1/15. 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.- - - - - - - - - - ranking = 1keywords = vessel (Clic here for more details about this article) |
2/15. 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 = 0.16666666666667keywords = vessel (Clic here for more details about this article) |
3/15. AngioJet thrombectomy and stenting for reperfusion in acute MI complicated with cardiogenic shock.AngioJet thrombectomy (AJ) has been shown to be safe and effective in treatment of acute myocardial infarction (AMI). However, use of AJ has not been studied extensively in AMI with cardiogenic shock (CS). Clinical outcomes in 19 patients with CS and treated with AJ were retrospectively analyzed. Immediate stenting was also performed. Procedure success (final diameter stenosis < 50% and TIMI flow > or = 2) was achieved in 95%, with final TIMI 3 flow in 89%. Clinical success (procedure success without major in-hospital cardiac events) was achieved in 68%. There were five in-hospital deaths and no patients experienced stroke or required emergent bypass surgery. At 30-day follow-up, there were no additional deaths or stroke, and two patients had undergone target vessel revascularization. AJ is relatively safe and effective in the setting of AMI complicated with CS, allowing for immediate definitive treatment. This strategy may offer improved mortality in these high-risk patients.- - - - - - - - - - ranking = 0.16666666666667keywords = vessel (Clic here for more details about this article) |
4/15. Right ventricular involvement in myocardial infarction and cardiogenic shock.CONTEXT: Right ventricular involvement in acute myocardial infarction and cardiogenic shock has received little attention by clinicians and researchers, although its pathophysiology, clinical presentation, and natural history are distinctly different from those of left ventricular infarction and associated cardiogenic shock. Right ventricular shock has important therapeutic implications for the management of patients, which need to be recognised. STARTING POINT: Investigators at the shock Registry (Alice Jacobs and colleagues, J Am Coll Cardiol 2003; 341: 1273-79) evaluated 49 patients with cardiogenic shock predominantly due to right ventricular infarction and compared them with 884 patients with cardiogenic shock and predominantly left ventricular failure. Perhaps surprisingly, these investigators found that the in-hospital mortality of patients with right ventricular shock was not significantly lower than that of patients with left ventricular shock (53% vs 61%, p=0.296), despite the fact that patients with right ventricular shock were younger, with a lower prevalence of previous infarctions, fewer anterior infarct locations, and less multivessel disease. There was a shorter median time between index infarction and diagnosis of shock in patients with right ventricular shock. In multivariate analysis, right ventricular shock was not an independent predictor of lower in-hospital mortality. WHERE NEXT? The unexpectedly high mortality of patients with cardiogenic shock due to predominantly right ventricular infarction challenges the general notion that right ventricular involvement in myocardial infarction has only little relevance for patient's outcome. Therefore, more attention should be given to the detection of right ventricular involvement in acute myocardial infarction and particularly in cardiogenic shock. If right ventricular shock is diagnosed, urgent reperfusion of the infarct related artery and appropriate circulatory support are required.- - - - - - - - - - ranking = 0.16666666666667keywords = vessel (Clic here for more details about this article) |
5/15. myocardial infarction as an uncommon clinical manifestation of intravascular large cell lymphoma.Intravascular large cell lymphoma (IVL) is a very rare variant of non-Hodgkin's lymphoma presenting with puzzling clinical manifestations. There is a predilection for the central nervous system, but the tumour often affects also skin, lung, and kidneys while lymphadenopathy and hepatosplenomegaly are usually absent. myocardial infarction due to IVL has not been reported so far. We here report on a 56-year-old patient who was admitted to our hospital with fever and clinical signs of erysipelas. He had a 6-month history of "collagen vasculitic disease" treated with prednisolone and azathioprine. He received antibiotic treatment, but after transient improvement fever recurred with generalized seizures and myocardial infarction, which required transfer to the intensive care unit where the patient died with signs of an acute cardiogenic shock. autopsy revealed a generalized high-grade B cell lymphoma of IVL type affecting and obstructing small vessels of a variety of tissues including heart, brain and lungs. The tumorous obliteration of small intramyocardial vessels had led to an acute ischaemia with infarction and subsequent signs of myocardial insufficiency. To the best of the authors' knowledge myocardial infarction as a leading symptom of IVL has not been described.- - - - - - - - - - ranking = 0.33333333333333keywords = vessel (Clic here for more details about this article) |
6/15. Salvage from cardiogenic shock by atherectomy after failed emergency coronary artery angioplasty.In this case report of a patient undergoing angioplasty for cardiogenic shock during acute myocardial infarction, recurrent occlusion resulted in recurrence of shock. atherectomy reestablished lasting patency and reversed the patient's hemodynamic collapse. atherectomy deserves further investigation as a means to salvage vessel patency during unsuccessful coronary angioplasty.- - - - - - - - - - ranking = 0.16666666666667keywords = vessel (Clic here for more details about this article) |
7/15. Vascular complications as a result of intra-aortic balloon pumping.Intra-aortic balloon conterpulsation (IABP) was used to assist 109 patients with extensive myocardial infarcts, unstable angina, cardiogenic shock, and unstable cardiodynamic states after cardiopulmonary bypass over a six year period. Severe vascular occlusion occurred in three patients (3%) which required an above the knee amputation. Each patient had a long history of smoking. obesity, atherosclerotic disease of the femoral vessels, and extensive coronary artery disease were additional contributing factors. Two of the three patients survived, but both survivors had extensive postoperative myocardial infarctions. A low flow cardiac state and the presence of atherosclerotic changes in the legs must be precipitating factors for the vascular complications. Several possible methods to minimize complications of this nature include 1) angiographic examination of the lower aorta and femoral arteries at the time of cardiac catheterization, 2) frequent monitoring with ultrasound equipment, and 3) use of anticoagulation during and after the period of counterpulsation.- - - - - - - - - - ranking = 0.16666666666667keywords = vessel (Clic here for more details about this article) |
8/15. Cardiac mortality and morbidity after vascular surgery.To determine the clinical, hemodynamic and pathological features that contribute to major cardiac complications after vascular surgery, six patients with early postoperative cardiogenic shock (group 1) were analysed retrospectively and compared to nine patients without complications (group 2) who were carefully analysed prospectively. Four group 1 patients had elective repair of an abdominal aortic aneurysm, one had repair of a false iliac artery aneurysm and one had a femoropopliteal graft inserted. Four group 2 patients had elective repair of an abdominal aortic aneurysm and five had aortobifemoral reconstruction. The Goldman multifactorial index was similar in both groups and indicated an expected death rate of 2% and a morbidity rate of 5%. In group 1, the earliest sign of cardiovascular compromise was an elevated pulmonary wedge pressure during operation. Postoperatively, electrocardiographic evidence of myocardial ischemia was present in all six patients and preceded cardiogenic shock. autopsy of the four patients who died demonstrated triple-vessel disease in all but recent occlusion in only one patient. There was evidence of extensive subendocardial infarction in all four. angiography of the two survivors in group 1 also demonstrated triple-vessel disease. The authors conclude that by using ordinary clinical methods it is difficult to identify patients likely to have major complications postoperatively. Elevated pulmonary wedge pressures or electrocardiographic evidence of myocardial ischemia may be early warning signs of impending cardiac catastrophe and should be treated aggressively. The underlying pathophysiology appears to be perioperative stress in a setting of severe triple-vessel coronary artery disease.- - - - - - - - - - ranking = 0.5keywords = vessel (Clic here for more details about this article) |
9/15. Immediate coronary bypass following failed streptokinase infusion in evolving myocardial infarction.Since December of 1980, 184 patients with evolving myocardial infarction (EMI) have undergone streptokinase infusion, with associated percutaneous transluminal coronary angioplasty (PTCA) in 68 patients. Emergency coronary bypass was deemed necessary in 24 of these patients. All 24 patients had severe triple-vessel disease and moderate to marked ventricular dysfunction, with eight (33%) requiring intra-aortic balloon pump (IABP) support for profound cardiac decompensation preoperatively. All 24 patients underwent immediate coronary bypass (average 4.1 grafts/patient), with four operative and two late deaths. Average postoperative blood loss was 1,453 ml, and average blood transfusion postoperatively was 8.2 units per patient. Thirteen patients had normal clotting studies immediately postoperatively, and only two patients developed frank coagulopathy (hyperfibrinolysis). Four patients required reexploration; two for coagulopathy, one for surgical bleeding, and one to rule out tamponade (negative). In those patients with EMI in whom streptokinase fails to result in adequate reperfusion, immediate emergency saphenous vein bypass grafting may be performed with reasonable morbidity and with acceptable hematologic consequences.- - - - - - - - - - ranking = 0.16666666666667keywords = vessel (Clic here for more details about this article) |
10/15. Emergency cardiopulmonary bypass support in patients with cardiac arrest caused by myocardial infarction.Emergency percutaneous cardiopulmonary bypass support (PCPS) was instituted in 3 patients with acute myocardial infarction in cardiac arrest refractory to conventional resuscitation measures. All had severe double or triple vessel disease. Percutaneous transluminal coronary angioplasty (PTCA) was performed in 1 patient and PTCA and directional coronary atherectomy (DCA) were performed in the other 2 patients on combined intraaortic balloon pumping (IABP) and PCPS. Flow rates of 2 to 5 L/min were achieved, with restoration of mean arterial pressure to more than 60 mm Hg during PCPS. The status of all patients was improved hemodynamically with PCPS. One patient died of hemorrhage during PCPS. DCA was successfully performed in the other 2 patients, and PCPS and IABP was discontinued. time on PCPS ranged from 10 h to 8 days. time on IABP ranged from 10 days to 2 weeks. These 2 patients died of pneumonia or multiorgan failure after 1.5 months. In conclusion, emergency PCPS is a powerful resuscitative tool that may stabilize the condition of patients in cardiac arrest to allow for definitive intervention.- - - - - - - - - - ranking = 0.16666666666667keywords = vessel (Clic here for more details about this article) |
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