Ventricular assistance with microaxial flow pump following mitral repair for dilated cardiomyopathy.

BACKGROUND: Postcardiotomy heart failure is still the main cause of death in patients undergoing palliative surgery for end-stage dilative cardiomyopathy. New micro-axial flow ventricular assisting devices (LVAD) have been suggested in such cases. OBJECTIVE: Evaluate the effect of the new LVAD on short-term outcome of a patient admitted for end-stage heart failure. STUDY DESIGN: Case report. DATA SOURCES: One patient admitted for severe mitral regurgitation secondary to end-stage dilative cardiomyopathy and chronic atrial fibrillation (AF). INTERVENTION: Preoperative intraaortic balloon pump (IABP) insertion, mitral plasty with radiofrequency ablation of AF, microaxial flow LVAD support. RESULTS: The patient was unweanable from cardiopulmonary bypass until microaxial flow LVAD unloaded the left ventricle and restored adequate cardiac function. The patient was discharged home and is still well at 5 months folllow-up. CONCLUSIONS: The miniinvasive insertion and withdrawal, low anticoagulation protocols, and the possibility of coupling with IABP make the microaxial flow LVAD promising for patients with end-stage heart failure undergoing surgery.

Infection by CagA-positive Helicobacter pylori strains in patients with ischemic heart disease: prevalence and association with exercise-induced electrocardiographic abnormalities.

The role of H. pylori infection in increasing the risk of ischemic heart diseases (IHD) is still debated. We determined serologically the prevalence of overall H. pylori and CagA-positive H. pylori infection in 63 consecutive patients with IHD and 189 gender- and age-matched controls. We also determined in patients the influence of the infection and the CagA serological status on the results of an exercise ECG test and other parameters considered possible variables that may enhance the risk of IHD. The prevalence of H. pylori infection in patients and controls was 79.3% and 73.0%, respectively (P = 0.403) and that of CagA-positive H. pylori infection was 69.8% and 42.3%, respectively (P = 0.0002). The scores of the ECG S-T segment and T-wave abnormalities in the course of an exercise ECG in uninfected patients and in patients infected by CagA-negative and CagA-positive H. pylori strains were (mean +/- SD): 1.59 +/- 0.67, 1.92 +/- 0.64, and 2.19 +/- 0.70, respectively; (P = 0.011, 95% confidence limits of difference 0.15-1.07, CagA-positive infected vs uninfected patients). There was no intergroup difference in the levels of peripheral white blood cells, glucose, cholesterol, triglycerides, creatinine, and systolic and diastolic pressure. In conclusion, genetic heterogeneity of H. pylori could possibly explain some conflicting results concerning the association of H. pylori infection with IHD. Coronary vessels of IHD patients infected by CagA-positive H. pylori strains may be damaged more severely than those of uninfected patients.

[Unusual cause of acute abdomen in childhood. Cystic fibrolymphangioma of the mesentery]. / Cause rare di addome acuto nell'infanzia. Il fibrolinfangioma cistico del mesentere.

Cystic fibrolymphangioma of the mesentery as an unusual cause of acute abdomen in infancy is described. This form is one of the many mesenteric cysts whose pathogenesis has not yet been established. Preoperative diagnosis of such cysts is very difficult, and there are very few cases in which a close study has been possible in the light of clinical suspicion. Intraoperative diagnosis is the most likely, therefore, though there are cases - such as that reported here - in which surgery is indicated to remedy the occlusion caused by the cyst, and not because a swelling has been noted on clinical examination.