Restoration Of Hemodynamics Research Articles

P1688 Rare cause of acute heart failure in patient with scleroderma

Abstract A 32-year old female patient, known to have scleroderma, presented with symptoms of recurrent attacks of palpitations, dyspnea (NYHA class III) & dizziness for 3 days before presentation. No chest pain or syncope. Physical examination at presentation revealed hemodynamic instability (BP: 80/50 mmHg, HR: 200 bpm/ regular thready pulse with fine bilateral basal chest crackles. ECG revealed ventricular tachycardia (figure 1), so electrical cardioversion was immediately done upon which the reverted to multifocal atrial tachycardia with RBBB and restoration of hemodynamics and disappearance of chest crackles. She also had thickening of the fingertips’ skin, amputated tip of the right middle finger with severe associated Raynaud’s phenomenon, skin tightness of both upper and lower limbs, Buccal buckling with limited mouth opening (figure 2 and 3). Renal function and serum electrolytes were normal with elevated troponin I, creatine kinase and CK-MB serum levels. Echocardiogram showed mild concentric LV hypertrophy with normal internal dimensions and severely impaired systolic function (EF∼ 20%) with severe global hypokinesia . The RV was also dilated and impaired (TAPSE∼8 mm). Mild pericardial effusion with no chamber collapse (Figure 4, 5 and 6). Coronary angiography revealed normal epicardial coronaries. Echocardiography one month prior to presentation revealed normal LV dimensions, preserved systolic function and mild diastolic dysfunction with no resting wall motion abnormalities, upper normal RV size with preserved RV systolic function and mild elevation of pulmonary artery systolic pressure. The presence of new acute biventricular failure in the absence of CAD and elevated cardiac biomarkers are highly suggestive of acute myocarditis. Medical therapy included loop diuretics, angiotensin-converting-enzyme inhibitor, beta-blocker and aldosterone receptor antagonist. She was discharged in NYHA I-II, with normal cardiac enzymes and left ventricle ejection fraction of 30% and resolution of the pericardial effusion. Discussion Scleroderma is rarely present with impaired LV contractility but more commonly presented with diastolic dysfunction (in up to 40% of cases) (1,2). This case was presented with acute myopericarditis with severe biventricular systolic dysfunction which is very rare with scleroderma and only mentioned in few case studies, so no consensus on specific treatment. Few patients with myocarditis and scleroderma were treated with immunosuppressants along with diuretics, beta-blockers, and ACE inhibitors with most of them showed improvement clinically with recovery of systolic function after 12 months of follow up (3). We noted improvement of patient symptoms within few days of diuretics, beta-blockers, Aldosterone antagonists and ACE inhibitors. This case had baseline conduction abnormalities (RBBB with multifocal atrial tachycardia) which could be present in up to 20% of cases (4). Abstract P1688 Figure.

VOLEMIC AND HEMODYNAMIC STATUS OF PATIENTS WITH COMORBIDITY OF CORONARY HEART DISEASE AND CHRONIC OBSTRUCTIVE PULMONARY DISEASE BEFORE AND AFTER MYOCARDIAL REVASCULARIZATION

Introduction . The comorbidity of chronic obstructive pulmonary disease (COPD) and coronary heart disease (CHD) significantly worsens the clinical course of these pathologies, which determines the need for careful hemodynamic monitoring during coronary artery bypass grafting (CABG). Aim. To evaluate the parameters of central and pulmonary hemodynamics during the performance of CABG under conditions of cardiopulmonary bypass (CPB) in patients with comorbidity of IHD and COPD. Materials and methods. Two groups of patients with IHD before and after CABG were examined. The first group included 11 patients with coronary heart disease in combination with COPD II-III severity without exacerbation, the second group included 29 patients with coronary heart disease without pulmonary pathology. Volumetric and hemodynamic parameters were measured by transpulmonary thermodilution using a Drager Delta XL monitor and the Pulsion PiCCO Plus module (Germany) at three stages of the study: after the start of artificial lung ventilation; completion of the CPB procedure; 24 hours after IR. Results. For patients with comorbidity of coronary heart disease and COPD, a specific set of volumic and hemodynamic parameters was characteristic that distinguishes them from persons with coronary artery disease without pulmonary pathology. In the early postoperative period, this was manifested by the formation of a hypokinetic type of blood circulation, an increase in systemic vascular resistance, a less noticeable decrease in the global final diastolic volume, intrathoracic and pulmonary blood volumes. In addition, in patients with cardio-respiratory comorbidity, the maximum values of the indices of extravascular water in the lungs and permeability of the pulmonary vessels were recorded. Timely diagnosis of these disorders contributed to the restoration of pulmonary hemodynamics and water balance. Conclusion. When conducting CABG in patients with comorbidity of IHD and COPD, it is advisable to use the method of transpulmonary thermodilution, which provides more accurate control of hemodynamics and a personalized approach to correcting its disorders.

Functional status of the cardiovascular system in young children who had correction for congenital heart defect by the age of 1 year

Background. The topic relevance is determined by the increasing number of children with congenital heart defect (CHD) who require surgical correction at an early age. For further follow-up it is necessary to determine a functional status of the cardiovascular system (CVS), its adaptation to new conditions of hemodynamics, that is especially important in childhood during the period of morphological and functional changes in the growing organism. Aim. To assess the functional status of the CVS in children with CHD using a test with dosed exercise load (EL) to determine the need for an individual approach to physical rehabilitation.Materials and methods. The study included 80 children, who have been surgically treated for CHD by the age of 1 year. The study population included 32 (40.0%) boys and 48 (60.0%) girls; an average age of patients was 33.5 ± 4.28 months. The control group included 50 conditionally healthy children, with an average age of 35.0 ± 4.1 months; of which 23 (46%) were boys and 27 (54%) were girls. To assess the functional status of the CVS, a test with dosed EL was performed (10 squats in 20 s). Blood pressure and heart rate were measured at rest and after exercise, the double product and the quality of response index were calculated. Results. In children with CHD 2 years after surgery, resting blood pressure was lower compared with healthy children, no significant differences in heart rate between groups were found. The double product in children of the main group was close to above average value. Analysis of hemodynamic changes due to EL showed a more pronounced increase in heart rate and less pronounced increase in pulse pressure and stroke volume in children with CHD after correction, which indicates the adaptation of CVS to EL due to an increase in the rate rather than the strength of heart contractions. The quality of response index in the group of children with CHD corresponded to an irrational reaction to EL. Analysis of CVS responses to the load showed that the most prevalent type was asymptaticotonic one (when there is an increase in heart rate and almost no changes in blood pressure). In the hypertensive type (revealed in a small number of children), there is a significant increase in both heart rate and systolic and diastolic blood pressure. The time of hemodynamics backing up to the baseline parameters did not exceed 5 minutes in both groups, no child complained during the test. Conclusions. In young children who had surgical correction for septal CHD in infancy, blood pressure is characterized by low parameters, that is associated with a possible alteration in the regulation of vascular tone. The predominant type of the CVS response to EL in young children with septal CHD which was corrected in infancy is the asympathicotonic one with a normal period of restoration of hemodynamics to the baseline parameters. The test with EL allows us to individualize the program of physical rehabilitation of young children who had surgery for septal CHD in infancy, taking into account the status of CVS and the initial fitness

Virgin rice bran oil alleviates hypertension through the upregulation of eNOS and reduction of oxidative stress and inflammation in L-NAME-induced hypertensive rats.

Endothelial dysfunction associated with reduction in nitric oxide (NO) bioavailability plays an important role in development of hypertension. Consumption of a diet rich in antioxidants appears to lower the risk for hypertension. Virgin rice bran oil (VRBO) possesses antioxidant, anti-inflammatory, and hypocholesterolemic activities. However, to our knowledge, the antihypertensive effect of VRBO has not been investigated. The aim of this study was to examine the antihypertensive effect of VRBO in Nω-nitro-l-arginine methyl ester (L-NAME)-induced hypertensive rats and its underlying mechanisms. Hypertension was induced in rats by administration of L-NAME, after which VRBO, lisinopril (Lis), or VRBO + Lis was administered. Studies were then conducted on the hemodynamics of vascular responses to vasoactive substances, plasma angiotensin-converting enzyme (ACE), plasma nitrate/nitrite, oxidative stress, and inflammatory markers. L-NAME administration induced hemodynamic changes including elevation of blood pressure, increased peripheral vascular resistance, and endothelial dysfunction. Reduction in plasma nitrate/nitrite, overproduction of vascular superoxide, and increases in plasma ACE, malondialdehyde, protein carbonyl, and plasma tumor necrosis factor-α were observed in L-NAME hypertensive rats. The changes were associated with a marked decrease in endothelial NO synthase expression, increased expression of gp91phoxand vascular cell adhesion molecule-1, and activation of nuclear factor-κB in aortic tissues. Administration of either VRBO or Lis significantly mitigated all of these deleterious effects. The combination of VRBO and Lis was more effective than either treatment alone. The antihypertensive effect of VRBO may be mediated by restoration of hemodynamics, increased NO bioavailability, and alleviation of oxidative stress and inflammation. VRBO has an additive effect on antihypertensive medication.

Cognitive and cerebral hemodynamic effects of endovascular recanalization of chronically occluded cervical internal carotid artery: single-center study and review of the literature.

Revascularization of a symptomatic, medically refractory, cervical chronically occluded internal carotid artery (COICA) using endovascular techniques (ETs) has surfaced as a viable alternative to extracranial-intracranial bypass. The authors aimed to assess the safety, success, and neurocognitive outcomes of recanalization of COICA using ETs or hybrid treatment (ET plus carotid endarterectomy) and to identify candidate radiological markers that could predict success. The authors performed a retrospective analysis of their prospectively collected institutional database and used their previously published COICA classification to assess the potential benefits of ETs or hybrid surgery to revascularize symptomatic patients with COICA. Subjects who had undergone CT perfusion (CTP) imaging and Montreal Cognitive Assessment (MoCA) testing, both pre- and postprocedure, were included. The authors then performed a review of the literature on patients with COICA to further evaluate the success and safety of these treatment alternatives. The single-center study revealed 28 subjects who had undergone revascularization of symptomatic COICA. Five subjects had CTP imaging and MoCA testing pre- and postrevascularization and thus were included in the study. All 5 patients had very large penumbra involving the entire hemisphere supplied by the ipsilateral COICA, which resolved postoperatively. Significant improvement in neurocognitive outcome was demonstrated by MoCA testing after treatment (preprocedure: 19.8 ± 2.4, postprocedure: 27 ± 1.6; p = 0.0038). Moreover, successful revascularization of COICA led to full restoration of cerebral hemodynamics in all cases. Review of the literature identified a total of 333 patients with COICA. Of these, 232 (70%) showed successful recanalization after ETs or hybrid surgery, with low major and minor complication rates (3.9% and 2.7%, respectively). ETs and hybrid surgery are safe and effective alternatives to revascularize patients with symptomatic COICA. CTP imaging could be used as a radiological marker to assess cerebral hemodynamics and predict the success of revascularization. Improvement in CTP parameters is associated with significant improvement in neurocognitive functions.

Pathophysiological Insights into Persistent Hyponatremia after LVAD Implantation

Purpose Persistent hyponatremia after LVAD implantation is not uncommon in patients with end-stage heart failure (HF) and maybe associated with adverse outcomes . The etiology of hyponatremia in HF patients is multifactorial. It is generally thought that with restoration of hemodynamics , hyponatremia would resolve after LVAD implantation. We sought to determine the etiology of persistent hyponatremia after LVAD implantation. Methods We performed a retrospective analysis of patients with end-stage HF who received a continuous-flow LVAD and subsequently underwent right heart catheterization (RHC) to assess invasive hemodynamics and for speed optimization. Data was collected concurrently on invasive hemodynamics, medication usage and basic metabolic panel . Hyponatremia was defined as serum sodium level Results We included 143 patients in our study. RHC was performed within 6 months from LVAD implantation in 70% of the population, the median time was 199 days. Patients with hyponatremia had a mean sodium of 130.5 mEq/L compared to 139.8 mEq/L in patients with normonatremia, p-value Conclusion Persistent hyponatremia after LVAD implantation does not appear to be related to low cardiac output state, volume expansion or depletion, RV dysfunction, use of ACEI or ARBs, loop diuretics or renal function. Hyponatremia may be an independent marker of adverse outcomes after LVAD implantation.

Abstract 16974: Experimental Insights Into Transapical Neochordplasty: A Quantitative Examination of Neochord Placement Using an Ex Vivo Left Heart Simulator

Introduction: Neochordoplasty is an important repair technique, though the optimal anchoring position is unknown. While typically anchored at papillary muscles, new percutaneous devices anchor the chordae at or near the ventricular apex, which we hypothesize will result in significantly higher forces on the chordae and neochord. Methods: Porcine mitral valves were dissected (n=3) and mounted in a custom 3D printed left heart simulator generating physiological pressure and flow. Hemodynamic and echocardiographic data were collected, and chordal forces were measured using Fiber Bragg Grating (FBG) strain gauge sensors. Isolated MR was induced by cutting P2 primary chordae resulting in prolapse. Regurgitant valves were then repaired with a PTFE neochord with transapical fixation, followed by papillary fixation for comparison. In both cases, the neochord was anchored to a customized force-sensing post positioned to mimic in vivo placement ( Fig. A ). Results: Hemodynamic and echocardiographic data confirmed that both techniques resulted in elimination of MR in all valves and restoration of physiologic hemodynamics. Peak forces on the chordae and neochord were lower for papillary than the transapical fixation (p=0.04). Force tracings were compiled for each class of chordae at baseline, after prolapse, and after both repair techniques ( Fig. B ). The maximum dF/dt for the neochord suture was 30.6 N/s with the papillary fixation and 51.7 N/s with the transapical fixation. These may translate into increased stress on the mitral valve apparatus. Conclusions: Transapical fixation results in higher peak forces on the chordae and noechord suture as well as an increased rate of loading on the neochord when compared to the papillary muscle fixation and may influence repair durability.

An unusually pulmonary embolism

Case report Pulmonary embolism is usually caused by blood clots that travel to the lungs from the legs or other parts and me life-threatening. More rarely, pulmonary vascular obstruction may be due to a tumor. We report the case of a 68-year old man who presented with symptoms and signs suggesting high-risk acute pulmonary embolism. The computed tomography pulmonary angiography initially confirmed the diagnosis showing filling defects within the pulmonary vasculature. Fibrinolysis treatment allowed hemodynamic restoration. Unfortunately, one month later, the patient presented with cardiogenic shock due to acute pulmonary obstruction. A rescue embolectomy was decided and the surgeon discovered a tumor instead of a clot. Anatomopathology confirmed an unusual pulmonary artery leiomyosarcoma not initially suspected.

Rehabilitation therapy as a component of the complex approach to the treatment of chronic forms the pelvic inflammatory disease in women

Issues of treatment and rehabilitation patients with pelvic's inflammatory diseases are still remain highly relevant, so relapses and chronic inflammation processes are worsen the prognosis for generative function in women, which is an important social and economic problem in modern time. Purpose of the study. Monitoring the effectiveness of therapeutic measures of rehabilitation step in chronic forms of this disease. Materials and methods. We examined 110 patients who handled to the clinic for women with complaints about the absence of pregnancy, of which a survey group was formed. The duration of pelvic inflammatory desiase (PID) in patients of the examination group did not exceed 2 years. The age of the patients was 25-35 years old. In patients of the examination group, according to clinical, laboratory and ultrasound ultrasound, laparoscopy, hysteroscopy and morphological findings, PID was verified including the presence of chronic endometritis and other endometrial pathology (for example, endometrial polyp, simple endometrial hyperplasia). Results. The rehabilitation stage of treatment (6 months) in patients with PID was aimed at restoring the morphofunctional potential of the tissue and eliminating the effects of secondary injuries, which include the restoration of hemodynamics and activity of the endometrial receptors. This stage of treatment is extremely important, especially for reproductive disorders. At this stage, the patients of the examination group were given hormone therapy and treatment with vasoactive drug (dipyridamole). The obtained results testified to the significance of the restoration of the vascular blood flow of the uterus and the functional layer of the endometrium. Conclusion. Rehabilitation therapy in patients with PID was primarily aimed at restoring the functional ability of the endometrium. Hormone therapy was a priority role, but at modern time, role of the vasoactive drugs that affect the blood flow in the uterus is emphasized. One of these drugs is dipyridamole, which contributes to the formation of collaterals (bypass paths) in ischemic zones. The results indicate that at the end of the 6-month rehabilitation phase, than of a three-layer endometrium was diagnosed (according to ultrasound on day 8-10 of the cycle) in 85 (77.27±4.00%) patients in the examination group.

Hemodynamic changes lead to alterations in aortic diameters and may challenge further stent graft sizing in acute aortic syndrome.

Precise stent graft sizing in Thoracic endovascular aortic repair (TEVAR) is crucial to receive optimal long-term results. Computed tomography (CT), as the current standard in assessing aortic diameters (ADs), is often performed at initial diagnosis. Since several acute aortic diseases are associated with blood loss and/or volume re-distribution, assessed AD might be influenced by impaired hemodynamic conditions. Intravascular ultrasound (IVUS) offers real-time assessment, especially after hemodynamic restoration, and might help for stent graft choice. We investigated the correlation between CT and later IVUS measurements in elective (n=83) and emergency patients (n=32) at the level distal to the left subclavian artery (LSA), a frequent proximal landing zone in TEVAR. Patients were grouped depending on their shock index (heart rate/systolic blood pressure): emergency patients with diagnosis of acute aortic syndrome, urgently required treatment after admission and had a shock index >1, otherwise were grouped as elective. Basic hemodynamics were assessed for both groups at admission and at definite IVUS-procedure. At time of admission the emergency group showed lower blood pressure (99±19.8 vs. 141±24 mmHg; P=0.001) and higher heart rate (98±13 vs. 70±12 bpm; P=0.001) compared to elective patients. By hemodynamic stabilization comparable blood pressure and heart rate were achieved in both groups at time of IVUS. In the emergency group, we found a significantly increase in AD after hemodynamic stabilization, whereas the diameters did not change in the elective group (IVUSmeanvs. CTmean: 5.1±1.0 vs. 0.4±2.2 mm; P=0.001 and IVUSminvs. CTmean: 3.9±1.3 vs. -0.3±2.2 mm; P=0.011). IVUS for stent graft sizing is a valuable approach during TEVAR, especially in the light of emergency treatment by offering real-time assistance. Impaired hemodynamic conditions might lead to relevant changes in AD and may strongly influence stent graft choice. In these cases, careful stent graft selection might contribute to avoidance of stent graft related complication.

Tempestività di intervento nella colica renale: aspetti fisiopatologici

Renal colic is one of the most common diagnoses of emergency room access and ureteral stone is one of the most common causes of renal colic due to ureteral obstruction. Ureteral obstruction initially causes an increase of intraureteral pressure, which returns to baseline values after a short time after the reduction in urine production and the progressive increase in the circumference and ureter length. Reduction in urinary flow depends on the renal hemodynamic response, which has three phases: initial vasodilation of the preglomerular afferent artery; vasoconstriction of the postglomerular efferent artery; and, finally, vasoconstriction of the preglomerular afferent artery. Renal parenchyma ischemia is associated with oxidative stress, inflammatory infiltrate and subsequent apoptosis of tubular cells and interstitial fibrosis. This degenerative pathological process tends to continue even after relatively early removal of the obstruction and despite the restoration of renal hemodynamics. Fibrosis progression is associated with alterations in renal function with hyperfiltration in the surviving nephronic population and alterations in tubular function. These pathophysiological aspects have to be considered in the management of patients with renal colic and ureteral obstruction. Expulsive treatment of renal stones should be carefully planned by accurate selection of patients and frequent follow-up controls. When the obstruction is severe or the expulsion time is prolonged, early treatment or temporary urinary diversion with deferred treatment should be considered. The time limit for awaiting spontaneous stone passage is not well defined and varies depending on the degree of obstruction and possible complicating factors, however it may be prudent to not exceed two to three weeks.

Modern approaches to therapy of burn shock

The article is an overview of publications 2015-2017 on the problems of the infusion therapy of burn shock. Restoration of central and peripheral hemodynamics in the acute period of burn injury is an extremely difficult problem due to the fact that the fluid is especially poorly retained in the bloodstream because of the "capillary leakage" syndrome. A large amount of infusion is dangerous for the development of interstitial edema of tissues and multiple organ failure, therefore the main part of the research is devoted to the development of new methods for optimal infusion therapy of burn shock. At this time, the best results in the treatment of patients during burn shock stage are achieved by the application of early goal directed individualized therapy. This strategy provides for a differentiat ed choice of a combination of colloids and crystalloids for the constant monitoring of hemodynamics using instrumental methods. Further increase in the effectiveness of burn resustication researchers are ass ociated with the use of computerized monitoring systems for infusion therapy, as well as with the improvement of solutions used for transfusion.

Novel applications of bedside monitoring to plumb patient hemodynamic state and response to therapy.

Hemodynamic monitoring is essential during the treatment of the critically ill in order to address the hemodynamic alterations and assess the response to treatment. Traditionally classified causes of shock and underlying pathophysiological mechanisms are often neglected by resuscitative strategies included in the guidelines. Most of hemodynamic management focuses on the ability to early recognize patients susceptible to increase cardiac output (CO) and mean arterial pressure (MAP) after a defined fluid challenge by eliciting Starling's law of the heart, and less is known of the ones presenting in shock and not volume responsive. All this influences the application of hemodynamic monitoring tools and their interpretation. Functional hemodynamic monitoring strategies, aiming to overcome limitations of traditional static pressures measurements, have been developed and recently acknowledged by guidelines for the treatment of septic shock. Nevertheless, those techniques share the same limitations of previous ones, being poorly reliable in various common situations such as in spontaneous breathing patients, right ventricular dysfunction of several causes or if arrhythmia occurs. Echocardiography has now become commonplace in the evaluation of the hemodynamic profile in the critically ill and mastering this technique is important in order to interpret pathophysiological patterns behind hemodynamic alteration while at the same time, screening for unexpected findings. More recently, pathophysiological and echocardiographic-based approaches have been introduced to investigate ventriculo-arterial coupling, the relationship between both left and right heart and the relative circulatory bed. Such techniques allowed establishing that in many critically ill scenarios, coupling between the heart and the circulation is inefficient and probably that is the reason why in this case hemodynamic restoration cannot be achieved by standard approaches. Combining echocardiography to better understand and treat in real-time pathophysiological determinants of altered hemodynamic states with functional approaches seems to be the key to plumb hemodynamic states although it remains to be demonstrated if this tailored approach will improve patient outcome.

Circulatory Flow Restoration Versus Cardiopulmonary Resuscitation: New Therapeutic Approach in Sudden Cardiac Arrest.

Sudden cardiac arrest (SCA) remains a major problem for health authorities worldwide. Insufficiencies of current cardiopulmonary resuscitation (CPR) are most probably related to an inappropriate concept and applied methods that still concentrate on heartbeat as priority, instead of blood circulation to maintain organs' perfusions. The aim of this works is to propose a new therapeutic approach for SCA in a more effective and secure manner compared with current CPR methods. It correlates to a non-invasive circulatory flow restoration (CFR) device composed of a multilayered thoracic and infradiaphragmatic compartments that will be pulsated alternatively and in fixed frequencies using a low-pressure pneumatic generator. Proof-of-concept studies with different prototypes and methods of SCA, showed restoration of hemodynamics (BP ≥ 100 mm Hg) and increased urine output after 20 min of cardiac arrest in pediatric dogs and piglets. In summary, a CFR device can induce shear stress-mediated endothelial function to restore microcirculation and cellular metabolism. This represents a cost-effective method, predisposes to return of spontaneous circulation in case of SCA, adaptable for all age groups, in public and hospital environments.

Early Development of Right Ventricular Ischemic Lesions in a Novel Large Animal Model of Acute Right Heart Failure in Chronic Thromboembolic Pulmonary Hypertension

BackgroundOur aim was to develop a model of acute right heart failure (ARHF) in the setting of pulmonary hypertension and to characterize acute right ventricular lesions that develop early after hemodynamic restoration. Methods and ResultsWe used a described piglet model of chronic pulmonary hypertension (cPH) induced by pulmonary artery occlusions. We induced ARHF in animals with cPH (ARHF-cPH group, n = 9) by volume loading and iterative acute pulmonary embolism until hemodynamic compromise followed by dobutamine infusion for hemodynamic restoration before sacrifice for right ventricular tissue evaluation. The median duration of ARHF before sacrifice was 162 (135–189) minutes. Although ventriculoarterial coupling (measured with multibeat pressure-volume loops) and stroke volume decreased after iterative pulmonary embolism and improved with dobutamine, relative pulmonary to systemic pressure increased by 2-fold and remained similarly increased with dobutamine. Circulating high-sensitivity troponin I increased after hemodynamic restoration. We found an increase in right ventricular subendocardial and subepicardial focal ischemic lesions and in expression of autophagy-related protein LC3-II (Western blot) in the ARHF-cPH group compared with the cPH (n = 5) and control (n = 5) groups. ConclusionsWe developed and phenotyped a novel large animal model of ARHF on cPH in which right ventricular ischemic lesions were observed early after hemodynamic restoration.

Ultrasonographic Diagnosis and Monitoring of Treatment for Deep Vein Thrombosis of the Lower Extremities

A survey and surgical treatment of 94 patients with deep vein thrombosis of the lower limbs were carried out. All patients underwent ultrasonography of the deep veins from the time of admission to day 90 of treatment (6 visits in total) in order to verify the diagnosis and to monitor the effectiveness of anticoagulant therapy. It was found that compression ultrasonography allowed with high probability to diagnose deep vein thrombosis: in 100 % of cases we have visualized a blood clot in a vein, preserving its lumen upon compression, the veins increase in diameter, swelling of perivascular fibers (48.6 %) and blurring of the contours of the vascular bundle (37.1 %). Ultrasonography allows you to set the duration of deep vein thrombosis before patient sought medical care and to conduct a differential diagnosis with pathologies with a similar clinical picture. It was determined that rapid restoration of venous hemodynamics took place in patients with acute deep vein thrombosis.

Does the infusion rate of fluid affect rapidity of mean arterial pressure restoration during controlled hemorrhage

ObjectiveThis study aimed to compare 2 fluid infusion rates of lactated Ringer (LR) and hydroxyethyl starch (HES) 130/0.4 on hemodynamic restoration at the early phase of controlled hemorrhagic shock. MethodsFifty-six anesthetized and ventilated piglets were bled until mean arterial pressure (MAP) reached 40 mm Hg. Controlled hemorrhage was maintained for 30 minutes. After this period, 4 resuscitation groups were studied (n=14 for each group): HES infused at 1 or 4mL/kg per minute or LR1 infused at 1 or 4mL/kg per minute until baseline MAP was restored. Hemodynamic assessment using PiCCO monitoring and biological data were collected. ResultsTime to restore baseline MAP ±10% was significantly lower in LR4 group (11±11 minutes) compared to LR1 group (41±25 minutes) (P=.0004). Time to restore baseline MAP ±10% was significantly lower in HES4 group (4±3 minutes) compared to HES1 (11±4 minutes) (P=.0003). Time to restore baseline MAP ±10% was significantly lower with HES vs LR whatever the infusion rate.No statistically significant difference was observed in cardiac output, central venous saturation, extravascular lung water, and arterial lactate between 4 and 1 mL/kg per minute groups. ConclusionsIn this controlled hemorrhagic shock model, a faster infusion rate (4 vs 1mL/kg per minute) significantly decreased the time for restoring baseline MAP, regardless of the type of infused fluid. The time for MAP restoration was significantly shorter for HES as compared to LR whatever the fluid infusion rate.

POSITIVE IMPACT OF CONTINUOUS FLOW LEFT VENTRICULAR ASSIST DEVICE (LVAD) IMPLANTATION ON GLYCEMIC CONTROL IN DIABETIC PATIENTS WITH ADVANCED SYSTOLIC HEART FAILURE

Restoration of hemodynamics and metabolism after left ventricular assist device (LVAD) implantation has been hypothesized to favorably affect the clinical course of diabetes. Several studies have sought to characterize this relationship; however, all have fewer than 50 patients. This was a

Restoration of physiologic hemodynamics in the ascending aorta following aortic valve Rreplacement: a 4D flow MR study

Restoration of physiologic hemodynamics in the ascending aorta following aortic valve Rreplacement: a 4D flow MR study

In-Series Versus In-Parallel Mechanical Circulatory Support for the Right Heart: A Simulation Study.

Right heart failure (RHF) is a serious health issue with increasing incidence and high mortality. Right ventricular assist devices (RVADs) have been used to support the end-stage failing right ventricle (RV). Current RVADs operate in parallel with native RV, which alter blood flow pattern and increase RV afterload, associated with high tension in cardiac muscles and long-term valve complications. We are developing an in-series RVAD for better RV unloading. This article presents a mathematical model to compare the effects of RV unloading and hemodynamic restoration on an overloaded or failing RV. The model was used to simulate both in-series (sRVAD) and in-parallel (pRVAD) (right atrium-pulmonary artery cannulation) support for severe RHF. The results demonstrated that sRVAD more effectively unloads the RV and restores the balance between RV oxygen supply and demand in RHF patients. In comparison to simulated pRVAD and published clinical and in silico studies, the sRVAD was able to provide comparable restoration of key hemodynamic parameters and demonstrated superior afterload and volume reduction. This study concluded that in-series support was able to produce effective afterload reduction and preserve the valve functionality and native blood flow pattern, eliminating complications associated with in-parallel support.