Pulmonary Artery Pulsatility Index Predicts Right Ventricular Failure Post-LVAD Implantation in Ischemic Cardiomyopathy
Salil KumarJ.S. JosephsKavali Samanth KumarOmar SaeedSnehal R. PatelS. MurthyJ. ShinS. ForestDaniel J. GoldsteinUlrich P. JordeDaniel B. Sims
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Ischemic Cardiomyopathy
Pulsatility index
補助人工心臓 (VAD) は末期心不全に対する外科治療として有効とされ，心臓移植までのブリッジやdestination therapy として使用されている．しかしながら，日本では極端なドナー不足や VAD の使用制限などの臓器移植システムに問題がある．最近まで認可がおりていたのは体外式補助人工心臓 (NIPRO VAD) のみであった．本研究では，NIPRO VAD を用いた左室補助人工心臓 (LVAD) の結果を報告する．2006 年から 2009 年までに 8 例に NIPRO 型 LVAD が植え込まれた．急性心筋梗塞による心原性ショックに対する LVAD の治療成績は不良であったが，劇症型心筋炎や心臓移植までの橋渡し治療として，LVAD 治療は有効であった．
Destination therapy
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Thoracotomy
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Stem cell therapy for heart failure is a rapidly progressing field. The objective of this study was to assess the safety, and short-term results of thoracoscopic direct injection of angiogenic cell precursors into patients with endstage cardiomyopathy. Cells were obtained from the patient's own blood, avoiding immunological concerns. The number of cells prior to injection was 29.1 ± 18.9 ×10 6 . Forty-one patients with cardiomyopathy (mean age, 58.5 ± 14.3 years) underwent stem cell injection; 21 had dilated cardiomyopathy and 20 had ischemic cardiomyopathy. Overall ejection fraction improved significantly by 4.8% ± 7.5% at 149 ± 98 days postoperatively. It increased from 25.9% ± 8.6% to 28.7% ± 9.8% in dilated cardiomyopathy, and from 26.6% ± 5.8% to 33.6% ± 7.8% in ischemic cardiomyopathy. New York Heart Association functional class was significantly better at 2 months in both groups. It was concluded that thoracoscopic intramyocardial angiogenic cell precursor injection is feasible and safe in patients with cardiomyopathy. The early results are good, and phase II trials are in progress.
Ischemic Cardiomyopathy
Dilated Cardiomyopathy
Restrictive cardiomyopathy
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Microaxial Flow Left Ventricular Assist Device as a Bridge to Transplantation after LVAD Malfunction
Evolving technology and improvements in the design of modern, continuous-flow left ventricular assist devices have substantially reduced the rate of device malfunction. As the number of implanted devices increases and as survival prospects for patients with a device continue to improve, device malfunction is an increasingly common clinical challenge. Here, we present our initial experience with an endovascular microaxial flow left ventricular assist device as a successful bridge to transplantation in a 54-year-old man who experienced left ventricular assist device malfunction.
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To evaluate pregnancy outcome in patients with increased uterine artery (UtA) pulsatility at 34 weeks' gestation as an isolated finding.Normotensive women attending at 34 weeks' gestation for fetal growth assessment were enrolled in the study if fetal growth was appropriate for age and mean UtA pulsatility index (PI) was persistently above the 95(th) centile for gestational age. Patients were excluded with any of the following conditions: multiple pregnancy, sonographic suspicion of fetal anomaly or fetal growth restriction, history of chronic maternal disease, hypertensive disorder or diabetes in the current pregnancy or one or more adverse events in their past obstetric history. The control group consisted of age- and body mass index-matched low-risk women attending at 34 weeks with normal uterine artery Doppler since the midtrimester.Sixty-six normotensive patients with normal fetal growth and increased UtA-PI at 34 weeks were included in the study group. Women with abnormal Doppler findings compared with controls showed significantly lower gestational age at delivery (38.2 ± 1.6 vs. 38.9 ± 1.3 weeks, P = 0.006), birth weight (2942 ± 583 vs. 3404 ± 469 g, P < 0.001), birth-weight Z-score (-0.61 ± 1.07 vs. 0.19 ± 1.05, P < 0.001) and increased risk of a small-for-gestational-age (SGA) newborn (13/66 vs. 1/66, P < 0.001). The occurrence of late pre-eclampsia (3/66 vs. 0/66, P = 0.24), admission to the neonatal intensive care unit (6/66 vs. 4/66, P = 0.74), rate of induction of labor (16/66 vs. 14/66, P = 0.83) and rate of Cesarean section due to fetal distress (6/66 vs. 3/66, P = 0.49) were comparable between the two groups.Increased UtA-PI as an isolated finding at 34 weeks' gestation is associated with an increased risk of delivering an SGA neonate.
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The application of transcranial Doppler ultrasound to the diagnosis of blocked ventriculo-peritoneal shunts was studied in 63 children. Thirty two of these required shunt revision, whereas in 31 children symptoms resolved without surgery. The group of children requiring shunt revision had a significantly higher mean Gosling pulsatility index, than both the group of children whose symptoms resolved and a group of age-matched controls (p less than 0.001). Those with a raised pulsatility index were more likely to have higher intracranial pressure. There was no correlation between CT scan changes and the pulsatility index.
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Transcranial Doppler
Anterior cerebral artery
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A 46-year-old man with a continuous flow left ventricular-assist device implanted as destination therapy 2 years ago (CF-LVAD; HeartMate II, Thoratec Corporation, Pleasanton, CA, USA) presented with syncope, low flow device alarms, and several brief device stoppage events. The patient had been off anticoagulation (warfarin, International Normalized Ratio goal of 2.0–2.5) and anti-platelet agent (aspirin, 81 mg daily) for 5 months due to a large …
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Kinam Shin, M.D., Won Chul Cho, M.D., Ph.D., Nara Shin, M.Sc., Hong Rae Kim, M.D., Min-Seok Kim, M.D., Ph.D., Cheol Hyun Chung, M.D., Ph.D., Sung-Ho Jung, M.D., Ph.D.. J Chest Surg -0001;0:. https://doi.org/10.5090/jcs.23.135
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