Cases reported "Shock, Cardiogenic"

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1/52. 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 In three children cardiac function improved and after up to 21 days mechanical support could be withdrawn.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.
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2/52. Cardiogenic shock due to coronary narrowings one day after a MAZE III procedure.

    A MAZE III procedure was performed on a patient with a small body surface area. On the first postoperative day, the patient developed severe dysfunction of the left ventricle, due to significant narrowings of the right and circumflex coronary arteries in the areas that were cryoablated during the MAZE III procedure. The coronary narrowings were treated by percutaneous transluminal coronary angioplasty (PTCA). At discharge the coronary anatomy was normal again with an almost normal left ventricular function.
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3/52. Diffuse myocardial infarction caused by isolated bilateral coronary ostial stenoses in a young woman: report of a case.

    A young Japanese woman who appeared to be free from any coronary risk factors was admitted to a local hospital with chest pain. Serological tests showed no evidence of inflammation; however, an electrocardiogram revealed diffuse myocardial ischemia and a coronary angiogram demonstrated isolated bilateral coronary ostial stenoses. Moreover, her serum creatine phosphokinase level was high. On the day following admission, the patient developed severe cardiogenic shock, and she was transferred to our hospital where emergency coronary artery bypass grafting with the saphenous veins was performed using retrograde tepid blood cardioplegia. Recovery of cardiac function was immediate and her postoperative course was uneventful. We suspect that fibromuscular dysplasia was the most likely cause of the ostial stenoses in this patient.
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keywords = operative
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4/52. Acute fatal vasoplegia and asystole induced by intravenous amiodarone after cardiopulmonary bypass in a patient with preoperative cardiogenic shock.

    Single dose intravenous amiodarone has been widely used and shown to be effective to treat supraventricular and ventricular arrhythemias in cardiac surgery. We, herein, report a 60-year-old female patient, sustaining cardiogenic shock in the course of percutaneous transluminal coronary angioplasty (PTCA) for unstable angina unrelieved by medication including nitroglycerin, succumbed to a life-saving emergent coronary artery bypass grafting (CABG) operation at the end of cardiopulmonary bypass (CPB) following a 180 mg bolus dose of amiodarone (3 mg/kg) directed at the ventricular arrhythmias, triggered by protamine and unresponsive to lidocaine treatment. Amiodaroneinduced asystole and vasoplegia were thought to be the causation of the failure of resuscitation. The causes of the development of these complications, the potential hazards of its use and the management relative to the consequential complications are reviewed and discussed.
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keywords = operative
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5/52. Emergency coronary surgery: Evolving indications.

    Between December 1970 and October 1973, 74 patients underwent emergency myocardial revascularization for the relief of acute coronary insufficiency. Through our experience in this area, we have established three categories for which we perform emergency surgery. The first of these is cardiogenic shock complicating acute myocardial infarction for which 14 patients underwent emergency saphenous vein grafting. Seven of these patients expired during operation and one died three months after operation. The second category is acute unstable myocardial infarction for which 25 patients received surgery. There were no operative deaths in this group, but two patients died at six weeks and four months after operation. Thrity-five patients were classified as pre-infarctional angina, the third category for which we perform surgery on an emergency basis. There was one operative death and two late deaths at four and ten months in this group of patients. Our experience suggests that immediate coronary angiography and revascularization will improve survival in the three above-named categories.
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ranking = 2
keywords = operative
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6/52. 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.
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keywords = operative
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7/52. Catastrophic consequences of a free floating thrombus in ascending aorta.

    Floating masses in ascending aorta are an uncommon source of embolism. We report the case of a 46-year-old woman, smoker, on synthetic progestagen, with no previous history of thrombotic events, who was admitted to our emergency department for an acute anterior myocardial infarction. Coronary angiogram showed occlusion of left main coronary trunk. Recanalization of the artery was obtained. Ascending aorta angiogram revealed a free floating mass attached to the aortic wall without evidence of aortic dissection. Transesophageal echocardiography confirmed the presence of a pedunculated mobile mass attached to the aortic wall superior to the left coronary ostium. The patient underwent urgent surgery. Intraoperatively a floating thrombus was localized in the posterior wall of ascending aorta. At macroscopical examination aortic wall and leaflets were normal. Post-operative low cardiac output refractory to inotropic drugs and intraaortic balloon counterpulsation required a circulatory assist device. Consequences for the patient were catastrophic in terms of outcome.
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ranking = 2
keywords = operative
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8/52. Giant anastomotic pseudoaneurysm after Bentall operation causing late postoperative cardiogenic shock.

    Pseudoaneurysm of the ascending aorta is a rare but severe complication occurring after composite graft surgery for combined aortic valve and ascending aorta disease. The diagnosis of this condition can be difficult because anastomotic pseudoaneurysms show highly variable clinical features depending on the site of the aortic dehiscence and on the involvement of the surrounding structures. We report an unusual case of a late postoperative aortic graft dehiscence, causing acute right heart failure.
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ranking = 5
keywords = operative
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9/52. Rescue percutaneous coronary intervention immediately following coronary artery bypass grafting.

    Perioperative graft failure after coronary artery bypass graft (CABG) can result in acute myocardial infarction with dire clinical consequences. We report a case of rescue percutaneous coronary intervention immediately after unsuccessful CABG. This approach salvaged the patient from cardiogenic shock and should be recognized as a viable alternative to immediate reoperation for certain patients.
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ranking = 1
keywords = operative
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10/52. Successful use of intra-aortic balloon counterpulsation in the treatment of refractory intraoperative cardiogenic shock.

    Intra-aortic balloon counterpulsation (IABC) has been used successfully in the treatment of shock following myocardial infarction. This report describes eight patients who developed medically refractory cardiogenic shock following cessation of cardiopulmonary bypass and who were treated with IABC. None of the eight became balloon dependent and seven of eight (87.5%) left the hospital doing well. The treatment of refractory intra-operative cardiogenic shock represents a new and additional indication for IABC.
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ranking = 5
keywords = operative
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