1/4. Transient left ventricular failure following bilateral lung transplantation for pulmonary hypertension.BACKGROUND: Bilateral lung transplantation is an established therapy for end-stage pulmonary hypertension. Its early postoperative outcome may be biased by various complications resulting in unexpected deterioration of the patient in terms of hemodynamics and blood gases. methods: We have reviewed the early postoperative course of patients who underwent bilateral lung transplantation for pulmonary hypertension at our institution and analyzed all available data, especially hemodynamic measurements, echocardiographic documentation and therapeutical strategies, in those cases where cardiac dysfunction was found to be responsible for clinical deterioration. RESULTS: Three out of 20 lung transplant recipients operated for pulmonary hypertension experienced severe respiratory insufficiency accompanied by hemodynamic decompensation during the first days after surgery. Clinical and laboratory findings together with results of echocardiography and pulmonary artery catheterism helped establish the diagnosis of left ventricular failure. This proved to be transitory, but the response to therapy (inotropic drugs, afterload reduction and eventually prostaglandins) was very variable. Adequately treated, this complication did not preclude the outcome of transplantation by itself. CONCLUSION: Left ventricular failure is a possible complication after lung transplantation for pulmonary hypertension. echocardiography and pulmonary artery catheterism may be useful adjuvant diagnostic tools, beside routine physical examination, chest X-ray, and laboratory analysis. Therapy of this complication must be adapted individually and may be complex.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/4. Pacing in right ventricular dysplasia after disconnection surgery.This report describes a 33-year-old patient with arrhythmogenic right ventricular (RV) dysplasia who had a dual chamber pacemaker implanted at age 23 years for drug-induced bradycardia. Pacing was continued after right ventricular free-wall disconnection (RVFWD) at age 24 years. Her pacemaker was not replaced after battery depletion 7 years later. She presented the following year in severe right-sided heart failure. Her old pacemaker generator was replaced. This was followed by rapid resolution of her clinical failure and return to a full, active, physical lifestyle. This observation suggests the potential benefit of dual chamber pacing in patients with RV dysplasia after RVFWD.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
3/4. Successful management of CAPD in infants with cardiac failure.Continuous ambulatory peritoneal dialysis (CAPD) was selected and introduced as a primary dialysis method in two infants with cardiac failure. CAPD was started at 14 days after birth with body weight of 2125 gm and at 7 months of age with body weight of 2325 gm. In both cases, cardiac failure was due to large ventricular septal defect (VSD) and renal failure was due to dysplastic kidneys. In the first case (case 1), direct closure of atrial septal defect and patch closure of VSD were successfully completed at 9.5 months of age with body weight of 4844 gm. CAPD has been managed well for 1 year and 8 months and the child reached a body weight of 8440 gm. In the second case (case 2), CAPD was managed well for 11 months with body weight increasing to 4920 gm at the age of 1 year and 7 months. This marked deterioration of this boy's physical growth was mainly caused by the delay in introducing CAPD and partly due to his cardiac dysfunction which has not been corrected surgically. Both cases show almost normal mental development and are managed well at home. Although CAPD introduction yielded water balance and physical growth in these infants, earlier introduction of CAPD may result in better clinical outcomes including management following open heart surgery. Selection of CAPD as a primary dialysis maneuver is strongly recommended for uremic infants with cardiac failure.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
4/4. chylous ascites as the main manifestation of left ventricular dysfunction: a case report.BACKGROUND: Ascites is one of the most common complications of liver diseases, even though in 15% of the cases it is related to extrahepatic diseases; 3% are of cardiac nature and they appear associated with signs and symptoms of heart failure. CASE PRESENTATION: A 70 year old man was admitted with more than one year history of abdominal distension and a weight gain of 10 kilograms. He is asymptomatic and walks 2000-3000 meters a day without angor or dyspnea. The physical examination shows moderate abdominal distension, with no hepatosplenomegaly or edema, and there is mild jugular vein distension. The studies performed (complete laboratory work up, paracentesis, liver biopsy, echocardiogram, intrahepatic pressure measurements, etc.) showed a chylous ascites related to portal hypertension, and left ventricular dysfunction was the only probable cause found. CONCLUSION: Asymptomatic heart dysfunction can mimic liver disease and should be kept in mind as a cause of chylous ascites.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |