Complicaciones mecánicas IAM e Infarto Ventriculo Derecho

Notas del editor

• #12: Cateterismo derecho= Se igualan las presiones diastólicas
• #13: Survival depends primarily upon the rapid recognition of myocardial rupture and provision of immediate therapy. Patients displaying suggestive symptoms, signs, and ECG changes require a bedside echocardiogram and echocardiographically-guided pericardiocentesis if fluid is visualized. Immediate surgery is indicated if the pericardiocentesis identifies the fluid as blood. Medical therapy aimed at hemodynamic stabilization should also be instituted. This includes fluids, inotropic support, vasopressors, pericardiocentesis, intraaortic-balloon pump counterpulsation, and percutaneous cardiopulmonary bypass (if available and necessary) [15,18-21,24,26]. Prompt surgical repair is also indicated for left ventricular false aneurysms because rupture of the pseudoaneurysm can occur [35]. Rapid institution of the above regimen can lead to an appreciable survival rate, particularly in subacute rupture. In one study, for example, 25 of 33 patients (76 percent) with subacute ventricular rupture survived the surgical procedure and 16 (48 percent) were long-term survivors [20
• #15: While there have been sporadically reports of interpericardial fibrin injection over the last 20 years [6, 8], there are only two small descriptive case report studies reporting the follow-up of patients with left ventricular wall rupture that received intrapericardial fibrin glue injections [9, 10]. Survival rates were 31% and 55% with a total of 28 patients studied. However, a considerable number of patients died before fibrin glue could be administered.
• #16: When immediate heart surgery is not available or applicable as in our case, intrapericardial injection of fibrin glue as reported here facilitates an alternative treatment in this desperate situation. Autopsy revealed focal peri- and epicardial adhesion of the defect by fibrin glue, proving its effectiveness
• #34: A diferencia de la rotura del tabique ventricular, que se encuentra en los infartos extensos, la rotura del músculo papilar aparece en infartos relativamente pequeños en la mitad de los casos aproximadamente. La magnitud de la enfermedad arterial coronaria en estos pacientes es, en ocasiones, también modesta.
• #35: La monitorización invasiva, que es clave en todos estos pacientes, permite también valorar este aspecto tan importante de la función ventricular. 1 Las presiones de llenado del ventrículo derecho e izquierdo (presiones de enclavamiento y de la aurícula derecha) orientan la administración de líquidos o el uso de diuréticos, al tiempo que la determinación del gasto cardíaco y la presión arterial media permite calcular la resistencia vascular sistémica y orientar el tratamiento con vasodilatadores. Salvo que la presión sistólica sea inferior a 90 mmHg, este tratamiento, que suele consistir en nitroglicerina o nitroprusiato, se debería iniciar lo más pronto posible en cuanto se disponga de monitorización hemodinámica. Esto puede resultar clave para estabilizar la situación del paciente mientras se le prepara para realizar más estudios diagnósticos y la reparación quirúrgica. Si no tolera el tratamiento vasodilatador o no se consigue la estabilidad hemodinámica pese a administrarlo, se debería colocar de forma inmediata un balón de contrapulsación intraaórtico.
• #38: 8 pacientes con Shock no recibieron BCIA Edad avanzada (3) Tortuosidad iliacas (2) Mejoría temporal con manejo médico (2) Necesidad Cx urgencia por taponamiento (1)
• #43: Se manifiestan clínica en menos 50% Falla VD  Disminuye precarga VI Dilatación VD Desplazamiento del Septo Isquemia AD
• #50: PAPi (<0.9), RA:PCWP (>0.86), and RVSW (<8.6) right atrial–to–pulmonary capillary wedge pressure ratio greater than 0.8 for AMI and 0.63 for post-LVAD failure, and an RV stroke work index less than 450 (units). More recently, the authors developed the pulmonary artery pulsatility index (PAPi) as a simple measure of RV failure without the need for an estimate of stroke volume. In several studies, a PAPi less than 1.0 correlated with severe RV failure
• #51: 1. All study subjects were required to have a clinical indicator of suspected RVD (sRVD) at the time of presentation including any one of the following: (1) hypotension defined as a systolic blood pressure <80 mm Hg, (2) bradycardia defined as a heart rate <50 beats per minute, or (3) ST-segment elevation >1 mm in lead V4R. A
• #54: PAPi (<0.9), RA:PCWP (>0.86), and RVSW (<8.6)
• #56: TandemHeart RVAD
• #58: 5 liters/min for an anticipated duration of up to 14 days.
• #59:  Bombas centrífugas: Usa conos giratorios que generan flujo. Existen actualmente varios tipos de bombas centrífugas disponibles Bio-Medicus® (Bio-Medicus Inc), Sarns® (Sarns/3M Ann Arbor®), AB-180® y Tandem heart VAD®, (Cardiac Assist Technologies). La mayoría requiere de toracotomía para su instalación, se asocian a hemólisis significativa y un alto riesgo de infección. Una experiencia en 18 pacientes cursando shock cardiogénico, en que se les instaló en forma percutánea un catéter en aurícula izquierda por vía transeptal y otro en arteria femoral, en ellos el uso de la bomba Tandem Heart® logró gastos cardíacos hasta de 4 L/min
• #61: Device flow rates ranged from 2.7 to 4.2 l/min after percutaneous implantation and from 3.1 to 7.4 l/min after surgical implantation
• #62: mean arterial pressure (MAP), cardiac index, and PA oxygen saturation were increased significantly, whereas RA pressure and PA Figure 1 Distribution of Patients in the Study (A) Patient distribution in the study by mode of vascular access for cannulation. Representative images of (B) percutaneous cannulation via the femoral vein (Fem V) to right internal jugular (R.IJ) and (C) surgical right atrial (RA) to pulmonary artery (PA) cannulation. JACC: Heart Failure Vol. 1, No. 2, 2013 Kapur et al. April 2013:127–34 Mechanical Right Ventricular Support 129systolic pressure decreased significantly in the total study population. No significant changes in mean PCOP, RVSW, or mean PA pressure were noted after device activation. No significant changes in parameters of hepatic congestion were observed. The number of vasoactive/ inotropic agents used was not significantly decreased within 48 h after CF-RVSD activation. IABP use was reported in 52% (n ¼ 24) of patients. Among all patients, laboratory parameters showed increased sodium and decreased hemoglobin and platelet values after device implantation.
• #63: Overall in-hospital mortality was 57% among CF-RVSD recipients and was due to multiorgan failure in all cases. The mean durations of CF-RVSD support were 4.8 " 6.1 days and 6.5 " 6.2 days in the percutaneous and surgical groups, respectively (Table 1). In-hospital mortality was similar between the percutaneous and surgical groups (50% vs. 62%; p ¼ 0.4). In-hospital mortality was highest among recipients who presented with acute myocarditis (100%), after valve surgery (87%), and after CABG (67%) and lowest among patients with RVF after orthotopic heart transplantation (40%), AMI (33%), chronic left heart failure (33%), and after LVAD implantation (20%).
• #64: as associated with a higher incidence of short-term death (odds ratio [OR] 3.2, 95% CI 2.4-4.1), cardiogenic shock (OR 3.2, 95% CI 2.4-3.5), sustained ventricular tachyarrhythmias (OR 2.7, 95% CI 2.1-3.5), and advanced atrioventricular block (OR 3.4, 95% CI 2.7-4.2)
• #65: Nearly complete recovery of RV function has been shown to occur in 62 to 82 percent of patients within the first few month