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1.
Cardiol J ; 27(1): 62-71, 2020.
Article in English | MEDLINE | ID: mdl-30155868

ABSTRACT

BACKGROUND: Acute heart failure patients could benefit from heart rate reduction, as myocardial consumption and oxidative stress are related to tachycardia. Ivabradine could have a clinical role attenuating catecholamine-induced tachycardia. The aim of this study was to evaluate hemodynamic effects of ivabradine in a swine model of acute heart failure. METHODS: Myocardial infarction was induced by 45 min left anterior descending artery balloon occlusion in 18 anesthetized pigs. An infusion of dobutamine and noradrenaline was maintained aiming to preserve adequate hemodynamic support, accompanied by fluid administration to obtain a pulmonary wedged pressure ≥ 18 mmHg. After reperfusion, rhythm and hemodynamic stabilization, the animals were randomized to 0.3 mg/kg ivabradine intravenously (n = 9) or placebo (n = 9). Hemodynamic parameters were observed over a 60 min period. RESULTS: Ivabradine was associated with a significant reduction in heart rate (88.4 ± 12.0 bpm vs. 122.7 ± 17.3 bpm after 15 min of ivabradine/placebo infusion, p < 0.01) and an increase in stroke volume (68.8 ± 13.7 mL vs. 52.4 ± 11.5 mL after 15 min, p = 0.01). There were no significant differences in systemic or pulmonary arterial pressure, or significant changes in pulmonary capillary pressure. However, after 15 min, cardiac output was significantly reduced with ivabradine (-5.2% vs. +15.0% variation in ivabradine/placebo group, p = 0.03), and central venous pressure increased (+4.2% vs. -19.7% variation, p < 0.01). CONCLUSIONS: Ivabradine reduces heart rate and increases stroke volume without modifying systemic or left filling pressures in a swine model of acute heart failure. However, an excessive heart rate reduction could lead to a decrease in cardiac output and an increase in right filling pressures. Future studies with specific heart rate targets are needed.


Subject(s)
Arterial Pressure , Cardiac Output , Cardiovascular Agents , Heart Failure , Heart Rate , Ivabradine , Animals , Female , Acute Disease , Arterial Pressure/drug effects , Cardiac Output/drug effects , Cardiovascular Agents/pharmacology , Disease Models, Animal , Heart Failure/drug therapy , Heart Failure/etiology , Heart Failure/physiopathology , Heart Rate/drug effects , Ivabradine/pharmacology , Myocardial Infarction/complications , Sus scrofa , Time Factors
2.
Ann Vasc Surg ; 43: 309.e5-309.e9, 2017 Aug.
Article in English | MEDLINE | ID: mdl-28461184

ABSTRACT

BACKGROUND: Perigraft hygromas or seromas are an unusual finding and/or complication after open aortic repair. METHODS AND RESULTS: We present a case of an 82-year-old man with a previous urgent aortic bifurcated graft for abdominal aortic aneurysm rupture. He received several treatments due to abdominal compartment syndrome, requiring a Bogota Bag and colostomy derivation. He was finally discharged home and lost on follow-up. Eight years after this procedure, he presented to the urgency department with an abdominal mass and pain. Urgent computed tomography (CT) scan revealed a giant bilobed aortic sac, corresponding with a huge hygroma. A 3-stage minimally invasive procedure was scheduled due to hostile abdomen. Six months after successful treatment, patient came with fever and abdominal pain. He was diagnosed with graft infection and aortoenteric fistula and was treated with explantation and silver in situ repair. CONCLUSIONS: Aortic hygroma or seromas after open repair should be treated by open means whenever possible. Endovascular techniques could be a valid option in selected patients; however, further evidence is needed.


Subject(s)
Aorta, Abdominal/surgery , Aortic Aneurysm, Abdominal/surgery , Aortic Rupture/surgery , Blood Vessel Prosthesis Implantation/instrumentation , Blood Vessel Prosthesis , Endovascular Procedures , Lymphangioma, Cystic/surgery , Vascular Neoplasms/surgery , Aged, 80 and over , Aorta, Abdominal/diagnostic imaging , Aortography/methods , Blood Vessel Prosthesis/adverse effects , Blood Vessel Prosthesis Implantation/adverse effects , Computed Tomography Angiography , Device Removal , Endovascular Procedures/adverse effects , Endovascular Procedures/instrumentation , Humans , Intestinal Fistula/diagnosis , Intestinal Fistula/microbiology , Intestinal Fistula/surgery , Lymphangioma, Cystic/diagnostic imaging , Male , Prosthesis-Related Infections/diagnosis , Prosthesis-Related Infections/microbiology , Prosthesis-Related Infections/surgery , Risk Factors , Stents , Time Factors , Treatment Failure , Vascular Fistula/diagnosis , Vascular Fistula/microbiology , Vascular Fistula/surgery , Vascular Neoplasms/diagnostic imaging
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