RESUMO
BACKGROUND: Infantile hepatic hemangioma (IHH) is a rare endothelial cell neoplasm, which may be concurrent with severe complications and result in poor outcomes. Moreover, the coexistence of IHH and congenial heart disease is even rarer. CASE PRESENTATION: We present a 10-day-old male born with IHH associated with patent ductus arteriosus (PDA), atrial septal defect (ASD) and pulmonary hypertension. Moreover, we reviewed a series of studies of IHH-associated high-output cardiac failure between 1974 and 2018, and summarized the treatment outcomes. CONCLUSIONS: Infantile hepatic hemangioma (IHH) has been known to induce high-output heart failure. There is no literature to summarize the severity of its impact on heart, which can lead to a high mortality rate. When IHH is detected by ultrasound, the heart should be evaluated to facilitate treatment. The outcomes of IHH associated with heart failure are good.
Assuntos
Débito Cardíaco Elevado/etiologia , Permeabilidade do Canal Arterial/complicações , Insuficiência Cardíaca/etiologia , Hemangioma/complicações , Hipertensão Pulmonar/etiologia , Neoplasias Hepáticas/complicações , Débito Cardíaco Elevado/diagnóstico por imagem , Débito Cardíaco Elevado/fisiopatologia , Débito Cardíaco Elevado/terapia , Permeabilidade do Canal Arterial/diagnóstico por imagem , Permeabilidade do Canal Arterial/fisiopatologia , Permeabilidade do Canal Arterial/terapia , Evolução Fatal , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Hemangioma/diagnóstico por imagem , Hemangioma/fisiopatologia , Hemangioma/cirurgia , Humanos , Hipertensão Pulmonar/diagnóstico por imagem , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar/terapia , Recém-Nascido , Neoplasias Hepáticas/diagnóstico por imagem , Neoplasias Hepáticas/fisiopatologia , Neoplasias Hepáticas/cirurgia , Masculino , Resultado do TratamentoAssuntos
Malformações Arteriovenosas/complicações , Débito Cardíaco Elevado/etiologia , Insuficiência Cardíaca/etiologia , Hemodinâmica , Complicações Cardiovasculares na Gravidez , Gêmeos , Adulto , Malformações Arteriovenosas/diagnóstico por imagem , Malformações Arteriovenosas/fisiopatologia , Malformações Arteriovenosas/terapia , Débito Cardíaco Elevado/diagnóstico por imagem , Débito Cardíaco Elevado/fisiopatologia , Débito Cardíaco Elevado/terapia , Cesárea , Diuréticos/uso terapêutico , Embolização Terapêutica , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Humanos , Nascido Vivo , Gravidez , Complicações Cardiovasculares na Gravidez/diagnóstico por imagem , Complicações Cardiovasculares na Gravidez/fisiopatologia , Complicações Cardiovasculares na Gravidez/terapia , Gravidez de Gêmeos , Resultado do TratamentoRESUMO
A 40-year-old man who was referred to our hospital due to dyspnea was found to have high output cardiac failure on Swan-Ganz catheterization. An endomyocardial biopsy revealed cardiomyocyte hypertrophy with a vacuolar structure consistent with mitochondrial disease (MD). The patient was discharged, then readmitted for high output cardiac failure with hypotension and hyperlactacidemia. Treatment with cardiopulmonary support and hemodiafiltration gradually improved his general condition, although it resulted in ischemic necrosis of the right leg. The hyperlactacidemia completely resolved after amputation, and the high output cardiac failure has not recurred for two years. High output cardiac failure is rare in MD patients and is related to myocardial abnormalities and hyperlactacidemia.
Assuntos
Débito Cardíaco Elevado/etiologia , Débito Cardíaco Elevado/terapia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/terapia , Doenças Mitocondriais/complicações , Adulto , Débito Cardíaco Elevado/fisiopatologia , Cardiomiopatias/complicações , Cardiomiopatias/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Hemodiafiltração , Humanos , Ácido Láctico/sangue , Síndrome MELAS/complicações , Síndrome MELAS/diagnóstico , Masculino , Doenças Mitocondriais/diagnósticoRESUMO
A 70-year-old Caucasian male presented 8 months postcadaveric renal transplant with slowly progressive shortness of breath, abdominal distention, and cough for a duration of a few days. Thorough evaluation found him to have severe pulmonary hypertension (PH) on echocardiogram with decompensated high-output congestive heart failure. A right heart catheterization was done, which confirmed elevated right-sided pressures and high cardiac output. The mean pulmonary artery pressure, on a Swan-Ganz catheter, improved from 37 to 30 mmHg on partial manual occlusion of his still functioning hemodialysis arteriovenous fistula. Subsequently, the patient underwent ligation of the fistula and this led to gradual improvement in his symptoms. Follow-up right heart catheterization and echocardiogram showed marked improvement and normalization of right heart pressures. We recommend that patients with arteriovenous fistula should undergo close monitoring for development of early signs and symptoms of congestive heart failure and screening for PH by echocardiography post-kidney transplant. Right heart catheterization should be considered if screening is positive. Risk and benefit of fistula closure should be weighed in face of reduced survival from PH in dialysis patients and closure should be considered in post-transplant patients.
Assuntos
Cateterismo Cardíaco , Débito Cardíaco Elevado , Insuficiência Cardíaca , Transplante de Rim , Diálise Renal , Idoso , Débito Cardíaco Elevado/etiologia , Débito Cardíaco Elevado/fisiopatologia , Débito Cardíaco Elevado/terapia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/terapia , Humanos , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/fisiopatologia , Hipertensão Pulmonar/terapia , MasculinoRESUMO
Large dural arteriovenous malformations (DAVMs) accompanied by cardiac failure usually carry a poor prognosis with a high risk of morbidity and death. The authors report on the case of a male neonate with a massive DAVM who presented at birth with macrocephaly and high-output cardiac failure. The child initially underwent treatment with surgical clipping of the large main feeding artery. Hydrocephalus, thought to be due to venous hypertension, developed when the boy was 8 months old. The condition resolved after interventional embolization treatment. The patient did not require placement of a ventriculoperitoneal shunt. At 21 months of age, the child had near normal development without any focal neurological deficits.
Assuntos
Malformações Vasculares do Sistema Nervoso Central/fisiopatologia , Malformações Vasculares do Sistema Nervoso Central/psicologia , Desenvolvimento Infantil/fisiologia , Débito Cardíaco Elevado/fisiopatologia , Débito Cardíaco Elevado/psicologia , Débito Cardíaco Elevado/terapia , Malformações Vasculares do Sistema Nervoso Central/terapia , Embolização Terapêutica , Insuficiência Cardíaca/fisiopatologia , Insuficiência Cardíaca/psicologia , Insuficiência Cardíaca/terapia , Humanos , Recém-Nascido , Masculino , Destreza Motora/fisiologia , Procedimentos NeurocirúrgicosRESUMO
A 67-year-old dialysis-dependent man presented to the cardiology service with worsening high output cardiac failure and was found to have a harsh, right-sided abdominal bruit on examination. Of significance, he had undergone several laparotomies related to a stab wound experienced 7 years earlier. A computed tomography scan revealed right renal artery pseudoaneurysms with fistulous communication to the vena cava. Successful percutaneous coil embolization and cyanoacrylate gluing enabled fistula closure without renal infarction. Symptoms of cardiac failure ultimately resolved following treatment. Catheter-based therapies provide minimally invasive and effective strategies for treating complicated fistulas involving the renal vasculature.
Assuntos
Falso Aneurisma/terapia , Fístula Arteriovenosa/terapia , Débito Cardíaco Elevado/etiologia , Embolização Terapêutica , Insuficiência Cardíaca/etiologia , Artéria Renal , Veia Cava Inferior , Ferimentos Perfurantes/complicações , Idoso , Falso Aneurisma/diagnóstico por imagem , Falso Aneurisma/etiologia , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/etiologia , Débito Cardíaco Elevado/diagnóstico por imagem , Débito Cardíaco Elevado/terapia , Cianoacrilatos/uso terapêutico , Embolização Terapêutica/instrumentação , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/terapia , Humanos , Masculino , Artéria Renal/diagnóstico por imagem , Adesivos Teciduais/uso terapêutico , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Veia Cava Inferior/diagnóstico por imagem , Ferimentos Perfurantes/cirurgiaRESUMO
Involvement of abdominal organs in Osler's disease may lead to the development of hepatic arteriovenous shunts with a dilatation of the hepatic artery. Right and subsequent global heart failure due to cardiac valvular insufficiency, pulmonary artery hypertension, and hepatomegaly as well as increased cardiac output may result. This hyperdynamic hepatic blood flow can be reduced by ligature or banding of the hepatic artery or by orthotopic liver transplantation. We report on two female patients suffering from Osler's disease (68 and 76 years old) with severe heart insufficiency (NYHA III-IV) caused by the high hepatic shunt volumes. A gradual banding of the hepatic artery directed by intraoperative flow measurement in the hepatic artery and control of the systemic hemodynamics by Swan-Ganz or COLD catheters was performed in these patients. The banding was achieved by encasing the hepatic artery in a PTFE cuff (length, 1.0 cm). The high cardiac output could be reduced from 11.2 to 7.0 l/min and from 10.7 to 6.0 l/min, respectively. The respective hepatic artery flow was reduced from 2.0 to 0.3 l/min and from 4.0 to 0.7 l/min. An improvement of heart insufficiency, a reduction in the severity of the cardiac valvular insufficiency, and a reduction of the pulmonary arterial hypertension could be already observed intraoperatively. One patient died of right cardiac failure after an orthotopic liver transplantation 7 months later. The other one died 3 years after the banding. The banding of the hepatic artery controlled by hepatic arterial flow measurement can be considered as an effective and safe palliative procedure in intrahepatic HHT compared to therapeutic alternatives such as hepatic artery ligation or embolization.
Assuntos
Débito Cardíaco Elevado/terapia , Insuficiência Cardíaca/terapia , Artéria Hepática/cirurgia , Circulação Hepática , Telangiectasia Hemorrágica Hereditária/complicações , Idoso , Débito Cardíaco Elevado/etiologia , Débito Cardíaco Elevado/fisiopatologia , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Hemodinâmica , Humanos , Ligadura , Telangiectasia Hemorrágica Hereditária/fisiopatologiaRESUMO
Renal arteriovenous fistula is a rare clinical entity that may produce high-output cardiac failure. This report describes the case of an 81-year-old woman in whom recurrent episodes of congestive heart failure developed over a relatively short time. A massive renal arteriovenous fistula was visualized by CT scan and arteriography. Successful embolization was performed under hemodynamic monitoring with complete resolution of the patient's symptoms.
Assuntos
Fístula Arteriovenosa/complicações , Oclusão com Balão , Débito Cardíaco Elevado/terapia , Insuficiência Cardíaca/terapia , Artéria Renal , Veias Renais , Idoso , Idoso de 80 Anos ou mais , Fístula Arteriovenosa/diagnóstico por imagem , Débito Cardíaco Elevado/diagnóstico por imagem , Débito Cardíaco Elevado/etiologia , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/etiologia , Humanos , Radiografia , Artéria Renal/diagnóstico por imagem , Veias Renais/diagnóstico por imagemRESUMO
PURPOSE: To report the perioperative management of arteriovenous fistula (AVF) closure in a patient with high-output heart failure and pulmonary hypertension. CLINICAL FEATURES: In a 71-yr-old man, closure of a long-standing massive AVF between the right femoral artery and vein was performed. After closure of the AVF, his pulmonary artery pressure (PAP) increased from 52/21 mmHg to 68/26 mmHg, his cardiac index decreased from 5.27 L.min(-1).m(-2) to 3.18 L.min(-1).m(-2), and his pulmonary wedge pressure increased from 15 mmHg to 32 mmHg due to an acute increase in afterload. Co-administration of prostaglandin E and a phosphodiesterase III inhibitor improved the cardiac index and the PAP. CONCLUSIONS: Surgical closure of the fistula may not always lead to resolution of the high output cardiac failure. In this case, afterload management using arterial dilators (prostaglandin E1, phosphodiesterase III inhibitor), use of inotropic drugs (phosphodiesterase III inhibitor), and close attention to volume status was crucial for a successful outcome after surgical AVF closure.