[Show abstract][Hide abstract] ABSTRACT: An Incor (Berlin Heart AG, Berlin) left ventricular assist device (LVAD) was implanted; 6 months later the patient was admitted to our department for intravenous antibiotic therapy for a driveline infection. Two days after admission under direct echocardiographic monitoring, the pump failure was noted to be entirely dependent on the position of the cable. The pump was successfully replaced without cardiopulmonary bypass as a matter of urgency.
ASAIO journal (American Society for Artificial Internal Organs: 1992) 01/2009; 55(1):121-2. DOI:10.1097/MAT.0b013e3181906e2a · 1.52 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Axial flow pumps have gained increased acceptance in recent years as a bridge to heart transplantation and, more recently, as destination therapy. As left ventricular (LV) assist device dysfunction will be increasingly prevalent, the aim of our work was to introduce an echocardiographic management protocol as a guide to recognize the causes of pump failure. In this article we describe the echocardiographic approach to 5 episodes of malfunction of an axial flow pump (DeBakey, MicroMed Technology Inc, Houston, Tex) in 4 patients: 4 episodes caused by thrombosis of LV assist device and one caused by abnormal increase of systemic vascular resistance. In our experience, echocardiography played a pivotal role in clinical management of LV assist device failure. It allowed us to: assess patency and position of inflow and outflow cannulae; research the source of thromboembolic material; assess adequate LV filling and unloading; and optimize right ventricular function, volume replacement therapy, and pharmacologic support.
Journal of the American Society of Echocardiography: official publication of the American Society of Echocardiography 01/2006; 18(12):1422. DOI:10.1016/j.echo.2005.04.011 · 4.06 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: The worsening evolution of patients undergoing surgical myocardial revascularization makes it difficult the stratification of the preoperative mortality risk, a correct evaluation of results and the comparison of results of different centers. The aim of the study was to evaluate the prognostic weight of comorbidity in surgical myocardial revascularization.
We evaluated the characteristics of preoperative morbidity in 4999 patients who underwent surgical myocardial revascularization during four different periods (1979-1980, 1991-1992, 1994-1998, 1999-2002). We also evaluated the in-hospital results.
By comparing the four different periods, an increase in older age, female sex, comorbidity, three-vessel disease, and severe left ventricular dysfunction was observed. Surgical mortality decreased to 2.3%. Multivariate analysis of the 1999-2002 period showed that only renal insufficiency was a risk factor for in-hospital mortality.
Although the preoperative risk is higher, nowadays hospital mortality is reduced thanks to new cardiac-surgical techniques and approaches that increasing the capacity of controlling comorbidity in the pre-, intra- and postoperative course. For a correct decision-making process it is crucial to assess how much comorbidity may influence the long-term follow-up in these patients independently of surgical myocardial revascularization.
Italian heart journal. Supplement: official journal of the Italian Federation of Cardiology 06/2004; 5(5):376-81.
[Show abstract][Hide abstract] ABSTRACT: This paper describes the transesophageal echocardiographic "oblique transgastric" view to assess the right ventricular inflow-outflow tract. With this approach it is possible to view the right atrium, tricuspid valve, right ventricular inflow and outflow tracts, and the main pulmonary artery. In 2 clinical cases we evaluated the clinical feasibility of this approach in the diagnostic phase; in 31 patients who underwent cardiac transplantation we examined the advantages of this noninvasive hemodynamic monitoring. An advantage of transgastric view compared with esophageal standard views at 30-60 degrees, is the feasibility to obtain the velocity-time integral of the outflow tract systolic flow to calculate cardiac output by the pulsed Doppler sample volume orientation, which in this view is parallel to pulmonary arterial flow; moreover, it is possible to evaluate pulmonary artery pressures from pulmonary and tricuspid regurgitation.
Italian heart journal. Supplement: official journal of the Italian Federation of Cardiology 04/2004; 5(3):225-9.