RESUMEN
Three children aged 11 months, and eight and nine years were supported with a Hemopump as a potentially life saving measure for circulatory failure. Left ventricular assist time ranged from 10 to 32 h. None of the three patients could be successfully weaned from the device because of complications of bleeding, arrhythmia or neurological insult. Despite poor outcomes, each patient demonstrated important hemodynamic stabilization with the device. The Hemopump is suggested as a potentially life saving treatment modality for selected pediatric patients who have critical left ventricular failure.
Asunto(s)
Corazón Auxiliar , Disfunción Ventricular Izquierda/terapia , Canadá , Niño , Femenino , Humanos , Lactante , Radiografía Torácica , Disfunción Ventricular Izquierda/diagnóstico por imagenRESUMEN
The outcome of stent implantation for children with pulmonary venous obstruction has been characterized by late reocclusion associated with a marked vessel neointimal proliferation. The purpose of this study was to compare the responses of the systemic vein and pulmonary vein to the presence of an intravascular stent, using a Yorkshire swine (N = 10) model. Under cardiopulmonary bypass, a single Palmaz stent was placed in the inferior vena cava (IVC) and right lower pulmonary vein (PV) with sacrifice at 4.9-6.1 months. Angiography and hemodynamic data were determined at 1 and 3 months post-stent implant and prior to euthanasia. All stents were found to be patent, with no difference in degree of thrombosis or neointimal formation. No statistical difference was found in the initial and final stent diameter for both inferior vena cava and pulmonary vein stents (PV initial 6.8 +/- 0.9; final 7.1 +/- 0.6) (IVC initial 10.4 +/- 1.2; final 10.4 +/- 1.2). Electron microscopy demonstrated smooth endothelialization of both pulmonary and systemic venous stent devices. No thrombosis was found on gross morphology. The data indicate that there is no intrinsic difference in the response of the pulmonary vein to the presence of a stent device. The clinical experience of restenosis following stent implantation for pulmonary vein stenosis appears to be more related to variables of final stent diameter combined with the marked intrinsic abnormal vessel architecture, as seen with this condition.
Asunto(s)
Hemodinámica/fisiología , Enfermedad Veno-Oclusiva Pulmonar/terapia , Stents , Angiografía , Animales , Endotelio Vascular/patología , Diseño de Equipo , Microscopía Electrónica de Rastreo , Venas Pulmonares/patología , Venas Pulmonares/fisiopatología , Enfermedad Veno-Oclusiva Pulmonar/patología , Enfermedad Veno-Oclusiva Pulmonar/fisiopatología , Propiedades de Superficie , Porcinos , Vena Cava Inferior/patología , Vena Cava Inferior/fisiopatologíaRESUMEN
Many heart centers are utilizing the total artificial heart for a bridging technique to transplantation, particularly in patients with bi-ventricular failure or irreversible left ventricular failure, where a donor heart is not readily available. This discussion includes the training procedure, operation and management of Canada's first total artificial heart performed on May 1, 1986.