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Sochman J.,IKEM Institute for Clinical and Experimental Medicine
Cor et Vasa | Year: 2012

A rare and fatal complication was encountered during a forensic deliberation. The case focused on a delayed pacing lead migration with multiple organ perforation and a trajectory crossing the right ventricular wall, pericardium, left inferior lung lobe, diaphragm, abdominal cavity to the left retroperitoneum, with the end of the pacing lead stopping close between the left psoas muscle and the left kidney. The above path-identified as the source of fatal bleeding-was found during revision surgery when the lead was removed. The bleeding was made easier by inhibiting platelet function and by a temporary decrease in platelet count as a result of low molecular weight heparin. No symptoms related to the above passage of the lead through the patient ́s body were noted. © 2012 The Czech Society of Cardiology.

Di Biase L.,The Texas Institute | Di Biase L.,University of Foggia | Di Biase L.,University of Texas at Austin | Auricchio A.,Fondazione Cardiocentro Ticino | And 19 more authors.
Europace | Year: 2011

Aims Functional mitral regurgitation (MR) could be managed by both cardiac resynchronization therapy (CRT) and mitral-valve surgery. Clinical decision making regarding the appropriateness of mitral-valve surgery vs. CRT is a challenging task. This study assessed the prevalence and prognosis of various degrees of functional MR in CRT candidates. Additionally, we sought to identify functional MR patients who either can be adequately managed by CRT only or will need surgery. Methods and results Cardiac resynchronization therapy recipients (n 794) were followed-up for 26 ± 18 months. Mitral regurgitation severity was quantified on scale 04. Cardiac resynchronization therapy responders were identified based on improvement in the New York Heart Association class and left-ventricular ejection fraction. Severity of MR and LV reverse remodelling were assessed at 3 and 12 months. Predictors of long-term MR change and CRT response were explored with multivariable models. Mitral regurgitation was present in 86, with 35 prevalence of advanced MR (grade 34). Improvement of MR <1° after 12 months occurred in 46 of patients. It was relatively more frequent in patients with advanced MR at baseline (63, P< 0.01). Baseline MR severity and change in MR at 3-month follow-up predicted response to CRT. Patients with <1° MR improvement at 12 months had more reverse remodelling compared with those with no change or worsening of MR. Conclusion sMitral regurgitation improvement at 3 months predicts CRT response and MR improvement at 12-month follow-up. This finding could have implications for subsequent MR surgical therapies. © The Author 2011.

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