Resolution Of Congestive Heart Failure Research Articles

Neonatal Rickets, Due to Maternal Vitamin D Deficiency, Complicated by Convulsion and Dilated Cardiomyopathy: Case Report

Deficiency rickets due to maternal hypovitaminosis D cause hypocalcaemia in infants, which may be complicated by dilated cardiomyopathy (DCM) with myocardial dysfunction. Calcium is central in myocardial contraction coupling, and hypocalcemia decreases myocardial contractility. However, dilated cardiomyopathy (DCM) due to hypocalcemia in infants has been rarely reported. Correction of hypocalcemia was associated with resolution of congestive heart failure and the left ventricular (LV) geometry and systolic function.
 We report the case of an infant who presented deficiency rickets due to maternal hypovitaminosis D, complicated by convulsion and dilated cardiomyopathy, with good improvement under treatment with calcium and vitamin D.

MO745CARDIOVASCULAR EFFECTS OF HIGH FLOW ARTERIO-VENOUSE FISTULA CLOSURE IN POST-KIDNEY TRANSPLANTATION PATIENTS

Abstract Background and Aims Presently, the dilemma of what to do with a functioning arterio-venous fistula (AVF) in post-kidney transplantation patients is a subject of debate. One of the arguments in favor of AVF closure is symptomatic congestive heart failure (CHF) due to AVF-induced cardiomyopathy. The subject of the study was the evaluation of the dynamics of some morpho-functional cardiac parameters in post-kidney transplantation patients with AVF-induced CHF before and after AVF closure. Method The results of prospective single center study are presented. 13 post transplantation patients with severe AVF-induced CHF (III-IV f.c. NYHA) were enrolled. Echocardiography (Echo), Doppler evaluation of AVF flow (Qa) and calculation of cardiopulmonary recirculation (Qa/CO) were performed simultaneously (split-protocol) at baseline together with estimation of creatinine plasma level. All patients underwent surgical closure of AVF. In 8 weeks after the closure, an assessment of CHF, Echo and creatinine plasma level were carried out in all enrolled patients. Statistical analysis was performed using the STATISTICA 13 software (T-test). Results The average age – 44 ±13 y, males 54%. All patients bore an upper arm proximal AVF. The average flow of AVF (Qa) – 3.4 ±1.4 L/min, average Qa/CO – 49 ±15%, Qa/CO was more than 30% in 92% of patients. The median of AVF vintage was 5 y (IR 3;10). In 8 weeks after AVF closure, complete clinical resolution of CHF, reduction of volumetric heart parameters, decrease of sPAP, improvement of diastolic function were observed. There was no significant difference in the serum creatinine value (1.85 ±0.66 mg/dL vs 1.97 ±0.95 mg/dL, p >0.05). The results of Echo data before and after AVF closure are presented in Table 1. Conclusion The surgical closure oh high flow AVF in post-kidney transplantation patients with AVF-induced CHF was resulted in significant improvement of morpho-functional cardiac parameters. The CHF due to AVF-induced cardiomyopathy should be considered as one of the indications to AVF closure in post-kidney transplantation patients. CO, cardiac output; CI, cardiac index; LV EDVi, left ventricular end-diastolic volume index; LV ESVi, left ventricular end-systolic volume index; LAVi, left atrial volume index; RAVi, right atrial volume index; TAPSE, tricuspid annular plane systolic excursion LVMi, left ventricular mass index; sPAP, systolic pulmonary arterial pressure; LVEF, left ventricular ejection fraction; Е/A ratio, E - peak early mitral inflow wave velocity, A - peak late mitral inflow wave velocity.

Management of re-stenosis following balloon catheter dilation of cor triatriatum dexter in a dog

Summary A 10-month-old male American Pitbull Terrier puppy was treated for the correction of cor triatriatum dexter by balloon catheter dilation under echocardiographic guidance. Two weeks after the interventional procedure, the dog presented ascites because re-stenosis of cor triatriatum dexter occurred. A second interventional procedure, by combining membranostomy and balloon catheter dilation of the intra-atrial septum, allowed the resolution of congestive heart failure. Based on the clinical outcome, the alternative approach described in this report appears to be a viable treatment option for dogs affected with cor triatriatum dexter, especially when re-stenosis occurs.

Impact of thyroidectomy on cardiac manifestations of Graves' disease.

Graves' disease (GD) has multiple adverse effects on the cardiovascular system. We aimed to examine the outcome of thyroidectomy in patients with cardiac manifestations of GD and evaluate their associated postoperative complications. Retrospective analysis using a prospectively collected database. A retrospective analysis of our prospectively collected thyroid surgery database was performed. Forty patients with hyperthyroidism due to GD were identified, and each was appropriately age matched to a euthyroid patient with multinodular goiter (MNG). All patients underwent total thyroidectomy. Data relating to cardiac comorbidities were collected from preoperative and postoperative clinic notes, hospital admissions, electrocardiograms, echocardiograms, and blood work. Perioperative biochemical, cardiovascular, and postoperative outcomes were analyzed. Twenty-four (60%) GD patients and 14 (35.0%) MNG patients had cardiac manifestations (P = .001). Hypertension resolved in 41.7% of GD patients and 7.7% of MNG patients (P = .00002). Two of the three GD patients with congestive heart failure (CHF) had resolution of CHF with significant improvement in ejection fraction, whereas the one MNG patient with CHF saw no change. Additionally, the majority of GD patients saw a resolution of their tachycardia (68.8%) and atrial fibrillation (100%). Four postoperative complications occurred in both the GD and MNG groups (4/40, 10%). Surgical treatment of GD in patients with cardiac manifestations offers rapid clinical improvement of hypertension, impaired left ventricular systolic function, and arrhythmias. When performed by a high-volume surgeon, the complication rate is similar to thyroidectomy for other benign disease. 4. Laryngoscope, 126:1256-1259, 2016.

Effects of treatment on respiratory rate, serum natriuretic peptide concentration, and Doppler echocardiographic indices of left ventricular filling pressure in dogs with congestive heart failure secondary to degenerative mitral valve disease and dilated cardiomyopathy

To evaluate the effects of treatment on respiratory rate, serum natriuretic peptide concentrations, and Doppler echocardiographic indices of left ventricular filling pressure in dogs with congestive heart failure (CHF) secondary to degenerative mitral valve disease (MVD) and dilated cardiomyopathy (DCM). Prospective cohort study. 63 client-owned dogs. Physical examination, thoracic radiography, analysis of natriuretic peptide concentrations, and Doppler echocardiography were performed twice, at baseline (examination 1) and 5 to 14 days later (examination 2). Home monitoring of respiratory rate was performed by the owners between examinations. In dogs with MVD, resolution of CHF was associated with a decrease in respiratory rate, serum N-terminal probrain natriuretic peptide (NT-proBNP) concentration, and diastolic functional class and an increase of the ratio of peak velocity of early diastolic transmitral flow to peak velocity of early diastolic lateral mitral annulus motion (E:Ea Lat). In dogs with DCM, resolution of CHF was associated with a decrease in respiratory rate and serum NT-proBNP concentration and significant changes in 7 Doppler echocardiographic variables, including a decrease of E:Ea Lat and the ratio of peak velocity of early diastolic transmitral flow to isovolumic relaxation time. Only respiratory rate predicted the presence of CHF at examination 2 with high accuracy. Resolution of CHF was associated with predictable changes in respiratory rate, serum NT-proBNP concentration, and selected Doppler echocardiographic variables in dogs with DCM and MVD. Home monitoring of respiratory rate was simple and was the most useful in the assessment of successful treatment of CHF.

Hypoalbuminemia and Lymphocytopenia in Patients With Decompensated Biventricular Failure

BackgroundIn patients hospitalized with decompensated biventricular failure having hypoalbuminemia and lymphocytopenia without underlying hepatic or renal disease, we addressed the presence of a protein-losing enteropathy (PLE). MethodsWe studied 78 patients having a dilated cardiomyopathy, who were hospitalized with congestive heart failure (CHF) and hypoalbuminemia of uncertain origin. In the first 19 patients, we investigated the presence of PLE using Tc-Dex70 scintigraphy together with serum albumin 2 to 4weeks later when compensation had been restored. In the next 59 patients, presenting with reduced serum albumin and relative lymphocyte count at admission, these parameters were again monitored (2–4 weeks) later when symptoms and signs of CHF had resolved. ResultsPLE, documented by Tc-Dex70 scintigraphy, was found in 10 of 19 patients and whose hypoalbuminemia (2.7±0.1g/dL, mean±standard error of mean) were corrected (3.3±0.1g/dL; P<0.05) with the resolution of CHF, whereas in the 9 patients without a PLE, reduced baseline serum albumin (2.6±0.1g/dL) failed to improve on follow-up (2.6±0.2g/dL) in keeping with malnutrition. Relative lymphocyte count was reduced (14.6±1.5%) in patients with PLE but was normal (21.4±3.3%; P<0.05) in those without PLE. Serum albumin and relative lymphocyte count were each reduced at admission (2.8±0.1g/dL and 14.4±1.0%, respectively) in 59 patients and increased (P<0.05) to normal values (3.5±0.1g/dL and 24.9±1.0%) 2 to 4weeks after they were compensated. ConclusionsEnteral losses of albumin and lymphocytes account for the reversible hypoalbuminemia and lymphocytopenia found in patients hospitalized with CHF having splanchnic congestion.

Assessment of balloon pulmonary valvuloplasty in six dogs

ABSTRACTThe effectiveness of balloon valvuloplasty was assessed, clinically and haemodynamically, in six dogs with moderate to severe pulmonic stenosis. The haemodynamic assessment was based on Doppler echocardiography, with colour flow mapping, in the conscious dog and by direct catheterisation in the anaesthetised dog, before and after balloon valve dilatation. Four of the six dogs were presented with exercise intolerance, of which two were in congestive heart failure. Balloon valvuloplasty resulted in improved exercise tolerance and resolution of congestive heart failure in these dogs. The average Doppler and catheter transvalvular pressure gradients were reduced to 43 per cent and 46 per cent of the preoperative gradient, respectively. The average pressure gradient obtained by catheter, in the anaesthetised dog, was 59 per cent of the pressure gradient obtained by spectral Doppler echocardiography in the conscious dog. Balloon valvuloplasty was considered successful in five out of the six dogs. Postoperative pulmonic regurgitation was not found to be a complication of balloon valvuloplasty.

Lung and myocardial thallium-201 kinetics in resting patients with congestive heart failure: Correlation with pulmonary capillary wedge pressure

Increased lung thallium-201 activity occurs with exercise in patients with severe coronary artery disease as a result of increased pulmonary capillary wedge pressure. No study has shown resting lung kinetics in chronic congestive heart failure. To better understand the relationship between lung and myocardial thallium uptake and pulmonary capillary wedge pressure, this study was performed. Resting lung and myocardial thallium uptake, expressed as a ratio, were compared with simultaneous pulmonary capillary wedge pressure in 16 patients with congestive heart failure and cardiomyopathy, all New York Heart Association class IV. There no variations in pulmonary capillary wedge pressure throughout the study protocol. There was a significant reduction in the lung/myocardium thallium ratio from 10 to 60 minutes (0.83 ± 0.30 to 0.59 ± 0.17; p < 0.001). At 60 minutes after thallium injection there was a linear correlation between the lung/myocardium ratio and capillary wedge pressure with an r value of 0.62 ( p < 0.01). Thus thallium-201 washout is rapid despite persistence of pulmonary capillary wedge pressure elevation, indicating that clearance does not imply resolution of congestive heart failure. In addition, a significant but imprecise correlation was found between capillary pressure and the lung/myocardium ratio. Rapid changes in lung activity during the early postinjection period may limit the clinical use of the lung/myocardium ratio.

Treatment of AIDS-associated heart disease.

Although the diagnosis of AIDS-associated heart disease is becoming routine, its treatment has not been reported except in anecdote. Also, it has been unclear whether the odds of successful treatment are altered because of the presence of cardiac involvement per se. This communication reports the authors' treatment of 18 patients with AIDS-associated heart disease. Their results are combined with the treatment results of all patients reported in the literature to date with AIDS-associated heart disease. Treatment success, defined as eradication of the organism and no relapse, was achieved in their patients with M. tuberculosis (M. tb), cardiac cryptococcosis, and Salmonella typhimurium. M. tb required emergency pericardiectomy (well tolerated in all patients), then administration of rifampin, isoniazid, and ethambutol. Cryptococcosis was treated acutely with amphotericin B and flucytosine, then with maintenance amphotericin B. The response, which included resolution of congestive heart failure, occurred within a week. Salmonella endocarditis was cured with administration of ampicillin and netilmicin for one month. When the patients' data were combined with those of patients from the literature, the authors found that the odds of successful treatment for tuberculous pericarditis were somewhat lower than if the tuberculosis was extracardiac (50% vs 67%). With cryptococcal heart disease, the odds of successful treatment were actually significantly better than when only extracardiac disease was present. The authors conclude that infectious forms of AIDS-associated heart disease are often treatable. Although some cardiac infections are less likely to respond to treatment if there is cardiac involvement, mostly the response to treatment is similar to the response with only extracardiac involvement.

Return of plasma norepinephrine to normal after resolution of congestive heart failure in congenital heart disease

Plasma norepinephrine is elevated in both adult and pediatric patients with congestive heart failure (CHF), and the degree of elevation corresponds to the severity of the CHF. 1–4 It is not known whether this abnormal increase in adrenergic activity is reversible with the resolution of CHF.