Search

Patients who suffer morbid obesity and heart failure (HF) present unique challenges. Two cases are described where concomitant use of laparoscopic sleeve gastrectomy (LSG) and left ventricular assist device (LVAD) placement enabled myocardial recovery and weight loss resulting in explantation. A 29‐year‐old male patient with a body mass index (BMI) of 59 kg/m2 and severe HF with a left ventricular ejection fraction (LVEF) of 20–25% underwent concomitant LSG and LVAD placement. Sixteen months after surgery, his BMI was reduced to 34 kg/m2 and his LVEF improved to 50–55%. A second 41‐year‐old male patient with a BMI of 44.8 kg/m2 with severe HF underwent the same procedures. Twenty‐four months later, his BMI was 31.1 kg/m2 and his LVEF was 50–55%. In both cases, the LVAD was successfully explanted and patients remain asymptomatic. HF teams should consult and collaborate with bariatric experts to determine if LSG may improve the outcomes of their HF patients. [ABSTRACT FROM AUTHOR]

A growing number of patients have undergone the Mustard procedure for transposition of the great arteries, after which the morphologic right ventricle serves as the systemic ventricle. If this ventricle fails, ventricular assist device support may be necessary, but implanting the inflow cannula can be challenging in these patients because of the moderator band and trabeculation of the morphologic right ventricle. We describe successful assist device implantation in a 34-year-old patient who had undergone the Mustard procedure in infancy., (© 2012 Wiley Periodicals, Inc.)

Background: In patients with a left ventricular assist device (LVAD), pump-related infection can cause adverse effects that may result in death., Methods: We describe three patients who had infections related to a fistula between the gastrointestinal (GI) tract and the LVAD pocket and who subsequently underwent successful heart transplantation without developing sepsis. In no case did the LVAD-related infection adversely affect the outcome of transplantation., Conclusions: For detecting the fistulas, full upper-GI endoscopy and colonoscopy were superior to other types of diagnostic imaging studies., (© 2012 Wiley Periodicals, Inc.)

Background: Postcardiotomy cardiogenic shock (PCS) is often fatal despite inotropic and circulatory support. We compared our experience with the CentriMag left ventricular assist device (LVAD) for patients with PCS at two time periods: in the operating room (OR) after unsuccessful weaning from cardiopulmonary bypass (CPB) and after transfer to the intensive care unit (ICU)., Methods: We reviewed 22 patients' records (13 men, nine women; age, 65 ± 12 years) who underwent open heart surgery (January 2004 to September 2009) and required LVAD support for PCS despite maximal inotropic and intra-aortic balloon pump (IABP) support. In ten patients who could not be weaned from CPB despite high-dose inotropic therapy (≥ 3 agents) and IABP support, the CentriMag was implanted in the OR (immediate group). The other 12 patients were weaned from CPB with high-dose inotropic therapy and IABP but became increasingly unstable or had a cardiac arrest in the ICU, and the CentriMag was implanted for circulatory support (delayed group)., Results: Preoperatively, the average ejection fraction was 40% ± 12%, the creatinine level was 1.6 ± 0.6 mg/dL, and the European Systematic Coronary Risk Evaluation was 13.1 ± 4.6. The duration of CentriMag support was 5 ± 3 days. The immediate group had significantly better survival (7/10 vs. 2/12, p = 0.027), higher cardiac index (2.4 ± 0.3 L/min/m(2) vs. 1.7 ± 0.3 L/min/m(2), p = 0.001), and lower pulmonary capillary wedge pressure (20 ± 6 mmHg vs. 29 ± 8 mmHg, p = 0.024) than the ICU group. No perioperative complications related to device implantation occurred., Conclusion: In patients with PCS, timely placement of a CentriMag LVAD may increase the chance of eventual recovery. , (© 2011 Wiley Periodicals, Inc.)

Left ventricular pseudoaneurysm is a rare lesion that occurs when a contained free-wall rupture occurs after a transmural myocardial infarction. Such a pseudoaneurysm may be lethal if subsequent rupture or progressive heart failure occurs. We describe a 67-year-old man who, one year after undergoing coronary artery bypass grafting, developed an infero-apical left ventricular pseudoaneurysm between the bases of two papillary muscles without incurring significant mitral regurgitation. This was a highly unusual presentation. We were able to repair the aneurysm and restore normal mitral geometry without causing regurgitation., (© 2010 Wiley Periodicals, Inc.)

We used the Impella Recover LD 5.0 Left Ventricular Assist Device to support a 61-year-old woman with an acute myocardial infarction, compromised pulmonary function, and severe cardiovascular disease during coronary artery bypass grafting (CABG). Off-pump CABG or CABG with cardiopulmonary bypass would have been risky. Our case highlights the usefulness of the Impella Recover LD, which can be inserted into the ascending aorta via a prosthetic graft, for providing hemodynamic support during and after CABG in patients with complex cardiovascular disease. , (© 2010 Wiley Periodicals, Inc.)

Pulmonary pneumatoceles are air-filled, thin-walled cavities that may develop within the lung parenchyma. Pneumatoceles typically develop as a complication of pneumonia, but they may also result from infections, trauma, or positive pressure ventilation. We describe the case of a patient with a left ventricular assist device for whom surgical resection of a large, infected pneumatocele was required. Instead of performing percutaneous drainage, we decided to surgically resect the pneumatocele in order to more effectively clean the upper lobe of the lung and prevent infection of the left ventricular assist device.