1/392. Mild hypothermia for temporary brain ischemia during cardiopulmonary support systems: report of three cases. Recovery without residual neurological damage after cardiac arrest with temporary cerebral ischemia is rare. Therefore, it is most important that every effort is made to prevent brain damage occurring immediately after successful cardiopulmonary resuscitation. We report herein the cases of three patients who suffered either cardiogenic or hypovolemic shock and were resuscitated by a cardiopulmonary support system followed by mild hypothermia. All three patients recovered completely without any neurologic damage. The outcomes of these three patients demonstrated that mild hypothermia may be important for cerebral preservation after cardiopulmonary resuscitation. ( info) |
2/392. New treatment strategies for cardiogenic shock in acute MI. Management options depend on the availability of a cath lab. Aggressive treatment strategies that include early revascularization may significantly improve survival from acute MI complicated by cardiogenic shock. Symptoms of impending cardiogenic shock include tachycardia, cool extremities, pallor, cyanosis, and a normal or low blood pressure. When possible, the right and left sides of the heart are catheterized immediately. For patients who need to be transferred to a hospital with a catheterization laboratory, use temporary support measures--intubation, administration of positive inotropic agents, and placement of an intra-aortic balloon pump. coronary angiography can reveal whether direct PTCA or bypass surgery is appropriate. Thrombolysis is limited to patients for whom transfer is delayed and those in whom cardiogenic shock is ruled out. ( info) |
| In two patients with massive pulmonary embolism and cardiogenic shock requiring mechanical ventilation and prolonged external cardiac massage, occluded pulmonary arteries were recanalized by primary mechanical fragmentation of thrombi using a percutaneously inserted catheter followed by fibrinolytic therapy. The hemodynamic and respiratory parameters rapidly and greatly improved. Pulmonary angiography before discharge revealed normal results in both patients. No central neurological abnormalities were detected. It is concluded that patients with cardiogenic shock due to massive pulmonary embolism may benefit from immediate mechanical thrombus fragmentation followed by fibrinolysis when thrombolysis or surgical embolectomy are strictly contraindicated or not available. ( info) |
4/392. Directional coronary atherectomy and its use in treating occluded left main arteries in cardiogenic shock patients: a case study. This article presents a case where directional coronary atherectomy was successfully performed on an occluded left main coronary artery in a cardiogenic shock patient in an emergency setting where thrombolytic agents were contraindicated. Further investigation is suggested and warranted and use of DCA may aid in management of cardiogenic shock patients. ( info) |
5/392. Resuscitation from cardiogenic shock by direct angioplasty and 23-hour balloon inflation using a coronary perfusion balloon. Direct angioplasty is an accepted treatment for acute myocardial infarction and has resulted in stabilization and improvement in the clinical, electrocardiographic, and hemodynamic consequences of acute myocardial infarction. This case demonstrates the effectiveness of coronary perfusion as a method of resuscitation during cardiogenic shock and asystole in a patient with massive acute diaphragmatic and right ventricular infarction. Utilization of prolonged balloon inflation in this case obviated the need for emergency coronary bypass surgery and provided the patient with remarkable and almost complete recovery of left and right ventricular function. ( info) |
6/392. Multiple stenting in acute myocardial infarction with double vessel occlusion, complicated with cardiogenic shock. Stenting of the infarct-related artery during the acute phase of myocardial infarction is a controversial issue. We report a case of primary multiple stent implantation in 2 vessels in a patient with AMI, double vessel total occlusion and cardiogenic shock. No intracoronary thrombotic therapy was given. Stenting provides an optimal angiographic result which may decrease the need for repeat interventions. Primary stenting in AMI deserves further investigation. ( info) |
7/392. Thrombotic occlusion of the main stem of the left coronary artery in a neonate. Thrombotic coronary arterial occlusion, and myocardial infarction, are rare in the newborn. We report such a happening presenting shortly after birth with cardiogenic shock, no left ventricular output and a systemic circulation dependent on flow from a patent arterial duct. ( info) |
| We describe a 66-year-old woman with right-sided heart failure and cardiogenic shock resulting from severe pulmonary embolism. Her hemodynamic status improved dramatically with the use of inhaled nitric oxide. A proposed mechanism of action and a review of the literature are presented. ( info) |
9/392. Children may survive severe myocarditis with prolonged use of biventricular assist devices. The outcome of acute myocarditis with cardiogenic shock is poor. In some children in whom aggressive medical treatment fails, artificial replacement of heart function may offer lifesaving support until the myocardium has recovered. Four previously healthy children (three boys aged 4, 6, and 1 years; one girl aged 5) developed acute myocarditis with ventricular failure and multiorgan dysfunction caused by low cardiac output. Biventricular assist devices (BVAD) were implanted for prolonged support. In three children cardiac function improved and after up to 21 days mechanical support could be withdrawn. They had full recovery of heart function. In the fourth patient there was no myocardial recovery after a period of 20 days. He underwent orthotopic heart transplantation with an uneventful postoperative course. Prolonged circulatory support with BVAD is an effective method for bridging until cardiac recovery or transplantation in children. ( info) |
| 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. ( info) |