1-year left ventricular assist device (LVAD) experience as bridge to heart transplantation in an infant with Bland-White-Garland syndrome.

Left ventricular assist device (LVAD) implantation has become an established therapy in adults as well as in children as a bridge to heart transplantation or to aid myocardial recovery. We describe the first case worldwide of an infant suffering from Bland-White-Garland syndrome successfully treated with a left ventricular assist device (Berlin Heart(R); Excor(R) Pediatric) as a bridge to heart transplantation for a period of more than one year.

[Heart and kidneys]. / Herz und Niere.

There is strong interaction between heart and kidneys in human beings. Both organs work together in many regulation mechanisms. Thus, heart failure leads in many cases to renal failure due to hemodynamic or hormonal feed-back mechanisms. Vice versa, chronic kidney disease turned out as a major and independent cardiovascular risk factor. Patients who suffer from both heart disease and chronic kidney disease are threatened from a very high morbidity and mortality. Moreover, the number of affected patients has doubled every 8-10 years--a dramatic trend which is ongoing. In many patients suffering from heart and chronic kidney disease, an under-use of cardiologic diagnostics as well as therapies has to be observed due to fears about adverse effects, which further enhances their worse prognosis.

Non-return valves do not prevent backflow and bacterial contamination of intravenous infusions.

Non-return valves (NRVs) are designed to avoid backflow of infusion fluid against the designated direction of flow (DDF) when more than one infusion is delivered via one venous access. We tested in vitro whether NRVs reliably prevent flow against the DDF at clinically relevant low flow rates. Since catheter-related infections caused by the infusion of contaminated fluids represent a relevant problem in patient care, we tested whether NRVs preclude bacterial contamination of infusions proximal to the NRVs and thus might play a role in preventing healthcare-associated infections. Additionally, the incidence of bacterial contamination of drips and infusion fluids in our intensive care unit (ICU) was quantified. In vitro, a low flow against the DDF of ten examples each of five different NRV models was applied and the integrity for fluid and transmigration of three different indicator micro-organisms was tested. Second, we investigated whether contamination of intravenous infusion tubing collected from patients treated on our ICU occurred. Largely independent from the model, 40% of the tested NRVs were not leak-tight for fluids when a pressure against the DDF was built up slowly. In 30%, bacteria migrated against the DDF and were detected proximal to the valve. In 6.7% of the tubing samples collected from ICU patients we detected bacterial contamination. In conclusion, contamination of drips is a relevant problem on ICU. NRVs neither reliably prevent backflow of fluids nor serve as micro-organism filters. Therefore they cannot be recommended as a way of reducing healthcare-associated infections.