scholarly journals A tale of three pumps and a mechanical heart

2020 ◽  
Vol 8 ◽  
pp. 2050313X2094054
Author(s):  
Tarek Omran ◽  
Cornelia S Carr ◽  
Lateef Wani ◽  
Imad Mahmoud ◽  
Rula Taha ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Left Ventricular ◽  
Circulatory Support ◽  
Acute Type ◽  
Ventricular Assist ◽  
Type A Aortic Dissection ◽  
Satisfactory Outcome ◽  
Left Ventricular Assist ◽  
Mechanical Circulatory Support Device

Temporary mechanical circulatory support device (tMCS) failure could qualify patients with advanced heart failure to receive a long-term solution. We report on a patient who presented with cardiorespiratory arrest that required a tMCS and developed acute type A aortic dissection. Data Sources: our case adds further evidence regarding the support of a patient with a second (or more) incidence of tMCS. This patient subsequently underwent left ventricular assist device insertion and type A aortic dissection repair, as a combined procedure, with a satisfactory outcome.

scholarly journals Successful treatment of an acute type A aortic dissection presented with ST segment elevation on ECG and pericardial tamponade. Case report

2014 ◽  
Vol 155 (44) ◽  
pp. 1763-1767
Author(s):  
Miklós Pólos ◽  
Zoltán Szabolcs ◽  
Astrid Apor ◽  
István Édes ◽  
Erzsébet Paulovich ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Successful Treatment ◽  
Acute Aortic Dissection ◽  
Type A ◽  
Pericardial Tamponade ◽  
Left Ventricular ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
St Segment Elevation ◽  
St Segment

Successful treatment of type A acute aortic dissection depends on the promptness of diagnostic evaluation and therapy. Fast diagnosis can be challenged by numerous complications such as myocardial ischemia, acute aortic insufficiency, and disturbances in organ perfusion and pericardial tamponade. The authors report the case history of a 72-year-old woman, who was admitted after resuscitation with ST segment elevation. Echocardiography revealed acute type A aortic dissection with signs of pericardial tamponade. An emergency operation consisting of the resection of the ascending aorta and the reconstruction of the aortic root was performed, which took six hours from admission until the end of the operation. Follow-up examinations demonstrated good left ventricular function and competent aortic valve. The authors propose that with the development of diagnostic and therapeutic options, faster and less invasive interventions will be introduced in near future for the treatment of acute aortic dissection, which may reduce the morbidity and mortality rates of this lethal illness. Orv. Hetil., 2014, 155(44), 1763–1767.

A case of acute type A aortic dissection with diastolic prolapse of the intimal flap into the left ventricular outflow tract

Choonpa Igaku ◽  
2009 ◽  
Vol 36 (4) ◽  
pp. 497-499
Author(s):  
Fumihiko HARA ◽  
Masahiko HARADA ◽  
Koichi YOSHIKAWA ◽  
Kyoko HAYASHI ◽  
Yuichi TAKARADA ◽  
...  
Keyword(s):  
Aortic Dissection ◽  
Left Ventricular Outflow Tract ◽  
Type A ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Outflow Tract ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Intimal Flap ◽  
Left Ventricular Outflow

The HeartMate II™ Continuous-Flow Left Ventricular Assist System

2019 ◽  
pp. 70-77
Author(s):  
David J. Farrar
Keyword(s):  
Left Ventricular ◽  
Circulatory Support ◽  
Left Ventricular Assist System ◽  
Heartmate Ii ◽  
Ventricular Assist ◽  
Pump Speed ◽  
System P ◽  
Left Ventricular Assist ◽  
Mechanical Circulatory Support Device ◽  
End Stage

The HeartMate II™ Left Ventricular Assist System has been implanted in more than 26,000 patients and is the most widely used and studied durable mechanical circulatory support device in patients with advanced heart failure. The device is intended for use as bridge to transplantation in candidates at risk of imminent death from non-reversible left ventricular (LV) failure and for destination therapy for use in patients with end-stage LV failure. This chapter describes each component of the system, the mechanisms of the pump itself, the physiology of blood flow under different pump speeds and pressure gradients, and ways to prevent pump thrombus. In addition, the functions and interface of the System Controller and System Monitor are detailed, including the settings displayed on the monitor and the type of alarms provided, as well as their appearance on the interface. The chapter closes with a discussion of how a ramped-speed study using echocardiography and hemodynamic assessment can identify the pump speed that provides the desired level of cardiac support for each patient.

scholarly journals Systolic anterior motion of the mitral valve associated with acute type A aortic dissection: a case report describing one-step surgery of ascending aortic replacement and interventricular septal myectomy

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Naoki Yamamoto ◽  
Koji Onoda
Keyword(s):  
Aortic Dissection ◽  
Type A ◽  
Left Ventricular ◽  
Acute Type ◽  
Systolic Anterior Motion ◽  
Type A Aortic Dissection ◽  
Septal Myectomy ◽  
Aortic Replacement ◽  
Ascending Aortic Replacement ◽  
One Step

Abstract Background Systolic anterior motion of the mitral valve associated with acute type A aortic dissection is rare in daily clinical practice. The prevention of systolic anterior motion is important, because once it occurs, the hemodynamics may become unstable, leading to a critical situation. In the surgical procedure to treat systolic anterior motion, the prevention of new iatrogenic aortic intimal tears is important in the context of acute type A aortic dissection. Case presentation We present a case of systolic anterior motion in a 68-year-old woman with an acute type A aortic dissection and suspected acute relative adrenal insufficiency. Preoperative transthoracic echocardiography revealed left ventricular outflow tract obstruction due to systolic anterior motion without left ventricular hypertrophy and interventricular septal bulging due to a narrow aorto-mitral angle. We successfully performed a one-step surgery for ascending aortic replacement and interventricular septal myectomy using the needle stick technique for the treatment of systolic anterior motion. Conclusions Concomitant interventricular septal myectomy using the needle stick technique with thoracic aortic replacement is a safe and feasible technique. Interventricular septal myectomy may be effective in preventing postoperative unstable hemodynamics due to systolic anterior motion in the management of acute aortic dissection.

scholarly journals Low arterial pressure on admission as a predictor of mortality in operated patients with type A aortic dissection

2011 ◽  
Vol 68 (5) ◽  
pp. 410-416 ◽  
Author(s):  
Katica Pavlovic ◽  
Nada Cemerlic-Adjic ◽  
Aleksandra Jovelic ◽  
Dalibor Somer
Keyword(s):  
Blood Pressure ◽  
Aortic Dissection ◽  
Arterial Hypertension ◽  
Type A ◽  
Left Ventricular ◽  
Ascending Aorta ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
History Of ◽  
Aorta Diameter

Background/Aim. Hypertension is a known predictor of proximal aortic dissection, but it is not commonly present in these patients on presentation. The associations between ascending aorta with left ventricular hypertrophy, cardiovascular risk factors and coronary atherosclerosis, and outcome of these patients are not fully elucidated. Methods. This retrospective study included 55 consecutive patients with acute type A aortic dissection treated surgically in our institution during the last 2 years. The diagnosis was based on imaging studies. Diameter of ascending aorta was measured with echocardiography. Results. The mean age of the patients was 55.4 ? 12.19 years, and 72.7% were men. A history of arterial hypertension was present in 76.4% of the patients. Maximal ascending aorta diameter was 4.09 ? 0.59 cm, while patients with frank aneurysm accounted for 5.5%. Systolic blood pressure on admission was < 150 mmHg in 58.2% of the patients. Diastolic blood pressure on admission was < 90 mmHg in 54.5% of the patients. Mean arterial pressure on admission was 104.9 ? 24.6 mmHg. No correlations were demonstrated between maximal ascending aorta diameter and diameter of the left ventricular wall, any obtained risk factor and with coronary artery atherosclerosis (p > 0.05). After six months 11 (20%) patients died, while intrahospital mortality was 72%. According to logistic regression analysis which included traditional risk factors, echo parameters, coronary artery disease and logistic euro scor, mean arterial blood pressure was the independent predictor of a six-month mortality [RR 0.956; CI (0.918-0.994 ); p = 0.024]. Conclusion. In our population the acute type A aortic dissection occurred rarely in the setting of frank ascending aortic aneurysms > 5.0 cm. The majority of patients had a history of arterial hypertension. A history of arterial hypertension was not associated with maximal ascending aorta diameter. Mean arterial blood pressure was the independent predictor of a six-months mortality.

scholarly journals Shone’s Complex and Aortic Dissection: Case Report and Review of a Rare, Underdiagnosed Congenital Heart Disease

2021 ◽  
Author(s):  
Steven Sinfield ◽  
Sachini Ranasinghe ◽  
Stephani Wang ◽  
Fernando Mendoza ◽  
Ali Khoynezhad
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Aortic Dissection ◽  
Atrial Flutter ◽  
Congenital Heart ◽  
Type A ◽  
Left Ventricular ◽  
Acute Type ◽  
Type A Aortic Dissection ◽  
Patient Prosthesis Mismatch

Abstract BackGround Shone’s complex is a rare congenital heart disease consisting of a variety of left ventricular inflow and outflow tract lesions. Patients typically present in childhood and require early surgical intervention. However, with improved surgical techniques these patients are surviving later into adulthood which comes with a new set of medical complications providers need to be aware of. Case Presentation We present a case of a patient with a complex cardiac history including an incomplete Shone’s complex diagnosed in childhood with multiple surgical interventions who presents with persistent symptomatic atrial flutter and a type A aortic dissection in the setting of severe patient prosthesis mismatch. The patient was being followed outpatient for an enlarging chronic aortic aneurysm and was non-compliant with his medications when he presented with sharp chest pain radiating to his back. He was found to have an acute type A aortic dissection and was taken emergently to the operating room for a skirted Bentall procedure, aortic valve replacement, and right sided MAZE. Conclusions Shone’s complex is a rare congenital heart disease associated with significant morbidities in adulthood, such as atrial flutter, patient prosthesis mismatch, and aortic dissection. As patients continue to live longer into adulthood with this disease, it is important to raise awareness of this rare syndrome for providers and highlight its potential complications. Further research is needed to determine appropriate guidelines for when to intervene on aortopathy-associated CHD.

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