1/13. Stenting to reverse left ventricular ischemia due to left main coronary artery compression in primary pulmonary hypertension.Angina is a common symptom of severe pulmonary hypertension. Although many theories for the source of this pain have been proposed, right ventricular ischemia is the one most commonly accepted as the cause. We report on two patients with primary pulmonary hypertension who had angina with normal activity or on provocation. One patient had severe left ventricular dysfunction. Both were found to have severe ostial stenosis of the left main coronary artery as a result of compression from a dilated pulmonary artery. Both patients underwent stenting of the left main coronary artery with excellent angiographic results, and complete resolution of the signs and symptoms of angina and left ventricular ischemia. Left ventricular ischemia due to compression of the left main coronary artery may be a much more common mechanism of angina and left ventricular dysfunction in patients with pulmonary hypertension than previously acknowledged. Stenting of the coronary artery can be done safely with the resolution of these symptoms.- - - - - - - - - - ranking = 1keywords = ventricular dysfunction, left ventricular dysfunction, dysfunction (Clic here for more details about this article) |
2/13. extracorporeal membrane oxygenation for unprotected left main stenting in a patient with totally occluded right coronary artery and severe left ventricular dysfunction.We report a case of unprotected left main stenting in an elderly female with severe left ventricular dysfunction and a totally occluded right coronary artery using hemodynamic support with the Extracorporeal Membrane Oxygenator (ECMO). There were no procedural complications and at 6-month follow-up, the patient was doing well with no cardiovascular events. Stenting of unprotected left main and the use of ECMO in high-risk coronary intervention are reviewed.- - - - - - - - - - ranking = 2.5keywords = ventricular dysfunction, left ventricular dysfunction, dysfunction (Clic here for more details about this article) |
3/13. Acute thrombosis of the sinus node artery: arrhythmological implications.A 53 year old woman was referred for percutaneous coronary intervention because of a recent inferior myocardial infarction. During right coronary artery stent implantation, intermittent occlusion of the coronary side branch for the sinus node occurred, associated with intermittent sinus arrest and junctional escape rhythm. This led to speculation about the potential mechanisms for sinus node dysfunction. Degenerative fibrosis of nodal tissue is actually considered the most common cause of bradyarrhythmias. Yet, in everyday practice, no particular attention is usually paid to other potential pathogenic mechanisms such as coronary artery disease. This may be particularly true for elderly patients or patients with multiple risk factors. Thus, sinus node dysfunction may be an unrecognised marker of coronary artery disease.- - - - - - - - - - ranking = 0.0016041919732764keywords = dysfunction (Clic here for more details about this article) |
4/13. Conflicting functional assessment of stenoses in patients with previous myocardial infarction.The utility of fractional flow reserve, absolute and relative flow reserve, and intravascular ultrasound may have an impact on decision-making for percutaneous coronary intervention in patients with previous myocardial infarction and microvascular dysfunction. The role for fractional flow reserve, absolute and relative flow reserve, and intravascular ultrasound is discussed.- - - - - - - - - - ranking = 0.00080209598663819keywords = dysfunction (Clic here for more details about this article) |
5/13. Uncommon presentation and surgical correction of unroofed coronary sinus syndrome.A 59-year-old man with signs and symptoms of congestive heart failure, occurring a few months after an infective episode, underwent cardiac investigations revealing severe biventricular dysfunction, persistent left superior vena cava with almost completely unroofed coronary sinus, and critical stenosis of the proximal right coronary artery. Surgical correction of the congenital malformation associated with revascularization of the right coronary allowed a prompt recovery of clinical conditions and ventricular function.- - - - - - - - - - ranking = 0.29460750406756keywords = ventricular dysfunction, dysfunction (Clic here for more details about this article) |
6/13. Successful direct stenting guided by intravascular ultrasound without contrast in a patient with renal dysfunction.We report a 60-year-old male with significant renal dysfunction who had a recent coronary angiography with mid coronary stenosis. To avoid worsening of his kidney failure, we performed primary stenting with a combination of intravascular ultrasound and a marker wire. No dye was used during the stenting procedure. Whereas this new technique needs to be validated in studies, it represents new hope for such patients.- - - - - - - - - - ranking = 0.004010479933191keywords = dysfunction (Clic here for more details about this article) |
7/13. Off-pump reduction aortoplasty and concomitant coronary artery bypass grafting.This report presents 4 off-pump reduction aortoplasty and concomitant coronary artery bypass grafting (CABG) cases. Severe left ventricular dysfunction, hemodialysis-dependent chronic renal failure, metastatic colon carcinoma, poor nutritional status, difficulties with early mobilization, and ascending aortic dilatation or aneurysm were the critical indications for off-pump reduction aortoplasty and concomitant CABG.- - - - - - - - - - ranking = 0.5keywords = ventricular dysfunction, left ventricular dysfunction, dysfunction (Clic here for more details about this article) |
8/13. End-stage heart failure with multiple intracardiac thrombi: a rescue strategy.The use of ventricular assist devices as a bridge to transplantation has become a widely used option for patients with end-stage heart failure. In contrast to total artificial hearts, ventricular assist devices support the failing heart by bypassing one or both ventricles. In certain cases (myocardial tumors, graft failure, transplant rejection, endocarditis, intracardiac thrombus formation), however, it may be advantageous to excise the heart and replace it with an artificial device. Total artificial hearts are intracorporeal devices designed for this purpose. Unfortunately, some patients are too small or are, for other reasons, ineligible for a total artificial heart. We describe the case of a 55-year-old woman who had ischemic cardiomyopathy and thrombus formation in all 4 cardiac chambers. To reduce the risk of thromboembolic events, we elected to replace her heart completely with 2 extracorporeal ventricular assist devices. The heart was excised via a median stemotomy approach, and the outflow cannulae (from device to patient) were connected to both atrial remnants. The 2 inflow cannulae (from patient to device) were anastomosed end-to-end to the aorta and the pulmonary artery, respectively. After attaining a flow of more than 5 L, the 2 extracorporeal assist devices effectively and efficiently performed the work of the native heart. Thus re-established, organ perfusion was improved by this mechanically driven circulation, as signified by an initial decrease in creatinine and blood urea nitrogen levels. The patient, however, did not recover from postoperative neurological dysfunction and died of respiratory insufficiency and multiple-organ failure on the 26th postoperative day.- - - - - - - - - - ranking = 0.00080209598663819keywords = dysfunction (Clic here for more details about this article) |
9/13. Coagulation management of a patient with factor v Leiden mutation, lupus anticoagulant, and activated protein c resistance: a case report.Although patients undergoing cardiac surgery often present with diverse comorbidities, those with coagulation derangements are especially challenging. The present report describes the management of a patient who presented with a factor v Leiden mutation, lupus anticoagulant, and acquired activated protein c resistance. A 42-year-old female presented with acute shortness of breath and chest pain. She was otherwise healthy 1 month prior to admission when she presented with dysfunctional uterine bleeding, resulting in the transfusion of three units of packed red blood cells. Coagulation evaluation revealed that the patient had lupus anticoagulant, factor v Leiden mutation and an activated protein c resistance. The patient presented with an acute myocardial infarction and was found to have 90% stenosis of her left main coronary artery, moderate mitral and tricuspid regurgitation, and a left ventricular ejection fraction of 25%. An emergent off-pump coronary artery bypass procedure with placement of a vein graft to the left anterior descending artery was completed. Intraoperative thrombophilia was encountered as evidenced by both an elevated thromboelastograph coagulation index ( 3.6) and an acquired antithrombin-III deficiency. Postoperatively, the patient was placed on low molecular weight heparin, but developed heparin-induced thrombocytopenia and was switched to a direct thrombin inhibitor, argatroban. The following case report describes the coagulation management of this patient from the time of admission to discharge 43 days later, and the unique challenges this combination of hemostatic defects present to the clinicians.- - - - - - - - - - ranking = 0.00080209598663819keywords = dysfunction (Clic here for more details about this article) |
10/13. Two adults requiring implantable defibrillators because of ventricular tachycardia and left ventricular dysfunction caused by presumed Kawasaki disease.There is an adult patient population in japan with undiagnosed coronary artery lesions caused by Kawasaki disease (KD) occurring before 1967, the time at which KD was first described. Two adult patients presented with a low left ventricular (LV) ejection fraction and ventricular tachycardia (VT) caused by presumed KD. A 43-year-old man with rapid VT had a history of an acute febrile illness with desquamation of the fingertips at the age of 10 months. coronary angiography (CAG) showed segmental stenosis of the right coronary artery (RCA) and occlusion of the left anterior descending artery with a giant aneurysm. The other patient was a 48-year-old man with a history of ischemic cardiomyopathy diagnosed after a previous myocardial infarction when he was 32 years old. He had segmental stenosis of the RCA on CAG. Non-sustained VT with transient unconsciousness was observed during 24-h Holter electrocardiography. Rapid VT with syncope was induced in both patients in the electrophysiologic studies and an implantable defibrillator was required to prevent sudden death. physicians must be aware that VT can occur in older patients with LV dysfunction many years after KD.- - - - - - - - - - ranking = 2.0008020959866keywords = ventricular dysfunction, left ventricular dysfunction, dysfunction (Clic here for more details about this article) |
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