentation signs. We report on a case of extensive cardiac involvement of a T-cell thymic lymphoma in a young woman, necessitating emergent extracorporeal membrane oxygenation (ECMO) circulatory support, with satisfactory hemodynamic recovery and subsequent ECMO weaning. Unfortunately, the following clinical course was rapidly fatal. This case seems to confirm that early aggressive instrumental diagnosis is crucial before severe myocardial impairment can prevent any therapeutic option. Extensive use of transesophageal echocardiographic examination and early endomyocardial biopsy are highly recommended.- - - - - - - - - - ranking = 0.2keywords = membrane (Clic here for more details about this article) |
5/19. Conversion of extracorporeal membrane oxygenation to non-pulsatile left ventricular assist device. Is it out-of-date for non-pulsatile LVAD?BACKGROUND: extracorporeal membrane oxygenation (ECMO) provides an immediate support for acute deterioration of hemodynamic and pulmonary status, but what is the best decision for these critical patients? Biventricular assist device (BVAD) or left ventricular assist device (LVAD)? We proposed a protocol of step-by-step conversion from ECMO to LVAD after assurance of the reversibility of right ventricle and pulmonary function. methods: After femoral venoarterial ECMO was inserted for the critical patients, the left atrial drainage was added to the ECMO firstly and the femoral arterial inflow was shifted to the ascending aorta for preventing possible peripheral vascular complications. Temporary clamp of right heart drainage was tried to test right heart function 24 to 48 hours later. The sweep gas flow of oxygenator could be reduced gradually to test the pulmonary function. Therefore, the right heart drain and the oxygenator could be withdrawn to become a non-pulsatile LVAD or shift to pneumatic LVAD directly. There were four clinical experiences with successful conversion without temporary right ventricular assist device. RESULTS: All of them were able to convert their ECMO to LVAD smoothly in 8.0 /-2.5 days. Three of them were shifted to non-pulsatile LVAD, and one was converted to HeartMate. All but one could be weaned from the ventilator. No BVAD was needed in these patients. Due to the shortage of donor hearts, only one had the chance to undergo heart transplantation. CONCLUSIONS: The protocol did provide a good guideline for decision-making for those under ECMO support necessitating bridge to transplantation.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
6/19. Clinical management of cardiogenic shock associated with prolonged propofol infusion.This case report details the development of cardiogenic shock after craniotomy in a patient sedated with a propofol infusion. The patient survived with the assistance of extracorporeal membrane oxygenation. A literature review summarizes the syndrome of cardiogenic shock associated with prolonged propofol infusion. This is the first report of survival in this syndrome resuiting from mechanical circulatory support.- - - - - - - - - - ranking = 0.2keywords = membrane (Clic here for more details about this article) |
7/19. Use of an extracorporeal left ventricular assist system after acute myocardial infarction due to occlusion of the left main coronary artery.A 35-year-old man presented to our institution one day after the onset of dyspnea. coronary angiography revealed the occlusion of the left main trunk. The left main coronary artery and the left circumflex artery were recanalized, but he was hypotensive with low cardiac output. Even after he was placed on circulatory support with veno-arterial extracorporeal membrane oxygenation (ECMO), hemodynamic deterioration could not be reversed, and lung edema developed. The decision was made to use Toyobo LVAS. With institution of left ventricular assist system (LVAS), however, the patient's arterial saturation decreased. Peripheral veno-venous (V-V) ECMO was promptly established, and the patient's arterial saturation improved. On postoperative day 3, the patient was successfully weaned from V-V ECMO. He was extubated on postoperative day 28. The patient was recovered without any serious complications. Although echocardiography showed no substantial improvement in left ventricular function, his general condition is doing quite well with the assist of Toyobo LVAS. He is on rehabilitation program and awaiting heart transplantation.- - - - - - - - - - ranking = 0.2keywords = membrane (Clic here for more details about this article) |
8/19. heparin-induced thrombocytopenia complicating support by the berlin Heart.Since 1992, miniaturized pulsatile air-driven ventricular assist devices (VADs), "berlin Heart," have been used at many institutions (36 cases in north america in 19 different institutions) for pediatric use. heparin-induced thrombocytopenia (HIT II) is a significant complication rarely reported in the setting of adult VAD support; no similar report exists concerning pediatric VAD support. We report on a 13-month-old, 8.1 kg girl who required LVAD support for cardiogenic shock of unclear etiology. The patient had a history of multiple surgical repairs for correction of complex congenital heart disease consisting of a series of left heart obstructive lesions (Shone's complex). Despite aggressive ventilatory and inotropic support, the patient continued to deteriorate and subsequently required extracorporeal life support. After 7 days of conventional venoarterial extracorporeal membrane oxygenation, a 10 ml berlin Heart VAD was implanted. After implantation, the patient developed persistent low-grade fever of unclear etiology, gradual thrombocytopenia, and deterioration of renal function. On postimplant day 10, the pump required replacement because of concerns about an inlet valve thrombus; the explanted device demonstrated a nearly occlusive clot not appreciable from external inspection. Simultaneously, HIT II was diagnosed as a result of hematology workup for persistent thrombocytopenia. We discuss the unique challenges posed by HIT II complicating pediatric VAD support and in relation to the heparin coating of the device.- - - - - - - - - - ranking = 0.2keywords = membrane (Clic here for more details about this article) |
9/19. Recovery from hemorrhagic pulmonary damage by combined use of a left ventricular assist system and right ventricular assist system and extracorporeal membrane oxygenation.A 13-year-old boy developed cardiogenic shock secondary to end-stage dilated cardiomyopathy and extracorporeal life support (ECLS) was initiated. However, pulmonary hemorrhage occurred due to severe pulmonary hypertension. He underwent implantation of a left ventricular assist system (LVAS) and right ventricular assist system (RVAS) plus extracorporeal membrane oxygenation (ECMO) shunting between the right and left atrium. Pulmonary damage was resolved and RVAS-ECMO was terminated after 8 days of support.- - - - - - - - - - ranking = 1keywords = membrane (Clic here for more details about this article) |
10/19. Triple bridge-to-transplant in a case of giant cell myocarditis complicated by human leukocyte antigen sensitization and heparin-induced thrombocytopenia type II.Bridge-to-bridge experience has documented the feasibility of a switch from short-term to long-term mechanical circulatory support until heart transplant. We describe a case of irreversible cardiogenic shock due to giant cell myocarditis treated consecutively with extracorporal membrane oxygenation, bi-ventricular assist device, and total artificial heart. The postoperative course was complicated by human leukocyte antigen sensitization and heparin-induced thrombocytopenia type II. Our patient successfully underwent heart transplant after 10 months of support and was discharged in good condition. This case illustrates suitable device selection for myocarditis and represents two treatable immunological complications.- - - - - - - - - - ranking = 0.2keywords = membrane (Clic here for more details about this article) |
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