Evaluation of micro-emboli in a patient with ventricular assist device support with hemolysis
The clinical relevance of transcranial Doppler (TCD) detection of micro-embolic signals (MES) in patients with ventricular assist devices (VADs) has been described. However, all of the previous studies concerning TCD in patients with VADs were conducted in patients with old devices; the clinical rel...
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| Veröffentlicht in: | Journal of artificial organs 2015-09, Vol.18 (3), p.276-279 |
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| creator | Seguchi, Osamu Saito, Kozue Fukuma, Kazuki Shimamoto, Keiko Sato, Takuma Nakajima, Seiko Sunami, Haruki Kuroda, Kensuke Sato, Takamasa Watanabe, Takuya Hata, Hiroki Yanase, Masanobu Fujita, Tomoyuki Kobayashi, Junjiro Nagatsuka, Kazuyuki Nakatani, Takeshi |
| description | The clinical relevance of transcranial Doppler (TCD) detection of micro-embolic signals (MES) in patients with ventricular assist devices (VADs) has been described. However, all of the previous studies concerning TCD in patients with VADs were conducted in patients with old devices; the clinical relevance of TCD in patients with newer devices has not been fully elucidated. We recently encountered a patient with a continuous-flow VAD with hemolysis. TCD monitoring was useful for the direct evaluation of micro-emboli in this patient. A 50-year-old male who underwent HeartMate II
®
VAD (Thoratec Corporation; Pleasanton, CA) implantation with a diagnosis of ischemic cardiomyopathy 15 months prior was admitted to our institution because of findings suggestive of hemolysis, such as elevated lactate dehydrogenase (LDH) and total bilirubin. Unfractionated heparin was started after admission and hemolysis gradually improved. On admission, TCD detected 146 MES during 30 min of monitoring. During the hospital course, the MES count decreased to 20 signals on hospital day 4 and further decreased to 2 signals on hospital day 15 along with decreases in LDH and total bilirubin. Since hemolysis in VAD patients is thought to be associated with thromboembolic outcomes, MES detected by TCD indicate subclinical micro-emboli. TCD monitoring may be useful for assessing the risk of thromboembolic events in newer continuous-flow VAD patients through direct visualization of micro-emboli. |
| doi_str_mv | 10.1007/s10047-015-0832-2 |
| format | Article |
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®
VAD (Thoratec Corporation; Pleasanton, CA) implantation with a diagnosis of ischemic cardiomyopathy 15 months prior was admitted to our institution because of findings suggestive of hemolysis, such as elevated lactate dehydrogenase (LDH) and total bilirubin. Unfractionated heparin was started after admission and hemolysis gradually improved. On admission, TCD detected 146 MES during 30 min of monitoring. During the hospital course, the MES count decreased to 20 signals on hospital day 4 and further decreased to 2 signals on hospital day 15 along with decreases in LDH and total bilirubin. Since hemolysis in VAD patients is thought to be associated with thromboembolic outcomes, MES detected by TCD indicate subclinical micro-emboli. TCD monitoring may be useful for assessing the risk of thromboembolic events in newer continuous-flow VAD patients through direct visualization of micro-emboli.</description><identifier>ISSN: 1434-7229</identifier><identifier>EISSN: 1619-0904</identifier><identifier>DOI: 10.1007/s10047-015-0832-2</identifier><identifier>PMID: 25796205</identifier><language>eng</language><publisher>Tokyo: Springer Japan</publisher><subject>Biomedical Engineering and Bioengineering ; Cardiac Surgery ; Cardiomyopathies - complications ; Cardiomyopathies - diagnostic imaging ; Cardiomyopathies - therapy ; Case Report ; Fibrinolytic Agents - therapeutic use ; Heart-Assist Devices - adverse effects ; Hemolysis - physiology ; Heparin - therapeutic use ; Humans ; Male ; Medicine ; Medicine & Public Health ; Middle Aged ; Nephrology ; Thromboembolism - diagnosis ; Thromboembolism - etiology ; Ultrasonography, Doppler, Transcranial</subject><ispartof>Journal of artificial organs, 2015-09, Vol.18 (3), p.276-279</ispartof><rights>The Japanese Society for Artificial Organs 2015</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c499t-e1897d615c8da3f6d0c1cde09aea53b9316e250bb7fc3e35bbd84d55bcc749e73</citedby><cites>FETCH-LOGICAL-c499t-e1897d615c8da3f6d0c1cde09aea53b9316e250bb7fc3e35bbd84d55bcc749e73</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s10047-015-0832-2$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s10047-015-0832-2$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/25796205$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Seguchi, Osamu</creatorcontrib><creatorcontrib>Saito, Kozue</creatorcontrib><creatorcontrib>Fukuma, Kazuki</creatorcontrib><creatorcontrib>Shimamoto, Keiko</creatorcontrib><creatorcontrib>Sato, Takuma</creatorcontrib><creatorcontrib>Nakajima, Seiko</creatorcontrib><creatorcontrib>Sunami, Haruki</creatorcontrib><creatorcontrib>Kuroda, Kensuke</creatorcontrib><creatorcontrib>Sato, Takamasa</creatorcontrib><creatorcontrib>Watanabe, Takuya</creatorcontrib><creatorcontrib>Hata, Hiroki</creatorcontrib><creatorcontrib>Yanase, Masanobu</creatorcontrib><creatorcontrib>Fujita, Tomoyuki</creatorcontrib><creatorcontrib>Kobayashi, Junjiro</creatorcontrib><creatorcontrib>Nagatsuka, Kazuyuki</creatorcontrib><creatorcontrib>Nakatani, Takeshi</creatorcontrib><title>Evaluation of micro-emboli in a patient with ventricular assist device support with hemolysis</title><title>Journal of artificial organs</title><addtitle>J Artif Organs</addtitle><addtitle>J Artif Organs</addtitle><description>The clinical relevance of transcranial Doppler (TCD) detection of micro-embolic signals (MES) in patients with ventricular assist devices (VADs) has been described. However, all of the previous studies concerning TCD in patients with VADs were conducted in patients with old devices; the clinical relevance of TCD in patients with newer devices has not been fully elucidated. We recently encountered a patient with a continuous-flow VAD with hemolysis. TCD monitoring was useful for the direct evaluation of micro-emboli in this patient. A 50-year-old male who underwent HeartMate II
®
VAD (Thoratec Corporation; Pleasanton, CA) implantation with a diagnosis of ischemic cardiomyopathy 15 months prior was admitted to our institution because of findings suggestive of hemolysis, such as elevated lactate dehydrogenase (LDH) and total bilirubin. Unfractionated heparin was started after admission and hemolysis gradually improved. On admission, TCD detected 146 MES during 30 min of monitoring. During the hospital course, the MES count decreased to 20 signals on hospital day 4 and further decreased to 2 signals on hospital day 15 along with decreases in LDH and total bilirubin. Since hemolysis in VAD patients is thought to be associated with thromboembolic outcomes, MES detected by TCD indicate subclinical micro-emboli. TCD monitoring may be useful for assessing the risk of thromboembolic events in newer continuous-flow VAD patients through direct visualization of micro-emboli.</description><subject>Biomedical Engineering and Bioengineering</subject><subject>Cardiac Surgery</subject><subject>Cardiomyopathies - complications</subject><subject>Cardiomyopathies - diagnostic imaging</subject><subject>Cardiomyopathies - therapy</subject><subject>Case Report</subject><subject>Fibrinolytic Agents - therapeutic use</subject><subject>Heart-Assist Devices - adverse effects</subject><subject>Hemolysis - physiology</subject><subject>Heparin - therapeutic use</subject><subject>Humans</subject><subject>Male</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Middle Aged</subject><subject>Nephrology</subject><subject>Thromboembolism - diagnosis</subject><subject>Thromboembolism - etiology</subject><subject>Ultrasonography, Doppler, Transcranial</subject><issn>1434-7229</issn><issn>1619-0904</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2015</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><recordid>eNqNkc1q3TAQhUVpyf8DdFME2XSjdCRZlrUMIW0CgWzaZRCyPG4UbMuV7Fvy9tHl3pRSCHQzM3C-OUJzCPnI4YID6C-51Eoz4IpBIwUT78gRr7lhYKB6X-ZKVkwLYQ7Jcc5PAFwrDQfkUChtagHqiDxcb9ywuiXEicaejsGnyHBs4xBomKijc9FwWujvsDzSTZlS8OvgEnU5h7zQDjfBI83rPMe0xx5xjMNzkU_Jh94NGc_2_YT8-Hr9_eqG3d1_u726vGO-MmZhyBuju5or33RO9nUHnvsOwTh0SrZG8hqFgrbVvZcoVdt2TdUp1XqvK4NanpDPO985xV8r5sWOIXscBjdhXLPl5Qi8kWCa_0DBSKN1LQt6_g_6FNc0lY9sqUYbrTgvFN9R5XI5J-ztnMLo0rPlYLcx2V1MtsRktzFZUXY-7Z3XdsTuz8ZrLgUQOyAXafqJ6a-n33R9AfifndA</recordid><startdate>20150901</startdate><enddate>20150901</enddate><creator>Seguchi, Osamu</creator><creator>Saito, Kozue</creator><creator>Fukuma, Kazuki</creator><creator>Shimamoto, Keiko</creator><creator>Sato, Takuma</creator><creator>Nakajima, Seiko</creator><creator>Sunami, Haruki</creator><creator>Kuroda, Kensuke</creator><creator>Sato, Takamasa</creator><creator>Watanabe, Takuya</creator><creator>Hata, Hiroki</creator><creator>Yanase, Masanobu</creator><creator>Fujita, Tomoyuki</creator><creator>Kobayashi, Junjiro</creator><creator>Nagatsuka, Kazuyuki</creator><creator>Nakatani, Takeshi</creator><general>Springer Japan</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QO</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8FD</scope><scope>8FE</scope><scope>8FG</scope><scope>8FH</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>ARAPS</scope><scope>AZQEC</scope><scope>BBNVY</scope><scope>BENPR</scope><scope>BGLVJ</scope><scope>BHPHI</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FR3</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>HCIFZ</scope><scope>K9.</scope><scope>KB0</scope><scope>LK8</scope><scope>M0S</scope><scope>M1P</scope><scope>M7P</scope><scope>NAPCQ</scope><scope>P5Z</scope><scope>P62</scope><scope>P64</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20150901</creationdate><title>Evaluation of micro-emboli in a patient with ventricular assist device support with hemolysis</title><author>Seguchi, Osamu ; Saito, Kozue ; Fukuma, Kazuki ; Shimamoto, Keiko ; Sato, Takuma ; Nakajima, Seiko ; Sunami, Haruki ; Kuroda, Kensuke ; Sato, Takamasa ; Watanabe, Takuya ; Hata, Hiroki ; Yanase, Masanobu ; Fujita, Tomoyuki ; Kobayashi, Junjiro ; Nagatsuka, Kazuyuki ; Nakatani, Takeshi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c499t-e1897d615c8da3f6d0c1cde09aea53b9316e250bb7fc3e35bbd84d55bcc749e73</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2015</creationdate><topic>Biomedical Engineering and Bioengineering</topic><topic>Cardiac Surgery</topic><topic>Cardiomyopathies - complications</topic><topic>Cardiomyopathies - diagnostic imaging</topic><topic>Cardiomyopathies - therapy</topic><topic>Case Report</topic><topic>Fibrinolytic Agents - therapeutic use</topic><topic>Heart-Assist Devices - adverse effects</topic><topic>Hemolysis - physiology</topic><topic>Heparin - therapeutic use</topic><topic>Humans</topic><topic>Male</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Middle Aged</topic><topic>Nephrology</topic><topic>Thromboembolism - diagnosis</topic><topic>Thromboembolism - etiology</topic><topic>Ultrasonography, Doppler, Transcranial</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Seguchi, Osamu</creatorcontrib><creatorcontrib>Saito, Kozue</creatorcontrib><creatorcontrib>Fukuma, Kazuki</creatorcontrib><creatorcontrib>Shimamoto, Keiko</creatorcontrib><creatorcontrib>Sato, Takuma</creatorcontrib><creatorcontrib>Nakajima, Seiko</creatorcontrib><creatorcontrib>Sunami, Haruki</creatorcontrib><creatorcontrib>Kuroda, Kensuke</creatorcontrib><creatorcontrib>Sato, Takamasa</creatorcontrib><creatorcontrib>Watanabe, Takuya</creatorcontrib><creatorcontrib>Hata, Hiroki</creatorcontrib><creatorcontrib>Yanase, Masanobu</creatorcontrib><creatorcontrib>Fujita, Tomoyuki</creatorcontrib><creatorcontrib>Kobayashi, Junjiro</creatorcontrib><creatorcontrib>Nagatsuka, Kazuyuki</creatorcontrib><creatorcontrib>Nakatani, Takeshi</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Biotechnology Research Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>Technology Research Database</collection><collection>ProQuest SciTech Collection</collection><collection>ProQuest Technology Collection</collection><collection>ProQuest Natural Science Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>Advanced Technologies & Aerospace Collection</collection><collection>ProQuest Central Essentials</collection><collection>Biological Science Collection</collection><collection>ProQuest Central</collection><collection>Technology Collection</collection><collection>Natural Science Collection</collection><collection>ProQuest One Community College</collection><collection>ProQuest Central Korea</collection><collection>Engineering Research Database</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Central Student</collection><collection>SciTech Premium Collection</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>ProQuest Biological Science Collection</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Biological Science Database</collection><collection>Nursing & Allied Health Premium</collection><collection>Advanced Technologies & Aerospace Database</collection><collection>ProQuest Advanced Technologies & Aerospace Collection</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Journal of artificial organs</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Seguchi, Osamu</au><au>Saito, Kozue</au><au>Fukuma, Kazuki</au><au>Shimamoto, Keiko</au><au>Sato, Takuma</au><au>Nakajima, Seiko</au><au>Sunami, Haruki</au><au>Kuroda, Kensuke</au><au>Sato, Takamasa</au><au>Watanabe, Takuya</au><au>Hata, Hiroki</au><au>Yanase, Masanobu</au><au>Fujita, Tomoyuki</au><au>Kobayashi, Junjiro</au><au>Nagatsuka, Kazuyuki</au><au>Nakatani, Takeshi</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Evaluation of micro-emboli in a patient with ventricular assist device support with hemolysis</atitle><jtitle>Journal of artificial organs</jtitle><stitle>J Artif Organs</stitle><addtitle>J Artif Organs</addtitle><date>2015-09-01</date><risdate>2015</risdate><volume>18</volume><issue>3</issue><spage>276</spage><epage>279</epage><pages>276-279</pages><issn>1434-7229</issn><eissn>1619-0904</eissn><abstract>The clinical relevance of transcranial Doppler (TCD) detection of micro-embolic signals (MES) in patients with ventricular assist devices (VADs) has been described. However, all of the previous studies concerning TCD in patients with VADs were conducted in patients with old devices; the clinical relevance of TCD in patients with newer devices has not been fully elucidated. We recently encountered a patient with a continuous-flow VAD with hemolysis. TCD monitoring was useful for the direct evaluation of micro-emboli in this patient. A 50-year-old male who underwent HeartMate II
®
VAD (Thoratec Corporation; Pleasanton, CA) implantation with a diagnosis of ischemic cardiomyopathy 15 months prior was admitted to our institution because of findings suggestive of hemolysis, such as elevated lactate dehydrogenase (LDH) and total bilirubin. Unfractionated heparin was started after admission and hemolysis gradually improved. On admission, TCD detected 146 MES during 30 min of monitoring. During the hospital course, the MES count decreased to 20 signals on hospital day 4 and further decreased to 2 signals on hospital day 15 along with decreases in LDH and total bilirubin. Since hemolysis in VAD patients is thought to be associated with thromboembolic outcomes, MES detected by TCD indicate subclinical micro-emboli. TCD monitoring may be useful for assessing the risk of thromboembolic events in newer continuous-flow VAD patients through direct visualization of micro-emboli.</abstract><cop>Tokyo</cop><pub>Springer Japan</pub><pmid>25796205</pmid><doi>10.1007/s10047-015-0832-2</doi><tpages>4</tpages></addata></record> |
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| ispartof | Journal of artificial organs, 2015-09, Vol.18 (3), p.276-279 |
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| subjects | Biomedical Engineering and Bioengineering Cardiac Surgery Cardiomyopathies - complications Cardiomyopathies - diagnostic imaging Cardiomyopathies - therapy Case Report Fibrinolytic Agents - therapeutic use Heart-Assist Devices - adverse effects Hemolysis - physiology Heparin - therapeutic use Humans Male Medicine Medicine & Public Health Middle Aged Nephrology Thromboembolism - diagnosis Thromboembolism - etiology Ultrasonography, Doppler, Transcranial |
| title | Evaluation of micro-emboli in a patient with ventricular assist device support with hemolysis |
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