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Infiltrative Diseases
Published in Andreas P. Kalogeropoulos, Hal A. Skopicki, Javed Butler, Heart Failure, 2023
Patients with cardiac amyloidosis are at high risk of thromboembolism. El-Am et al. showed that patients with cardiac amyloidosis had a high cancellation rate of direct current cardioversion compared with controls, due to the presence of intracardiac thrombus despite appropriate anticoagulation. Given these findings, a transesophageal echocardiogram is recommended prior to cardioversion despite anticoagulation.25 In a large autopsy study of patients with cardiac amyloidosis, 33% had an intracardiac thrombus identified, with AL amyloidosis being an independent risk factor for thromboembolism. Atrial thrombosis also occurred in normal sinus rhythm, most likely secondary to atrial mechanical dissociation.26 Therefore, the decision for anticoagulation should be based on clinical context instead of just CHA2DS2-VASc score.
Infections in Cirrhosis in the Critical Care Unit
Published in Cheston B. Cunha, Burke A. Cunha, Infectious Diseases and Antimicrobial Stewardship in Critical Care Medicine, 2020
John M. Horne, Laurel C. Preheim
Features of IE are similar in cirrhotic and non-cirrhotic patients. Predisposing valvular disease and left-sided IE are common (48% aortic valve, 45% mitral valve), and most IE is caused by S. aureus or Streptococcus spp. Cirrhotic patients, however, have higher rates of renal failure, poorer outcomes, and a lower likelihood of valve replacement [70]. The preferred diagnostic tool for IE, the transesophageal echocardiogram, may be contraindicated or dangerous in some cirrhotic patients who are at risk of upper gastrointestinal bleeding.
Ventricular Assistance for Postcardiotomy Cardiogenic Shock
Published in Wayne E. Richenbacher, Mechanical Circulatory Support, 2020
In the operating room a general anesthetic is administered. A Swan-Ganz catheter and radial arterial line are inserted. A transesophageal echocardiogram probe is inserted. Prior to proceeding with the operation hemodynamic indices and echocardiographic images should provide final confirmation that ventricular function has returned. The patient’s chest, abdomen, and both anterior thighs including groins are prepped and draped into the operative field. Inotropes are mixed and available and an IABP and console are brought into the operating room for use as needed. VAD cannulae are prepped but draped out of the operative field in order to avoid mediastinal contamination.
Update on percutaneous and perventricular device closure of congenital ventricular septal defect
Published in Expert Review of Cardiovascular Therapy, 2023
John S Lozier, Maram Sati, Ira M Cheifetz, Martin L Bocks
To cross the VSD from the LV, a pigtail catheter is advanced retrograde into the LV. The septum is profiled, and a ventriculogram is performed. Transesophageal echocardiogram (TEE) is used to assess the size and position of the VSD. After initial angiographic and echo imaging, the closure device is selected. The pigtail catheter is exchanged for a right coronary catheter or another directional catheter in the LV. To cross the VSD, a wire is advanced through the catheter, and using fluoroscopic and echocardiographic guidance, across the VSD and into the right ventricular outflow tract. A J-tipped wire is preferred to ensure that the wire and catheter cross the largest channel of the VSD. We use the Wholey wire (Medtronic, Minneapolis, MN), when a straight wire is needed. In some cases, the location of the VSD is very difficult to reach, and multiple diagnostic catheters can be used to reach the defect. In some cases, a 6- or 7-French balloon-tipped wedge catheter can be positioned in the LV, and the inflated balloon will catch the flow through the VSD and cross it unaided [13]. The wedge catheter can be directed toward the VSD by a curved stiff wire, if necessary.
Sarcoidosis-associated renal AA amyloidosis and crescentic necrotizing glomerulonephritis
Published in Baylor University Medical Center Proceedings, 2022
Albert Bui, Cherise Cortese, Nabeel Aslam
A 66-year-old white woman presented with generalized fatigue and an 80-pound weight loss over 2 years. Comorbidities were significant for a surgical bioprosthetic bovine aortic valve replacement. Workup at an outside hospital showed persistent leukocytosis and multiple peripherally enhancing, low-attenuation lesions in the liver and spleen. She received empiric antifungal therapy for 8 months due to a positive serum assay for b-D-glucan and continued growth of the lesions on abdominal imaging. Thereafter, she received a splenectomy and liver biopsy. Pathology revealed necrotizing granulomatous inflammation in the spleen. There were scattered nonnecrotizing granulomas in the liver (Figure 1). Special pathology stains/cultures and blood cultures for bacteria, acid-fast bacilli, and fungi were negative. A heavy metals screen and serologies for hepatitis and biliary pathologies were negative. A transesophageal echocardiogram was unremarkable for valvular vegetations or defects, wall motion abnormalities, or elevated chamber pressures. Chest imaging showed prominent mediastinal and axillary lymph nodes and small bilateral pleural effusions. There was no hilar lymphadenopathy. Serial magnetic resonance imaging of the abdomen showed innumerable foci of signal enhancement throughout the liver and axial skeleton with increasing size. There were also prominent upper abdominal and retroperitoneal lymph nodes. Lastly, a bone marrow biopsy with flow cytometry was negative for malignancy.
Dalbavancin for infective endocarditis: a single centre experience
Published in Journal of Chemotherapy, 2021
Emanuele Durante-Mangoni, Filomena Boccia, Maria Paola Ursi, Arta Karruli, Roberto Andini, Maria Galdo, Rosa Zampino
At baseline clinical evaluation, clinical history taking, physical examination, body mass index (BMI), chest X-ray, abdominal ultrasound scan and laboratory analyses (including CRP, creatinine, urea, glycaemia, blood count, INR) were performed. A trans-thoracic echocardiogram (TTE) was performed in all patients within 72 hours of admission, followed by a transesophageal echocardiogram (TEE) where needed. Detailed information about IE characteristics (on native, prosthetic or cardiac implantable electronic device [CIED]), endocardial vegetations and isolated causative pathogens were also collected. Embolic complications were also recorded. Co-morbidities including chronic heart failure (CHF), chronic kidney disease (CKD), liver disease and diabetes mellitus were scrutinized and the Charlson comorbidity index (CCI, maximum value 37) and the cumulative illness rating scale (CIRS, maximum value 56) calculated.