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Approach to the Febrile Patient
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
(a) “admission fever” (of psychogenic cause) in patients following admission to the hospital for diseases not usually accompanied by fever; (b) anesthesia induced fever (including malignant hyperthermia); (c) drug fever; (d) transfusion reaction; (e) postcardiotomy syndrome; (f) pulmonary emboli; (g) atelectasis following surgery; (h) deep vein thrombosis.
Intra-aortic balloon pump counterpulsation and percutaneous left ventricular support
Published in Debabrata Mukherjee, Eric R. Bates, Marco Roffi, Richard A. Lange, David J. Moliterno, Nadia M. Whitehead, Cardiovascular Catheterization and Intervention, 2017
Amirreza Solhpour, Richard W. Smalling
Since introduction of the TandemHeart percutaneous ventricular assist device (pVAD) in 2001, the device has been successfully performed in a multitude of settings. According to company resources, nearly 1,500 procedures were performed worldwide as of November 2008. In the past 7 years, the TandemHeart has been used for support of cardiogenic shock following acute MI and for mechanical complications of acute MI. In the setting of chronic heart failure, the TandemHeart has been used as temporary support, as a bridge to transplant, and as a bridge-to-bridge. In the surgical arena, the TandemHeart is effective support for postcardiotomy syndrome. More recently case reports have demonstrated benefit in the setting of critical aortic stenosis for support during high-risk mitral valvuloplasty and as effective right ventricular assist device (RVAD).68 Versatility of the TandemHeart has also been demonstrated with alternative anticoagulants, including argatroban and bivalirudin. In short, the TandemHeart shows promise as a truly percutaneous, fully supportive VAD. Although a mortality benefit has not been demonstrated, increasing patient comorbidities and the escalating demand for innovative percutaneous therapies will likely necessitate a greater role for TandemHeart in coming years.
The Conception Vessel (CV)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
Heart surgery (coronary grafting, with or without concurrent aortic valve replacement) may produce chronic pain syndromes such as postcardiotomy syndrome, brachial plexopathy, and post-sternotomy neuralgia.7 The latter arises from two potential pathologies: trigger points along the parasternal “corridor” (the last segment of the KI channel) and/or scar-entrapped neuromas of the ventral rami of the first 4-6 intercostal nerves that meet along the CV channel. The neuromas typically appear on the left intercostal spaces and arise where sternal wires or needles were inserted at the intercostal spaces. Tension on the wires may incite a strong wound healing reaction, more commonly on the left because, perhaps, surgeons tie the wires on the left. While the painful areas do appear to respond to local anesthetic or neurolytic injection, treatment with acupuncture and related techniques such as laser therapy would be worthwhile to try before a more invasive mode of therapy.
Decision making in anomalous aortic origin of a coronary artery
Published in Expert Review of Cardiovascular Therapy, 2023
Hitesh Agrawal, Alexandra Lamari-Fisher, Keren Hasbani, Stephanie Philip, Charles D. Fraser, Carlos M. Mery
The AAOCA literature includes many retrospective single-center studies, most of them with limited follow-up [65,71–75]. One of the largest single-center retrospective studies by the Stanford group included 115 patients that underwent repair of AAOCA [65]. Of these, approximately 50% had pre-operative ischemia, 30% were asymptomatic, and 20% had other congenital heart defects requiring surgery. In general, an unroofing was performed for patients with an intramural segment. For those that had no intramural segment, if there were two separate coronary ostia, a coronary translocation was performed, and if there was a single coronary ostium, a pulmonary artery translocation procedure was undertaken. There were no operative mortalities. One patient required early revision for residual narrowing and four patients had postcardiotomy syndrome. At 6 years follow-up, there were no deaths but two patients required reintervention after unroofing. One had a coronary translocation for persistent symptoms and was then found to have a myocardial bridge for continuing symptoms. Another patient had a repeat intervention to unroof a myocardial bridge.