A 57-year-old female patient underwent combined off-pump coronary artery bypass grafting and abdominal aortic aneurysm replacement. Anesthesia was maintained with propofol, fentanyl, and thoracic epidural anesthesia. Propofol doses were adjusted to maintain bispectral index (BIS) between 40-60. Despite the remarkable hemodynamic changes, BIS remained stable at about 50 during the surgery. The average dose of propofol was 3.3 mg.kg-1.hr-1. The patient awoke an hour after the surgery and was extubated 1.5 hours thereafter. This case report suggests that BIS is a useful index to determine the depth of anesthesia during surgeries which induce marked hemodynamic changes.
A 31-year-old woman with primary mediastinal large B-cell lymphoma refractory to conventional chemotherapy was treated with high-dose chemotherapy containing cyclophosphamide (CY). Subsequently, she was treated with auto peripheral blood stem cell transplantation. Although a complete remission was obtained, heart failure developed two months later. Echocardiography showed an impaired systolic function with pericardial effusion. A biopsy of the endomyocardial region from the left ventricle demonstrated spotty myocardial hemorrhage and myocardial fibrosis with disruption and aggregation of mitochondrial cristae. Based on these findings, CY-induced cardiotoxicity was diagnosed. The patient was treated with conventional therapy for heart failure, which required approximately one year to improve her condition.
Although the prognosis for patients with stress-induced cardiomyopathy (Takotsubo cardiomyopathy) is relatively good, some patients with this syndrome develop torsades de pointes, which can be fatal. The present report describes a patient with Takotsubo cardiomyopathy and torsades de pointes induced by premature atrial contraction associated with QT interval prolongation, hypokalemia and hypomagnesemia.
Aim We evaluated the effect of pimobendan, a positive inotropic agent, in elderly patients with frequent readmission as a result of heart failure despite conventional therapy. Methods Pimobendan was given to five male patients with severe chronic heart failure ( N ew Y ork H eart A ssociation class III – IV ) (age range 69–89 years; mean 78 ± 8 years; ischemic cardiomyopathy in three cases, dilated cardiomyopathy in two cases) who required repeated admission for heart failure despite conventional therapy with angiotensin inhibitors, beta‐blockers, diuretics and anti‐arrhythmic agents. After the addition of pimobendan at a dose of 1.25–3.75 mg/day, we evaluated serum levels of brain natriuretic peptide ( BNP ), left ventricular ejection fraction ( LVEF ), septal e′ and left ventricular end‐diastolic diameter ( LVDD ) by echocardiography, as well as readmission rates for more than 2 years. Results The serum level of BNP significantly decreased after treatment with pimobendan, although its level returned to pretreatment levels after 2 years. LVEF significantly improved after the treatment, with the improvement continuing beyond the 2 years, although LVDD did not change after treatment. Septal e′ significantly improved after the treatment, although its level returned to pretreatment levels at 2 years after the treatment. Readmission rates significantly decreased for 2 years after the treatment, although one patient required cardiac resynchronization therapy for severe heart failure, and another patient required cardiac pacemaker implantation for sick sinus syndrome 2 years after adding pimobendan. Conclusions Pimobendan in conjunction with conventional therapy for heart failure decreases the readmission rate in elderly patients with severe heart failure for at least 2 years. Geriatr Gerontol Int 2014; 14: 109–114.
The rupture of spontaneous dissecting coronary artery pseudoaneurysms is rare, and no standard therapy has yet been established for this condition. This report describes a case of a ruptured spontaneous dissecting coronary artery pseudoaneurysm in a patient with cardiac tamponade that was successfully treated with emergent implantation of a covered stent.
We report a 16-year-old man with severe heart failure due to idiopathic pulmonary arterial hypertension (IPAH). The patient was initially treated with a combination of beraprost, a prostacyclin analog, and sarpogrelate, a serotonin receptor inhibitor. However, he was unresponsive to the treatment. We then changed the treatment to sildenafil, and his condition dramatically improved. Sildenafil has an immediate pulmonary vasodilator effect in patients already receiving vasodilators for IPAH.
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