A 42-year-old male with a history of end-stage heart failure secondary to idiopathic cardiomyopathy diagnosed in 1998, with severely dilated left ventricle, was treated with enalapriloc, 20% end-stage, hydrochlorothiazide and hydrochlorothiazide.
The right heart sound showed a pulmonary vascular resistance of 2.1 Wood units (UW).
In January 2006, she suffered a sudden death from a ventricular tachycardia that degenerated into a ventricular fibrillation, of which she was successfully resuscitated.
Under these conditions, the patient was transferred to our center under intravenous amiodarone infusion.
Due to his heart disease and his very poor ventricular function, he was included in the waiting list for cardiac transplantation.
During the waiting period of a donor, a bilayer was implanted.
In the following months, the patient presented a significant clinical deterioration that led to a FC III.
In April 2006, a new right catheterization revealed an increase in PVR at UW, reaching 7.3 WU in August 2006, which determined to add sildenafil to treatment (25 mg every 8 h).
Fifteen days later, the hemodynamic study was repeated to evaluate reversibility.
Baseline PVR was 4.3 WU, which decreased to 2.26 WU with sodium nitroprusside infusion.
The patient was admitted in October 2006.
The CPB time was 215 min, with a total graft ischemia time of 178 min. Upon removal of the CPB, a severe pulmonary hypertension was evidenced that caused a right ventricular failure catastrophic balloon pump, which required aortic balloon pump.
During the immediate postoperative period in the Maximum Heart Failure Treatment Unit (CVC), he required vasopressin doses: noradrenaline 0.1 mcg/kg/min; dopamine 0.1 mcg/kg/kl/min;
APD remained 1:1 and AVD between 2000 and 2,500 RPM.
Additionally, 0.1 mcg/kg/min for 24 h was administered through continuous infusion; prostaglandin 0.01 mcg/kg/min; sildenafil 50 mg via orogastric route.
The treatment described remained unchanged during the first 72 h, which allowed an improvement in the hemodynamic condition, so inotropic support could be withdrawn.
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At 48 h postoperatively, progressive ADL withdrawal was initiated, decreasing support from 2000 to 1400 PMR.
On the third day, it was possible to reduce from 1,400 to 1,000 RPM.
The ADL was surgically removed on the fifth day in the operating room.
The progressive clinical stabilization allowed the withdrawal of the PACU on day 6 and its extubation of ADL on day 7.
On the 9th day after cardiac transplantation, the patient was discharged from the CVICU to the Cardiovascular Intermediate Care Unit with oral treatment.
At the 3 week, the patient was discharged from the hospital with FC I, without pulmonary hypertension or right ventricular failure.
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DESCRIPTION OF THE TECHNIQUE OF DERECY MECHANICAL VENTRICULAR ASSISTANCE
In both cases, the ADL technique was performed by surgically connecting a Ne 24 Pacific cannula to the right atrium (RA) and a curved Argyle cannula Ne 22 in the pulmonary artery trunk.
These were exteriorized by endoscopy.
The extracorporeal circuit was connected to the cone of the centrifuge through 2 120 cm long extensions, thus allowing the blood of the pulmonary artery to aspirate through the effect towards the pulmonary artery.
The optimal flow delivered by the centrifuge could be obtained by measuring cardiac output by Doppler, as well as by adjusting the system's MPR.
Associated with the procedure, both patients were referred to the CVICU where they were closely monitored for adequate control of the centrifugal output and adjusted for inotropic drugs according to the hemodynamic response obtained.
The partial thromboplastin time (TTPK) was maintained between 50 and 70 s in order to avoid postoperative bleeding.
The centrifugal pumps used were Sarns, Delphin model (3 M, Ann Arbor, Mi) in the first case, and Biomedicus (Eden Prairie MN) in the second case.
