Successful pregnancy in a patient with double outlet right ventricle

Background:The double outlet right ventricle is uncommon and usually makes patients have haemodynamic and structural complications. Having a hyperdynamic state, such as pregnancy, with volume overload is very risky for a patient with complex CHD (CCHD). The diagnosis in early stages can prevent cardiac complications. The multi-disciplinary assessment of the disease lets patients make choices in treatment and reproductive life.Objective:Present a case of a successful pregnancy in a patient with a rare CCHD.Participant:A pregnant 19-year-old patient with a double outlet right ventricle without haemodynamic or structural complications and no fetal abnormalities.

Hyperthyroidism-induced dilated cardiomyopathy

Hyperthyroidism is a common endocrine disorder with a prevalence of 1.3% in the generalpopulation, affecting more women than men. Prolonged hyperthyroidism without appropriatemanagement may lead to high output cardiac failure characterized by increases in heart rate,cardiac contractility, and cardiac output and by reductions in peripheral systemic vascularresistance. Dilated cardiomyopathy with impaired systolic function is rare and occurs in lessthan 1% of patients with thyrotoxicosis. The exact mechanism of hyperthyroidism-induceddilated cardiomyopathy is not well established. The combination of direct toxic effects of excessthyroid hormone along with prolonged tachycardia, arrhythmia, and a hyperdynamic state couldbe contributing factors. We present a case of a young woman with prolonged sinus tachycardiadue to a long history of medication non-compliance who developed dilated cardiomyopathywith low output heart failure. Early detection and management of hyperthyroidism are crucialto restore cardiac function.

Pulmonary hypertension in patients with hepatic cirrhosis and portal hypertension. An echographic study

Aim of the study. The aim of the study is to determine the frequency of pulmonary hypertension in patients with hepatic cirrhosis and portal hypertension, to determine the possibility of an accurate ultrasound diagnosis of the characteristics of this complication.Method. 347 patients with liver cirrhosis consecutively hospitalized at Coltea Clinical Hospital were screened. 61 were excluded because of other possible causes of portal or pulmonary hypertension. All patients were investigated clinically and by abdominal and cardiac ultrasonography.Results. 0f the remaining 286 patients, 116 had portal hypertension, 27 of them (23%) having pulmonary hypertension. In this group we found a higher cardiac index and right atrial volume, higher pressures in the right atrium, suggesting a hyperdynamic state. Porto-pulmonary hypertension was found in only one patient.Conclusion. Echocardiography permits characterization of patients with cirrhosis and portal hypertension

Cardiac index by thermodilution or transthoracic echocardiography in dogs at different hemodynamic states

ABSTRACT: Proper monitoring of cardiac index (CI) in critically ill patients requires accurate and minimally invasive methods. The aim of this study was to compare the CI values obtained by thermodilution or echocardiography using different methods in dogs in different hemodynamic states. Nine dogs weighing 19.6±1.3kg were anesthetized with isoflurane at 1.4V% (Baseline) and subjected to mechanical ventilation (MV),a hypodynamic state (Hypo) with isoflurane at 3.5V% and hyperdynamic state (hyper) with dobutamine infusion at 5μgkg-1min-1. CI analysis was performed by thermodilution (TD) and using the modified Simpson's method, aortic velocity-time integral (A-VTI) method and pulmonary VTI (P-VTI) method. We performed Pearson's correlation and Bland-Altman analysis. The CI values (Lm-2min-1) of the animals in the Baseline, MV, Hypo and Hyper states were 4.3±1, 3.6±0.7, 2.9±0.66 and 6.1±2, for TD; 2.8±0.7, 2.4±0.3, 1.7±0.7 and 4.4±1.2, for Simpson's method; 3.4±0.9, 3.1±0.7, 2.6±3.4, 6.1±1.8 for A-VTI; and 3.6±0.8, 3.6±0.8, 2.7±0.6 and 6.2±1.5, for P-VTI. The CI values using Simpson's method were lower than those obtained by TD in all states, and it was observed a significant correlation in the Hypo (r=0.89) and Hyper (r=0.76) groups. In addition,the percent error in the Hypo group using Simpson's method was 26% relative to TD, which allowed for the identification of the different hemodynamic states. With respect to the other methods and states, there was no agreement or correlation between the methods and TD. We concluded that none of the tested echocardiography methods exhibited acceptable agreement with thermodilution at different hemodynamic states.

Angiopoietin-2 Is an Early Indicator of Acute Pancreatic-Renal Syndrome in Patients with Acute Pancreatitis

Within the first week of the disease, acute kidney injury (AKI) is among the most common causes of mortality in acute pancreatitis (AP). Recently, serum angiopoietin-2 (Ang-2) has been associated with hyperdynamic state of the systemic circulation. The aim of this study was to examine the associations between Ang-2 and the clinical AP severity during the first 72 hours of the disease, and organ disfunction, including AKI.Methods. Study included patients admitted to the surgery ward, diagnosed with AP. AKI was diagnosed according to KDIGO guidelines and renal failure according to modified Marshall scoring system. Ang-2 was determined in serum with ELISA.Results. AP was classified as mild (MAP) in 71% of patients, moderately severe (MSAP) in 22%, and severe (SAP) in 8%. During the first 72 hours of AP, 11 patients developed AKI and 6 developed renal failure. Ang-2 at 24, 48, and 72 hours following the onset of AP symptoms significantly predicted SAP and MSAP, as well as AKI and renal failure. Also, Ang-2 significantly correlated with acute phase proteins as well as with the indicators of renal disfunction.Conclusions. Serum Ang-2 may be a relevant predictor of AP severity, in particular of the development of AP-renal syndrome.

Hyperdynamic circulation and serotonin levels in patients with liver cirrhosis

Patients with liver cirrhosis and portal hypertension develop hyperdynamic state of circulation. Recent studies indicate that nitric oxide, prostaglandin's, endothelin-1 and serotonin are of major importance in the pathogenesis of portal hypertension and other hemodynamic complications. In our study we estimated the levels of serotonin in sera and 24h urine in 20 patients with liver cirrhosis, using original solid phase extraction procedure. Concentration of serotonin in sera was ranged from 18 to 270 nmol/L and in 24h urine ranged from 97 to 238 nmol/L/24h. In comparison with reference values (determined in range from 280 ?1300 nmol/L in sera and determined in the range from 157.8?1035.4 nmol/ L/24h in urine), a significant fall of serotonin concentration in sera, and urine was noted. A statistically significant correlation between serotonin levels in sera and platelet count was found (p = 0.017). Colour Doppler ultrasonography and peroral fiberpanendoscopy was applied in the whole series to evaluate degree of portal hypertension. The average diameter of portal vein was 16 mm (SD=1.36) and mean blood flow velocity in portal vein was 12 cm/s (SD=1.12). Splenomegaly was approved in the whole group and the mean splenic craniocaudal distance was 17.75 mm (SD=1.65). Esophageal varices grade I?II were detected in 8 (40%) of our patients and reamaining 12 (60%) were grade III?IV. In cirrhotic liver, the spleen congestion, result from platelet degradation. Serotonin, release in to spleen sinusoidal spaces, induces strong vasoconstriction response in portal venous circulation, which contributes to maintain portal hypertension. However, we consider that the decrease of serotonin levels in sera lead to development of hyperdynamic state of circulation.