Publications by authors named "Tim Balthazar"

12 Publications

  • Page 1 of 1

Ultrasound Diagnosis of Cardiac Arrest in an 81-Year-Old Postoperative Patient.

Chest 2021 Aug;160(2):e233-e236

Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium; Department of Cardiac Intensive Care, University Hospitals Leuven, Leuven, Belgium.

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http://dx.doi.org/10.1016/j.chest.2020.07.105DOI Listing
August 2021

Venous Thromboembolism in Patients Discharged after COVID-19 Hospitalization.

Semin Thromb Hemost 2021 Jun 23;47(4):362-371. Epub 2021 Apr 23.

Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.

Background:  Venous thromboembolism (VTE) is a frequent complication of COVID-19, so that the importance of adequate in-hospital thromboprophylaxis in patients hospitalized with COVID-19 is well established. However, the incidence of VTE after discharge and whether postdischarge thromboprophylaxis is beneficial and safe are unclear. In this prospective observational single-center study, we report the incidence of VTE 6 weeks after hospitalization and the use of postdischarge thromboprophylaxis.

Methods:  Patients hospitalized with confirmed COVID-19 were invited to a multidisciplinary follow-up clinic 6 weeks after discharge. D-dimer and C-reactive protein were measured, and all patients were screened for deep vein thrombosis with venous duplex-ultrasound. Additionally, selected high-risk patients received computed tomography pulmonary angiogram or ventilation-perfusion (V/Q) scan to screen for incidental pulmonary embolism.

Results:  Of 485 consecutive patients hospitalized from March through June 2020, 146 patients were analyzed, of which 39% had been admitted to the intensive care unit (ICU). Postdischarge thromboprophylaxis was prescribed in 28% of patients, but was used more frequently after ICU stay (61%) and in patients with higher maximal D-dimer and C-reactive protein levels during hospitalization. Six weeks after discharge, elevated D-dimer values were present in 32% of ward and 42% of ICU patients. Only one asymptomatic deep vein thrombosis (0.7%) and one symptomatic pulmonary embolism (0.7%) were diagnosed with systematic screening. No bleedings were reported.

Conclusion:  In patients who had been hospitalized with COVID-19, systematic screening for VTE 6 weeks after discharge revealed a low incidence of VTE. A strategy of selectively providing postdischarge thromboprophylaxis in high-risk patients seems safe and potentially effective.
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http://dx.doi.org/10.1055/s-0041-1727284DOI Listing
June 2021

Managing Patients With Short-Term Mechanical Circulatory Support: JACC Review Topic of the Week.

J Am Coll Cardiol 2021 03;77(9):1243-1256

Department of Cardiovascular Diseases, University Hospitals Leuven, Leuven, Belgium.

The use of mechanical circulatory support for patients presenting with cardiogenic shock is rapidly increasing. Currently, there is only limited and conflicting evidence available regarding the role of the Impella (a microaxial, continuous-flow, short-term, left or right ventricular assist device) in cardiogenic shock; further randomized trials are needed. Patient selection, timing of implantation, and post-implantation management in the cardiac intensive care unit are crucial elements for success. Particular challenges at the bedside include the practical management of anticoagulation, evaluation of correct device position, and the approach to use in a patient with signs of insufficient hemodynamic support. Profound knowledge of these issues is required to enable the maximal potential of the device. This review provides a comprehensive overview of the short-term assist device and describes a practical approach to optimize care for patients supported with the device.
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http://dx.doi.org/10.1016/j.jacc.2020.12.054DOI Listing
March 2021

Fulminant eosinophilic myocarditis treated with steroids and mechanical unloading: a case report.

Eur Heart J Case Rep 2020 Dec 7;4(6):1-5. Epub 2020 Dec 7.

Department of Cardiovascular Diseases, Universitaire Ziekenhuizen Leuven, Herestraat 49, 300 Leuven, Belgium.

Background: Eosinophilic myocarditis is a rare form of myocardial inflammatory disease. Eosinophilic infiltration of the myocardium is often the consequence of a systemic disorder but can remain unexplained in up to a third of patients. The disease course can range from mild to fulminant myocarditis and mortality remains high for fulminant cases.

Case Summary: A 42-year-old male was admitted for cardiogenic shock. He presented in another hospital with fever, low blood pressure, diffuse electrocardiogram-abnormalities, and elevated troponin T (4.5 µg/L; reference <0.013 µg/L) levels. Coronary angiography was unremarkable. Mechanical circulatory support with the Impella CP device was initiated. Since fulminant myocarditis was suspected and magnetic resonance imaging was not feasible in urgency, an endomyocardial biopsy was performed. He transiently developed right ventricular failure after Impella implantation, requiring the re-institution of an inotropic agent. Biopsy showed eosinophilic myocarditis, even though there was no increase in the peripheral blood eosinophil count. Methylprednisone and Ramipril were initiated to which he responded well. No systemic disease or parasitic infection was found during further work-up. Left ventricular ejection fraction rapidly improved and was completely normalized at discharge.

Discussion: This case demonstrates the usefulness of myocardial biopsy in fulminant myocarditis since the only histopathology guided us towards the diagnosis of eosinophilic myocarditis. Treatment with methylprednisone and an angiotensin-converting enzyme-inhibitor resulted in rapid improvement. Awake mechanical circulatory support with the Impella device proved feasible and might have helped by unloading the left ventricle, as was reflected in an immediate decrease in troponin levels, even before methylprednisone initiation.
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http://dx.doi.org/10.1093/ehjcr/ytaa444DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7891289PMC
December 2020

Left Impella®-device as bridge from cardiogenic shock with acute, severe mitral regurgitation to MitraClip®-procedure: a new option for critically ill patients.

Eur Heart J Acute Cardiovasc Care 2021 May;10(4):415-421

Department of Adult Intensive Care, Royal Brompton and Harefield NHS Foundation Trust, Sydney St, Chelsea, London SW3 6NP, UK.

Aims: Patients presenting with cardiogenic shock (CS) related to acute, severe mitral regurgitation (MR) are often considered too ill for immediate surgical intervention. Therefore, other less invasive techniques for haemodynamic stabilization should be explored. The purpose of this exploratory study was to investigate the feasibility and outcomes in patients with CS due to severe MR by using a novel approach combining haemodynamic stabilization with left Impella-support plus MR-reduction using MitraClip®.

Methods And Results: We analysed whether a combined left Impella®/MitraClip®-procedure in a rare population of CS-patients with acute MR requiring mechanical ventilation is a feasible strategy to recovery in patients who had been declined cardiac surgery. Six INTERMACS-1 CS-patients with acute MR were studied at two tertiary cardiac intensive care units. The mean EURO-II score was 39 ± 19% and age 66.8 ± 4.9 years. All patients had an initial pulmonary capillary wedge pressure >20 mmHg and pulmonary oedema necessitating invasive ventilation. Cardiac output was severely impaired (left ventricular outflow tract velocity time index 9.8 ± 1.8 cm), requiring mechanical circulatory support (MCS) (Impella®-CP; mean flow 2.9 ± 1.8 L per minute; mean support 9.7 ± 6.0 days). Despite MCS-guided unloading, weaning from ventilation failed due to persisting pulmonary oedema necessitating MR-reduction. In all cases, the severe MR was reduced to mild using percutaneous MitraClip®-procedure, followed by successful weaning from invasive ventilation. Survival to discharge was 86%, with all surviving and rare readmission for heart failure at 6 months.

Conclusions: A combined Impella®/MitraClip®-strategy appears a novel, feasible alternative for weaning CS-patients presenting with acute, severe MR. Upfront Impella®-stabilization facilitates safe bridging to Mitraclip®-procedure and the staged approach facilitates successful weaning from ventilatory support.
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http://dx.doi.org/10.1093/ehjacc/zuaa031DOI Listing
May 2021

Interpreting the Deep Sulcus Sign.

Am J Respir Crit Care Med 2021 08;204(3):357-358

Intensive Care Unit, University Hospital Brussels, Jette, Belgium; and.

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http://dx.doi.org/10.1164/rccm.202007-2629IMDOI Listing
August 2021

Pulsus Alternans as a Sign of Right Ventricular Failure After Left Ventricular Assist Device Implantation.

J Card Fail 2020 Dec 19;26(12):1093-1095. Epub 2020 Sep 19.

University Hospitals Leuven, Department of Cardiovascular Diseases & Cardiac Intensive Care Unit, Leuven, Belgium.

Temporary left ventricular assist devices such as the ImpellaTM are increasingly used in patients with cardiogenic shock. The right ventricle remains the Achilles heel of left ventricular assist device-supported circulation. However, right ventricular failure after implantation of a left ventricular assist device remains incompletely defined and understood. We describe the first case of pulsus paradoxus emerging after the initiation of circulatory support using a left ventricular ImpellaTM device, which is an early sign of right ventricular failure, that was completely abolished after the addition of a temporary right ventricular assist device.
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http://dx.doi.org/10.1016/j.cardfail.2020.09.010DOI Listing
December 2020

Impella to Resist the Storm.

Circ Heart Fail 2020 05 1;13(5):e006698. Epub 2020 May 1.

Departments of Cardiovascular Diseases (T.C., T.B., T.A., J.E., S.J., R.W., C.V.), University Hospitals Leuven, Belgium.

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http://dx.doi.org/10.1161/CIRCHEARTFAILURE.119.006698DOI Listing
May 2020

Impella Protected PCI: Exploring the Mechanism of Ventriculoarterial Uncoupling.

JACC Cardiovasc Interv 2019 10 17;12(19):1979-1980. Epub 2019 Jul 17.

Department of Cardiovascular Medicine, University Hospitals Leuven, Leuven, Belgium.

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http://dx.doi.org/10.1016/j.jcin.2019.05.037DOI Listing
October 2019

Rare cause of cerebrovascular event.

Acta Cardiol 2019 Aug 27;74(4):363-364. Epub 2018 Sep 27.

a Department of Cardiology, University Hospitals Leuven , Leuven , Belgium.

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http://dx.doi.org/10.1080/00015385.2018.1494794DOI Listing
August 2019

Pulmonary vein signal in mitral regurgitation.

Crit Care 2018 05 11;22(1):123. Epub 2018 May 11.

Department of cardiology, University Hospitals Leuven, Herestraat 49, 3000, Leuven, Belgium.

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http://dx.doi.org/10.1186/s13054-018-2031-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5946452PMC
May 2018
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