Orthotopic heart transplantation in a patient with D-transposition of the great arteries: after a Mustard procedure.

During heart transplantation, the atrial septum is most often used to reconstruct the right atrial reservoir. We report the case of a patient with corrected D-transposition of the great arteries who underwent successful cardiac transplantation despite the lack of an atrial septum. We then used the donor heart's atrial septum for the roof of the left atrium and used the recipient's left atrium for the back wall of the left atrium.

Posttransplant off-pump coronary bypass and laser revascularization in a Jehovah's Witness.

A 57-year-old man, who had received a heart transplant 14 years earlier, underwent coronary artery bypass grafting and transmyocardial laser revascularization for left main, left anterior descending, and circumflex coronary artery disease. The procedures were performed through a left thoracotomy incision without cardiopulmonary bypass. Because the patient was of the Jehovah's Witness faith, no blood or blood products were transfused.

Left ventricular free wall rupture in acute myocardial infarction: a case report and literature review.

We describe a case of subacute left ventricular free wall rupture during acute myocardial infarction in a 68-year-old man. The diagnosis was confirmed by echocardiography. The patient was supported by an intra-aortic balloon pump until the ruptured wall could be successfully repaired by suturing and gluing a pericardial patch over the defect and bypassing the left anterior descending coronary artery with a vein graft.

Endovascular exclusion of a thoracoabdominal aortic aneurysm after retrograde visceral artery revascularization.

Historically, open surgical repair of thoracoabdominal aortic aneurysms has been associated with high morbidity and mortality rates. Furthermore, endovascular exclusion alone can restrict blood flow to visceral arteries. We report a case of thoracoabdominal aortic aneurysm that was repaired using a hybrid approach: surgery followed by an endovascular procedure.

Total circulatory support with an LVAD in an adolescent with a previous Fontan procedure.

We report the case of a 14-year-old boy who developed ischemic contracture of the heart after open heart surgery to correct complex congenital heart disease. Because he had no cardiac function, an extracorporeal, continuous-flow device was used to support him until he was transferred to our institution. Shortly after his arrival, an implantable, long-term left ventricular assist device was implanted.

Stem celltherapy for ischemic heart failure.

As the prevalence and incidence of ischemic heart disease continue to increase, so does interest in ischemic heart failure management. Limitations of current therapies have led to research aimed at regenerating and repairing ischemically damaged myocardium through stem-cell therapy. Cell types being evaluated include embryonic stem cells, fetal and neonatal cardiomyocytes, skeletal myoblasts, bone marrow stem cells, peripheral blood CD34+ cells, endothelial progenitor cells, cardiac progenitor cells, and fibroblasts.

The effect of LVAD aortic outflow-graft placement on hemodynamics and flow: Implantation technique and computer flow modeling.

Axial-flow ventricular assist devices (VADs) can be implanted either through a left thoracotomy with outflow-graft anastomosis to the descending thoracic aorta or through a midline sternotomy with anastomosis to the ascending aorta. Each method has advantages and disadvantages. Because these VADs produce nonpulsatile flow, their hemodynamic characteristics differ from those of pulsatile devices.

Myocardial thievery: the coronary-subclavian steal syndrome.

Coronary-subclavian steal syndrome entails the reversal of blood flow in a previously constructed internal mammary artery coronary conduit, which produces myocardial ischemia. The most frequent cause of the syndrome is atherosclerotic disease in the ipsilateral, proximal subclavian artery. Although coronary-subclavian steal was initially reported to be rare, the increasing documentation of this phenomenon and its potentially catastrophic consequences in recent series suggests that the incidence of the problem has been underreported and that its clinical impact has been underestimated.

Percutaneous tracheostomy after mechanical ventricular assist device implantation.

Background: Several studies have shown that percutaneous dilational tracheostomy (PDT) is safe and cost-effective for patients recovering from surgery that requires a median sternotomy. We report our experience with PDT in patients receiving mechanical cardiac assistance.

Methods: We reviewed the medical records of all patients who underwent ventricular assist device implantation at our institution between July 2000 and July 2003, and who subsequently required long-term ventilatory support during the same hospital admission.

Aortic pseudoaneurysm.

Reoperative aortic surgery is a therapeutic challenge. We examine a case of reoperative aortic surgery involving a pseudoaneurysm that occurred after surgical treatment of an abdominal aneurysm. A systematic approach to diagnosis, followed by treatment tailored to diagnostic findings, can minimize morbidity.

Pulmonary microthrombi during left ventricular assist device implantation.

Critically ill heart failure patients undergoing left ventricular assist device implantation have alterations in their coagulation profiles; as a result, hemorrhagic complications during the postoperative period are the most common and serious problems during device support of these patients. The use of aprotinin therapy is generally accepted for reducing bleeding after coronary artery bypass grafting procedures, heart transplantation, and insertion of a left ventricular assist device. We describe the case of a patient who had a suprasystemic increase in pulmonary artery pressure, caused by thromboembolic occlusion of the pulmonary arterioles after urgent implantation of a left ventricular assist device.

Vascular thrombosis during support with continuous flow ventricular assist devices: correlation with computerized flow simulations.

Continuous flow pumps are increasingly used to treat severe heart failure. These pumps alter flow physiology by lowering pulsatility in the arterial circulation. In patients with peripheral stenosis, continuous flow pumps may lead to thrombosis of peripheral vessels, possibly predisposing to vascular thrombosis in areas of non-flow-limiting stenosis.

Concomitant brachiocephalic and coronary artery disease: outcome and decision analysis.

Background: In patients with coronary artery disease, concomitant brachiocephalic disease may affect outcome and influence decision making regarding operative staging, technique, and choice of conduit.

Methods: Eighty consecutive patients (mean age, 59.3 years; 60.

Brachiocephalic reconstruction II: operative and endovascular management of single-vessel disease.

Objective: Although the surgical management of brachiocephalic disease is well established, evolving endovascular techniques present new options for treatment. We explored the potential benefits and drawbacks of these interventions in terms of outcome.

Methods: From 1966 to 2004, 391 consecutive patients (43.

Brachiocephalic reconstruction I: operative and long-term results for complex disease.

Objectives: Complex brachiocephalic disease involves multiple vessels and is frequently associated with multisystem atherosclerosis. We reviewed surgical outcome and examined the impact of this problem on decision making regarding operative staging, technique, and choice of conduit.

Methods: Between 1966 and 2000, 157 consecutive patients (mean age, 54.

Left ventricular unloading with an assist device results in receptor relocalization as well as increased beta-adrenergic receptor numbers: are these changes indications for outcome?

Background: The use of left ventricular (LV) assist devices (LVADs) can improve performance and recovery of failing human hearts.

Aim: Following our alpha-adrenergic receptor work, we hypothesized that mechanical unloading in patients with low output syndrome and LV failure would yield similar results with beta-adrenergic receptors ((beta)AR), that being increased numbers and intra-myocytic relocalization.

Methods: (beta)AR density and localization were investigated by fluorescence deconvolution microscopy and compared at LVAD insertion and removal in 13 heart failure patients, the patients therefore acting as their own control.

Alterations in alpha adrenoreceptor density and localization after mechanical left ventricular unloading with the Jarvik flowmaker left ventricular assist device.

Cardiac alpha one adrenoreceptors (alpha(1)AR) are known to mediate positive inotropism in human ventricular myocardium. In the early stages of heart failure, ventricular contractility is maintained by adrenergic stimulation, rennin-angiotensin activation, and other neurohormonal and cytokine system responses. As the disease progresses, however, these compensatory mechanisms cease to provide benefit; ventricular dilation and fibrosis occur and cardiac function deteriorates.

The effect of intermittent low speed mode upon aortic valve opening in calves supported with a Jarvik 2000 axial flow device.

We assessed the effects of an axial flow left ventricular assist device (LVAD) upon aortic valve opening, pump outflow, and biologic and hematologic parameters when operated in intermittent low speed (ILS) mode. An ILS controller equipped Jarvik 2000 LVAD was implanted in six calves. Pump speed was maintained at 10,000 rpm, and pump outflow was measured throughout the study period (71 +/- 6 days [mean +/- SD]).

Lung cancer after heart transplantation: a 17-year experience.

Background: The effects of heart transplantation on lung cancer incidence in heart transplant recipients are unclear.

Methods: In an observational study, we retrospectively reviewed the charts of all patients undergoing heart transplantation at our institution from July 1982 to July 1999. Data on lung cancer incidence, risk factors, treatment, and outcome were collected.

Direct thrombolytic therapy for intraventricular thrombosis in patients with the Jarvik 2000 left ventricular assist device.

One of the complications that can occur with continuous, axial-flow left ventricular assist devices (LVADs) is thrombosis within the left ventricle, adjacent to the device's inflow conduit, which may cause inflow obstruction and recurrent heart failure. We describe 2 cases in which we used a catheter to continuously infuse recombinant tissue plasminogen activator (tPA) into the left ventricle until signs of successful thrombolysis was achieved. By monitoring the result and administering only as much tPA as necessary to achieve thrombolysis, we were able to successfully lyse the obstructing thrombus with a minimal dose of tPA without causing any significant bleeding problems.

Evaluation of myocardial function in patients with end-stage heart failure during support with the Jarvik 2000 left ventricular assist device.

In 2 patients with the Jarvik 2000 left ventricular assist device (LVAD), we assessed left ventricular systolic function through pressure-volume loops and E(max) at the beginning and end of the support period to potentially predict the possibility of pump removal without transplantation. Immediately before LVAD implantation and explantation, pressure and volume measurements were made with catheters and echocardiography, respectively, the E(max) being calculated from the slope of the pressure-volume loops, and the left ventricular ejection fraction (LVEF) being estimated by echocardiography. Transplantation was performed after 14 and 62 days, respectively, during which the LVEF increased by 75% (from 12% to 21%) in Patient 1 and remained unchanged (from 16% to 18%) in Patient 2, whereas the E(max) increased from 0.

Evaluation of a new cardiac recovery system in a bovine model of volume overload heart failure.

We evaluated the short-term hemodynamic efficacy of the Cancion cardiac recovery system (CRS) in a bovine model of volume overload heart failure. We created severe mitral regurgitation (MR) by disrupting the mitral chordae tendineae of two calves, which were allowed to survive for 13 and 11 months. Four hours before we killed the calves, we introduced the CRS, which maintained flows of 1.