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1.
Am J Cardiol ; 206: 31-34, 2023 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-37677880

RESUMO

Intravenous epoprostenol improves exercise capacity and survival in patients with pulmonary arterial hypertension (PAH); however, it has side effects. Reviewing the side effects associated with epoprostenol and treprostinil is essential for improving the long-term treatment strategies for PAH. This retrospective review included patients with PAH who transitioned from intravenous epoprostenol to intravenous treprostinil owing to intolerable side effects, including high cardiac output symptoms, ascites, and thrombocytopenia. Of the 85 patients who received epoprostenol at our hospital between 2013 and 2021, 16 (11 women), with a median age of 33 (range 26 to 40) years (including 12 with idiopathic PAH, 3 with hereditary PAH, and 1 with connective tissue disease pulmonary hypertension), had to switch from intravenous epoprostenol to treprostinil owing to the side effects. After transitioning, epoprostenol-associated intolerable side effects, such as high cardiac output symptoms, ascites, and thrombocytopenia, were ameliorated. In conclusion, for patients with PAH who have intolerable side effects from epoprostenol and have difficulty in continuing treatment, switching from epoprostenol to treprostinil may be an option. Switching treatment leads to better adherence and improved long-term prostacyclin therapy.


Assuntos
Hipertensão Arterial Pulmonar , Trombocitopenia , Humanos , Feminino , Adulto , Epoprostenol/efeitos adversos , Anti-Hipertensivos/uso terapêutico , Hipertensão Arterial Pulmonar/tratamento farmacológico , Ascite , Débito Cardíaco Elevado/induzido quimicamente , Débito Cardíaco Elevado/tratamento farmacológico
2.
ESC Heart Fail ; 10(4): 2702-2706, 2023 08.
Artigo em Inglês | MEDLINE | ID: mdl-37216928

RESUMO

We are presenting a 35-year-old woman with past medical history of disseminated leiomyomatosis who presented with heart failure symptoms and was found to have post-capillary pulmonary hypertension and high cardiac output state in right heart catheterization secondary to a huge pelvic arterio-venous fistula.


Assuntos
Fístula Arteriovenosa , Cardiopatias , Insuficiência Cardíaca , Feminino , Humanos , Adulto , Débito Cardíaco Elevado/diagnóstico , Débito Cardíaco Elevado/etiologia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Artéria Pulmonar , Fístula Arteriovenosa/complicações , Fístula Arteriovenosa/diagnóstico
3.
J Physiol Anthropol ; 42(1): 6, 2023 Apr 13.
Artigo em Inglês | MEDLINE | ID: mdl-37055843

RESUMO

BACKGROUND: Acute mountain sickness (AMS) affects around 30% of people climbing Mt. Fuji, but its pathogenesis is incompletely understood. The influence of a rapid ascent to high altitude by climbing and summiting Mt. Fuji on cardiac function in the general population is unknown, and its association with altitude sickness has not been clarified. METHODS: Subjects climbing Mt. Fuji were included. Heart rate, oxygen saturation, systolic blood pressure, cardiac index (CI) and stroke volume index were measured multiple times at 120 m as baseline values and at Mt. Fuji Research Station (MFRS) at 3,775 m. Each value and its difference from the baseline value (Δ) of subjects with AMS (defined as Lake Louise Score [LLS] ≥ 3 with headache after sleeping at 3,775 m) were compared with those of non-AMS subjects. RESULTS: Eleven volunteers who climbed from 2,380 m to MFRS within 8 h and stayed overnight at MFRS were included. Four suffered AMS. Compared with the non-AMS subjects, CI in the AMS subjects was significantly higher than that before sleeping (median [interquartile range]: 4.9 [4.5, 5.0] vs. 3.8 [3.4, 3.9] mL/min/m2; p = 0.04), and their ΔCI was significantly higher before sleeping (1.6 [1.4, 2.1] vs. 0.2 [0.0, 0.7] mL/min/m2; p < 0.01) and after sleeping (0.7 [0.3, 1.7] vs. -0.2 [-0.5, 0.0] mL/min/m2; p < 0.01). ΔCI in the AMS subjects dropped significantly after sleeping versus before sleeping (3.8 [3.6, 4.5] vs. 4.9 [4.5, 5.0] mL/min/m2; p = 0.04). CONCLUSIONS: Higher values of CI and ΔCI were observed at high altitude in the AMS subjects. A high cardiac output might be associated with the development of AMS.


Assuntos
Doença da Altitude , Humanos , Doença da Altitude/epidemiologia , Altitude , Débito Cardíaco Elevado , Doença Aguda , Cefaleia
4.
Respir Med ; 206: 107034, 2023 01.
Artigo em Inglês | MEDLINE | ID: mdl-36511685

RESUMO

Pulmonary hypertension (PH) is usually associated with a normal or decreased cardiac output (CO). Less commonly, PH can occur in the context of a hyperdynamic circulation, characterized by high CO (>8 L/min) and/or cardiac index ≥4 L/min/m2 in the setting of a decreased systemic vascular resistance. PH due to high CO can occur due to multiple conditions and in general remains understudied. In this review article we describe the pathophysiology, etiology, diagnosis, hemodynamic characteristics, and management of PH in the setting of high CO. It is important to recognize this distinct entity as PH tends to improve with treatment of the underlying etiology and PH specific therapies may worsen the hemodynamic state.


Assuntos
Débito Cardíaco Elevado , Hipertensão Pulmonar , Humanos , Débito Cardíaco , Hemodinâmica/fisiologia , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/etiologia , Hipertensão Pulmonar/terapia , Resistência Vascular/fisiologia
6.
BMC Cardiovasc Disord ; 22(1): 149, 2022 04 05.
Artigo em Inglês | MEDLINE | ID: mdl-35382741

RESUMO

BACKGROUND: High-output heart failure is a rare condition that occurs when the heart is unable to respond to a sustained increase in blood demand. On echocardiography, a cardiac index of > 4 L/min/m2 (or 6 L/min) is a clear indicator of this disorder. The causes of high-output heart failure vary, but they all involve peripheral vasodilation or arteriovenous shunting. Renal cell carcinoma is well known for producing high levels of angiogenic growth factors that induce arteriovenous shunts. The decrease in peripheral arterial resistance and the increase in venous return result in a permanent high cardiac output, followed by congestive heart failure. Single bone metastases of renal clear cell carcinoma tumours causing high cardiac output and heart failure symptoms have been reported less than ten times in the medical literature. CASE PRESENTATION: Before a right-shoulder painful lump with a murmur when auscultated, magnetic resonance imaging revealed a large scapular mass, which was biopsied and found to be a bone metastasis of renal cell carcinoma. Two months later, the patient developed heart failure for the first time. There was no evidence of cardiac disease on echocardiography. The cardiac output was 9.8 L/min and the cardiac index was 5.1 L/min/m2. Doppler ultrasound revealed numerous arteriovenous shunts in the large scapular metastasis and a right axillary artery flow of 24% of cardiac output. Sustained lower cardiac output was obtained following lesion-focused radiotherapy and systemic antiangiogenic treatment with axitinib and pembrolizumab. CONCLUSIONS: Herein, we present a unique case of high-output heart failure in a 70-year-old man diagnosed by echocardiography and upper-limb Doppler ultrasound in the context of metastatic renal cell carcinoma without pre-existing cardiac disease. We stress the potentially life-threatening hemodynamic consequences of hypervascularity associated with arteriovenous shunts within a single metastatic renal cell carcinoma implant, the importance of auscultating any progressing bone mass, and the utility of non-invasive Doppler ultrasound assessment in this setting.


Assuntos
Carcinoma de Células Renais , Insuficiência Cardíaca , Neoplasias Renais , Idoso , Carcinoma de Células Renais/complicações , Carcinoma de Células Renais/diagnóstico por imagem , Carcinoma de Células Renais/terapia , Débito Cardíaco Elevado/etiologia , Ecocardiografia/efeitos adversos , Insuficiência Cardíaca/complicações , Insuficiência Cardíaca/etiologia , Humanos , Neoplasias Renais/complicações , Neoplasias Renais/diagnóstico por imagem , Masculino
7.
Chest ; 161(1): e23-e28, 2022 01.
Artigo em Inglês | MEDLINE | ID: mdl-35000713

RESUMO

CASE PRESENTATION: A 55-year-old woman with a medical history of hereditary hemorrhagic telangiectasia (HHT) complicated by recurrent nosebleeds, severe blood loss anemia, hepatic arterial-venous malformation (AVM), pulmonary hypertension, and severe tricuspid regurgitation presented to the HHT specialty clinic with acute hypoxic respiratory failure (new 3-L O2 requirement), weight gain, and volume overload. She was directly admitted to the pulmonary hypertension unit of our hospital. She had two recent admissions for similar symptoms thought to be due to worsening pulmonary arterial hypertension. In prior admissions, she had undergone right heart catheterization demonstrating mild pulmonary hypertension (pulmonary arterial pressure, 29 mm Hg, cardiac output by Fick 5.76, and cardiac index 3.22, mildly elevated pulmonary vascular resistance to 5.5 woods units). She would undergo diuresis with symptomatic improvement; however, after discharge she would rapidly develop recurrent heart failure symptoms. She reported compliance with guideline-directed medications, diuretics, and dietary restrictions and was still suffering severe symptoms. Notably she had previously elevated liver enzymes concerning for cirrhosis and had begun a workup to evaluate for causes of cirrhosis; she had a history of mild alcohol use, negative hepatitis viral serology, and no known history of liver disease.


Assuntos
Malformações Arteriovenosas/fisiopatologia , Débito Cardíaco Elevado/diagnóstico , Insuficiência Cardíaca/diagnóstico , Fígado/irrigação sanguínea , Telangiectasia Hemorrágica Hereditária/fisiopatologia , Insuficiência da Valva Tricúspide/fisiopatologia , Malformações Arteriovenosas/complicações , Cateterismo Cardíaco , Débito Cardíaco Elevado/etiologia , Débito Cardíaco Elevado/fisiopatologia , Ecocardiografia , Ecocardiografia Doppler em Cores , Feminino , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Artéria Hepática/anormalidades , Veias Hepáticas/anormalidades , Humanos , Pessoa de Meia-Idade , Veia Porta/anormalidades , Hipertensão Arterial Pulmonar , Radiografia Torácica , Telangiectasia Hemorrágica Hereditária/complicações , Telangiectasia/congênito , Insuficiência da Valva Tricúspide/complicações , Desequilíbrio Hidroeletrolítico/etiologia , Desequilíbrio Hidroeletrolítico/fisiopatologia
8.
BMC Anesthesiol ; 21(1): 219, 2021 09 08.
Artigo em Inglês | MEDLINE | ID: mdl-34496748

RESUMO

BACKGROUND: Circulatory failure frequently occurs after out-of-hospital cardiac arrest (OHCA) and is part of post-cardiac arrest syndrome (PCAS). The aim of this study was to investigate circulatory disturbances in PCAS by assessing the circulatory trajectory during treatment in the intensive care unit (ICU). METHODS: This was a prospective single-center observational cohort study of patients after OHCA. Circulation was continuously and invasively monitored from the time of admission through the following five days. Every hour, patients were classified into one of three predefined circulatory states, yielding a longitudinal sequence of states for each patient. We used sequence analysis to describe the overall circulatory development and to identify clusters of patients with similar circulatory trajectories. We used ordered logistic regression to identify predictors for cluster membership. RESULTS: Among 71 patients admitted to the ICU after OHCA during the study period, 50 were included in the study. The overall circulatory development after OHCA was two-phased. Low cardiac output (CO) and high systemic vascular resistance (SVR) characterized the initial phase, whereas high CO and low SVR characterized the later phase. Most patients were stabilized with respect to circulatory state within 72 h after cardiac arrest. We identified four clusters of circulatory trajectories. Initial shockable cardiac rhythm was associated with a favorable circulatory trajectory, whereas low base excess at admission was associated with an unfavorable circulatory trajectory. CONCLUSION: Circulatory failure after OHCA exhibits time-dependent characteristics. We identified four distinct circulatory trajectories and their characteristics. These findings may guide clinical support for circulatory failure after OHCA. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02648061.


Assuntos
Débito Cardíaco Elevado/fisiopatologia , Baixo Débito Cardíaco/fisiopatologia , Parada Cardíaca Extra-Hospitalar/fisiopatologia , Resistência Vascular/fisiologia , Estudos de Coortes , Feminino , Humanos , Unidades de Terapia Intensiva , Masculino , Pessoa de Meia-Idade , Fatores de Tempo
9.
Ann Vasc Surg ; 74: 431-449, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33556504

RESUMO

High-output cardiac failure is a rare form of heart failure associated with the formation of arteriovenous fistula (AVF) in hemodialysis patients. The pathophysiology underlying the HOCF is complex and multifactorial. Presence of AVF can cause long term hemodynamic changes that ultimately lead to increased cardiac output and consequently cardiac failure. A number of risk factors have been associated with the development of HOCF post-AVF construction, including male sex, a proximally located AVF and a state of volume overload. Dysregulation of tissue inhibitor of matrix metalloproteinase 4, Sirtuin-1 and Sirtuin-3 gene expression have been associated with the development of heart failure. The differences observed between genders have been attributed to altered activity of the ß-adrenoceptor system. Numerous biomarkers including cardiac troponin T and I, atrial natriuretic peptide, brain natriuretic peptide among others have shown both prognostic and diagnostic potential; however further research is needed to establish their utility in clinical practice for patients with AVF associated HOCF. In recent years risk stratification models have been developed to help identify patients at the highest risk of developing HOCF post AVF which could be revolutionary in its identification and management. Potential options for managing HOCF post-AVF include AVF ligation, banding and anastoplasty however these procedures are not without their own associated risks. In this review, we discuss the pathophysiology, risk stratification and management of patients with AVF associated HOCF.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Insuficiência Cardíaca/etiologia , Diálise Renal/efeitos adversos , Biomarcadores/sangue , Débito Cardíaco Elevado/etiologia , Insuficiência Cardíaca/genética , Insuficiência Cardíaca/terapia , Humanos , Falência Renal Crônica/complicações , Falência Renal Crônica/terapia , Peptídeos Natriuréticos/sangue , Qualidade de Vida , Fatores de Risco , Ciência Translacional Biomédica , Troponina/sangue
10.
Pediatr Cardiol ; 42(3): 700-706, 2021 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-33416919

RESUMO

Failed Fontan Patients with high cardiac output (CO) heart failure (HF) might have vasodilatory syndrome and markedly high mortality rates. The aim of this study was to review the clinical effects of vasoconstrictor therapy (VCT) for failed Fontan hemodynamics. We retrospectively reviewed 10 consecutive patients with Fontan failure (median age, 33 years) and high CO-HF who had received VCT. The hemodynamics were characterized by high central venous pressure (CVP: median, 16 mm Hg), low systolic blood pressure (median, 83 mm Hg), low systemic vascular resistance (median, 8.8 U·m2), high cardiac index (median, 4.6 L/min/m2), and low arterial oxygen saturation (median, 89%). VCT included intravenous noradrenaline infusion for five unstable patients, oral midodrine administration for nine stable patients, and both for four patients. After VCT introduction with a median interval of 1.7 months, the median systolic blood pressure (102 mm Hg, p = 0.004), arterial oxygen saturation (90%, p = 0.03), and systemic vascular resistance (12.1 U·m2, p = 0.13) increased without significant changes in CVP or cardiac index. After a median follow-up of 21 months, the number of readmissions per year decreased from 4 (1-11) to 1 (0-9) (p = 0.25), and there were no VCT-related complications; however, five patients (50%) developed hepatic encephalopathy, and six patients (60%) eventually died. VCT was safely introduced and could prevent the rapidly deteriorating Fontan hemodynamics. VCT could be an effective therapeutic strategy for failed Fontan patients with high CO-HF.


Assuntos
Débito Cardíaco Elevado/tratamento farmacológico , Técnica de Fontan/efeitos adversos , Insuficiência Cardíaca/tratamento farmacológico , Vasoconstritores/uso terapêutico , Adulto , Débito Cardíaco Elevado/etiologia , Pressão Venosa Central/efeitos dos fármacos , Feminino , Cardiopatias Congênitas/cirurgia , Insuficiência Cardíaca/etiologia , Humanos , Masculino , Estudos Retrospectivos , Resistência Vascular/efeitos dos fármacos
11.
Vasc Endovascular Surg ; 55(2): 177-182, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32878580

RESUMO

Arterio-hepatic venous fistula (AHVF) is an exceedingly rare phenomenon compared to arterio-portal venous fistula with only 8 cases reported in world literature. Many listed causes can be attributed to the development of there are no reported cases of AHVF following a core-needle biopsy. We report a case of 38 year-old-female with EHPVO, who underwent splenectomy with a proximal splenorenal shunt. She had an injury to left hepatic artery, consequent to a blind intra-operative core needle biopsy from the liver, which led to the development of a fistulous connection between left hepatic artery and middle hepatic vein causing high output cardiac failure. She was successfully managed with trans-arterial embolization. The present review emphasizes the possibility of AHVF following a liver biopsy and the role of digital subtraction angiography in the diagnosis, therapeutic intravascular interventions, and follow-up.


Assuntos
Fístula Arteriovenosa/etiologia , Biópsia com Agulha de Grande Calibre/efeitos adversos , Artéria Hepática/lesões , Veias Hepáticas , Lesões do Sistema Vascular/etiologia , Adulto , Angiografia Digital , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/terapia , Débito Cardíaco Elevado/etiologia , Embolização Terapêutica , Feminino , Insuficiência Cardíaca/etiologia , Artéria Hepática/diagnóstico por imagem , Veias Hepáticas/diagnóstico por imagem , Humanos , Resultado do Tratamento , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/terapia
12.
Ann Vasc Surg ; 72: 666.e13-666.e21, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33346123

RESUMO

Formation of a clinically significant iatrogenic arteriovenous fistula after endovenous laser treatment of the great saphenous vein is an extremely rare complication. Because of the infrequency of reported cases, there is no clear consensus on how to best manage this complication. We present a unique case of an iatrogenic high-output superficial femoral artery-common femoral vein fistula resulting in right heart failure and a distal deep vein thrombosis. Deployment of a covered arterial stent graft resulted in resolution of the arteriovenous fistula and high-output cardiac state. Clinically significant arteriovenous fistulas resulting from inadvertent vessel injury during endovenous laser treatment appear to be amenable to percutaneous endovascular interventions. During these challenging endovascular cases, intravascular ultrasonography can be used to help delineate the morphology of the fistula tract and obtain vessel measurements to ensure accurate endoprosthesis sizing and placement.


Assuntos
Fístula Arteriovenosa/etiologia , Débito Cardíaco Elevado/etiologia , Insuficiência Cardíaca/etiologia , Doença Iatrogênica , Terapia a Laser/efeitos adversos , Veia Safena/cirurgia , Úlcera Varicosa/cirurgia , Lesões do Sistema Vascular/etiologia , Insuficiência Venosa/cirurgia , Idoso , Fístula Arteriovenosa/diagnóstico por imagem , Fístula Arteriovenosa/cirurgia , Prótese Vascular , Implante de Prótese Vascular/instrumentação , Débito Cardíaco Elevado/diagnóstico por imagem , Doença Crônica , Procedimentos Endovasculares/instrumentação , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Humanos , Veia Safena/diagnóstico por imagem , Stents , Resultado do Tratamento , Úlcera Varicosa/diagnóstico por imagem , Lesões do Sistema Vascular/diagnóstico por imagem , Lesões do Sistema Vascular/cirurgia , Insuficiência Venosa/diagnóstico por imagem , Trombose Venosa/diagnóstico por imagem , Trombose Venosa/etiologia , Trombose Venosa/terapia
13.
J Am Heart Assoc ; 9(20): e016197, 2020 10 20.
Artigo em Inglês | MEDLINE | ID: mdl-33054561

RESUMO

Background Patients with hereditary hemorrhagic telangiectasia have liver vascular malformations that can cause high-output cardiac failure (HOCF). Known sequelae include pulmonary hypertension, tricuspid regurgitation, and atrial fibrillation. Methods and Results The objectives of this study were to describe the clinical, echocardiographic, and hemodynamic characteristics and prognosis of hereditary hemorrhagic telangiectasia patients with HOCF who were found to have a subaortic membrane (SAoM). A retrospective observational analysis comparing patients with and without SAoM was performed. Among a cohort of patients with HOCF, 9 were found to have a SAoM in the left ventricular outflow tract by echocardiography (all female, mean age 64.8±4.0 years). The SAoM was discrete and located in the left ventricular outflow tract 1.1±0.1 cm below the aortic annular plane. It caused turbulent flow, mild obstruction (peak velocity 2.8±0.2 m/s, peak gradient 32±4 mm Hg), and no more than mild aortic insufficiency. Patients with SAoM (n=9) had higher cardiac output (12.1±1.3 versus 9.3±0.7 L/min, P=0.04) and mean pulmonary artery pressures (36±3 versus 28±2 mm Hg, P=0.03) compared with those without SAoM (n=19) during right heart catheterization. Genetic analysis revealed activin receptor-like kinase 1 mutations in each of the 8 patients with SAoM who had available test results. The presence of a SAoM was associated with a trend towards higher 5-year mortality during follow-up. Conclusions SAoM with mild obstruction occurs in patients with hereditary hemorrhagic telangiectasia and HOCF. SAoM was associated with features of more advanced HOCF and poor outcomes.


Assuntos
Débito Cardíaco Elevado , Estenose Subaórtica Fixa , Cardiopatias Congênitas , Insuficiência Cardíaca , Fígado , Telangiectasia Hemorrágica Hereditária , Receptores de Activinas Tipo II/genética , Débito Cardíaco Elevado/diagnóstico , Débito Cardíaco Elevado/etiologia , Débito Cardíaco Elevado/fisiopatologia , Estenose Subaórtica Fixa/diagnóstico , Estenose Subaórtica Fixa/genética , Estenose Subaórtica Fixa/fisiopatologia , Ecocardiografia/métodos , Feminino , Cardiopatias Congênitas/diagnóstico , Cardiopatias Congênitas/genética , Cardiopatias Congênitas/fisiopatologia , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Fígado/irrigação sanguínea , Fígado/diagnóstico por imagem , Masculino , Pessoa de Meia-Idade , Mutação , Prognóstico , Estudos Retrospectivos , Análise de Sobrevida , Telangiectasia Hemorrágica Hereditária/diagnóstico , Telangiectasia Hemorrágica Hereditária/epidemiologia , Telangiectasia Hemorrágica Hereditária/genética , Telangiectasia Hemorrágica Hereditária/fisiopatologia , Estados Unidos/epidemiologia , Malformações Vasculares/diagnóstico , Malformações Vasculares/fisiopatologia
14.
BMC Surg ; 20(1): 106, 2020 May 18.
Artigo em Inglês | MEDLINE | ID: mdl-32423401

RESUMO

BACKGROUND: A large plexiform neurofibroma in patients with neurofibromatosis type I can be life threatening due to possible massive bleeding within the lesion. Although the literature includes many reports that describe the plexiform neurofibroma size and weight or strategies for their surgical treatment, few have discussed their possible physical or mental benefits, such as reducing cardiac stress. In addition, resection of these large tumors can result in impaired wound healing, partly due to massive blood loss during surgery. CASE PRESENTATION: A 24-year-old man was diagnosed with neurofibromatosis type I and burdened with a large plexiform neurofibroma on the buttocks and upper posterior thighs. The patient was 159 cm in height and 70.0 kg in weight at the first visit. Cardiac overload was indicated by an echocardiography before surgery. His cardiac output was 5.2 L/min with mild tricuspid regurgitation. After embolism of the arteries feeding the tumor, the patient underwent surgery to remove the neurofibroma, followed by skin grafting. Follow-up echocardiography, performed 6 months after the final surgery, indicated a decreased cardiac output (3.6 L/min) with improvement of tricuspid regurgitation. Because the blood loss during the first surgery was over 3.8 L, malnutrition with albuminemia was induced and half of the skin graft did not attach. Nutritional support to improve the albuminemia produced better results following a second surgery to repair the skin wound. CONCLUSION: Cardiac overload may be latent in patients with neurofibromatosis type I with large plexiform neurofibromas. As in pregnancy, the body may compensate for this burden. In these patients, one stage total excision may improve quality of life and reduce cardiac overload. In addition, nutritional support is likely needed following a major surgery that results in either an extensive skin wound or excessive blood loss during treatment.


Assuntos
Nádegas/cirurgia , Débito Cardíaco Elevado/fisiopatologia , Neoplasias Primárias Múltiplas/cirurgia , Neurofibroma Plexiforme/fisiopatologia , Neurofibroma Plexiforme/cirurgia , Neurofibromatose 1/fisiopatologia , Coxa da Perna/cirurgia , Débito Cardíaco Elevado/complicações , Humanos , Masculino , Neoplasias Primárias Múltiplas/fisiopatologia , Qualidade de Vida , Transplante de Pele , Adulto Jovem
15.
J Vasc Access ; 21(5): 753-759, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32103699

RESUMO

BACKGROUND: Arteriovenous fistula (AVF) for haemodialysis (HD) induces a volume/pressure overload which impairs bi-ventricular function and increases systolic pulmonary arterial pressure (PAPS) and left ventricular mass (LVM). In the presence of high blood flow (Qa) AVF (> 1.5 L/min/1.73 m2) and cardio-pulmonary recirculation (>20%), high-output congestive heart failure (CHF) may occur and AVF flow reduction is recommended. Proximal Radial Artery Ligation (PRAL) is an effective technique for distal radio-cephalic (RC) AVF flow reduction. METHODS: we evaluated six HD and four transplant patients with high-flow RC AVF and symptoms of CHF who underwent PRAL. We compared echocardiographic (ECHO) findings before (T0) and 1 and 6 months (T1,T6) after PRAL. Preoperative ECHO was performed before (T0b) and after AVF anastomosis manual compression (T0c). RESULTS: At T1 AVF flow reduction rate was 58.4% ± 13% and 80% of patients reported improved CHF symptoms. ECHO data showed an improvement of tricuspid annular plane systolic excursion (TAPSE) at T1 (p = 0.03) and a reduction of PAPS at T6 (p = 0.04). TAPSE improved after AVF anastomosis compression during preoperative ECHO (p = 0.03). Delta of TAPSE at the dynamic manoeuvre at T0 directly correlated with early (1 month after PRAL, p = 0.01) and late (6 months after PRAL, p = 0.04) deltas of TAPSE. CONCLUSIONS: AVF flow reduction after PRAL induces immediate regression of CHF symptoms, early improvement of TAPSE and late improvement of PAPS, suggesting a prevalent right sections involvement in CHF. Preoperative TAPSE modification after AVF anastomosis compression could represent a useful evaluation tool to determine which patients would benefit of PRAL.


Assuntos
Derivação Arteriovenosa Cirúrgica/efeitos adversos , Débito Cardíaco Elevado/cirurgia , Ecocardiografia Doppler em Cores , Antebraço/irrigação sanguínea , Insuficiência Cardíaca/cirurgia , Hemodinâmica , Artéria Radial/cirurgia , Diálise Renal , Idoso , Velocidade do Fluxo Sanguíneo , Débito Cardíaco Elevado/diagnóstico por imagem , Débito Cardíaco Elevado/etiologia , Débito Cardíaco Elevado/fisiopatologia , Feminino , Insuficiência Cardíaca/diagnóstico por imagem , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/fisiopatologia , Humanos , Transplante de Rim , Ligadura , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Estudos Prospectivos , Artéria Radial/diagnóstico por imagem , Artéria Radial/fisiopatologia , Recuperação de Função Fisiológica , Fatores de Risco , Fatores de Tempo , Resultado do Tratamento
16.
Niger J Clin Pract ; 23(2): 198-204, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32031094

RESUMO

BACKGROUND: Pulmonary hypertension (PH) is a serious cardiovascular complication in patients with end stage renal disease (ESRD) undergoing hemodialysis (HD) via arterio-venous fistulas (AVF). AIM: The aim of this study was to assess pulmonary vascular resistance (PVR), AVF flow volume (AVF-FV) and cardiac output (CO) and to highlight the impact of their augmentation, as well as of the duration of HD, on the occurrence of PH in patients with ESRD. METHODS: Our study group consisted of 51 dialyzed patients, with ESRD, without history of PH. We determined by ultrasonography the systolic pulmonary arterial pressure (PAPs), the left ventricular ejection fraction (EF), the cardiac output (CO), PVR and AVF-FV. RESULTS: We documented PH in 27 (52.94%) patients. All had elevated PVR, higher AVF-FV and CO comparing to patients without PH. They were undergoing HD for a longer period and had lower EF than those without PH. For all patients, we documented strong correlations between PAPs and PVR (r = 0.933, P < 0.001) and the duration of HD (r = 0.702, P < 0.001), but moderate ones with AVF-FV (r = 0.583, P < 0.001) and CO (r = 0.519, P < 0.001). CONCLUSION: In patients with ESRD undergoing HD, PH was a common finding being associated with increased PVR, a longer duration of HD and chronic glomerulonephritis as etiology for ESRD. The majority of patients with PH had altered left ventricular systolic function, predisposing them to an increased risk to develop heart failure.


Assuntos
Insuficiência Cardíaca/etiologia , Hipertensão Pulmonar/etiologia , Falência Renal Crônica/terapia , Artéria Pulmonar/fisiopatologia , Diálise Renal/efeitos adversos , Adulto , Idoso , Fístula Artério-Arterial , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Débito Cardíaco Elevado/etiologia , Feminino , Insuficiência Cardíaca/fisiopatologia , Humanos , Hipertensão Pulmonar/complicações , Hipertensão Pulmonar/diagnóstico , Hipertensão Pulmonar/epidemiologia , Falência Renal Crônica/complicações , Falência Renal Crônica/diagnóstico , Masculino , Pessoa de Meia-Idade , Fatores de Tempo , Resultado do Tratamento , Ultrassonografia
18.
Ann Vasc Surg ; 65: 288.e1-288.e4, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31778764

RESUMO

High-volume shunt flow after arteriovenous fistula (AVF) creation for hemodialysis can cause high-output heart failure. We used the Frame™ (Vascular Graft Solutions Ltd., Tel Aviv, Israel) external support, a stent, to limit vein dilatation and consecutive high-volume shunt in a 62-old female who underwent brachial-basilic upper arm transposition. After maturation, the shunt was used for dialysis and showed a plateauing flow volume 3 months after the operation. This case illustrates the safety and feasibility of this intervention when performed during AVF formation.


Assuntos
Derivação Arteriovenosa Cirúrgica , Artéria Braquial/cirurgia , Procedimentos Endovasculares/efeitos adversos , Falência Renal Crônica/terapia , Diálise Renal , Stents , Extremidade Superior/irrigação sanguínea , Veias/cirurgia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Velocidade do Fluxo Sanguíneo , Artéria Braquial/diagnóstico por imagem , Artéria Braquial/fisiopatologia , Débito Cardíaco Elevado/etiologia , Débito Cardíaco Elevado/fisiopatologia , Débito Cardíaco Elevado/prevenção & controle , Feminino , Humanos , Falência Renal Crônica/diagnóstico , Pessoa de Meia-Idade , Fluxo Sanguíneo Regional , Resultado do Tratamento , Veias/diagnóstico por imagem , Veias/fisiopatologia
19.
Ann Vasc Surg ; 66: 665.e5-665.e8, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31863947

RESUMO

The creation of an arteriovenous fistula (AVF) is the preferred mode of access for hemodialysis in patients with End-Stage Renal Disease (ESRD). High output cardiac failure is a known but rare complication of AVF resulting from high flow volume. This case report describes the use of intraoperative ultrasound as a guide for the banding of an AVF to decrease flow volume in a patient with high cardiac output failure. The access was preserved, and a gradual decline of cardiac function before and recovery after banding is demonstrated over an 18-year period.


Assuntos
Aneurisma/cirurgia , Derivação Arteriovenosa Cirúrgica/efeitos adversos , Débito Cardíaco Elevado/etiologia , Insuficiência Cardíaca/etiologia , Falência Renal Crônica/terapia , Diálise Renal , Ultrassonografia de Intervenção , Extremidade Superior/irrigação sanguínea , Aneurisma/diagnóstico por imagem , Aneurisma/etiologia , Aneurisma/fisiopatologia , Débito Cardíaco Elevado/diagnóstico , Débito Cardíaco Elevado/fisiopatologia , Feminino , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/fisiopatologia , Humanos , Falência Renal Crônica/diagnóstico , Ligadura , Pessoa de Meia-Idade , Recuperação de Função Fisiológica , Volume Sistólico , Fatores de Tempo , Resultado do Tratamento , Função Ventricular Esquerda
20.
Rev. bras. ciênc. mov ; 27(4): 219-227, out.-dez. 2019. ilus
Artigo em Português | LILACS | ID: biblio-1053332

RESUMO

O objetivo do presente estudo foi levantar, na literatura atual, estudos relevantes que identifiquem as possíveis respostas hemodinâmicas encontradas em indivíduos hipertensos praticantes do Método Pilates. A revisão sistemática conduzida conforme as recomendações PRISMA em cinco bases de dados eletrônicas (PEDro, PubMed, SciELO, LILACS e Cochrane), disponibilizado desde o início das bases até Março de 2019, com descritores MESH conforme segue: [("Adult" OR "Young adult" OR "Middle Aged" OR "Aged" OR "Elderly") AND ("exercise movement techniques" OR "Pilates-Based Exercises" OR "Pilates Training") AND ("Hemodynamics" OR "Heart Rate" OR "Cardiac Chronotropy" OR "Heart Rate Control" OR "hypertension" OR "Blood Pressure" OR "High Blood Pressure" OR "Systolic Pressure" OR "Diastolic Pressure" OR "High Blood Pressure" OR "Pulse Rate Determination")], posteriormente ajustado para as demais bases. Busca complementar manual nas referências dos artigos incluídos na pesquisa e Google Scholar. Foram incluídos estudos de intervenção, com idade maior ou igual a 18 anos; diagnóstico de hipertensão arterial sistêmica (HAS); submetidos a exercícios de pilates solo e/ou pilates aparelhos como método de intervenção e incluído a descrição de análise das variáveis hemodinâmicas de pressão arterial (PA), frequência cardíaca (FC) e duplo produto (DP). Após processo de seleção foi selecionado apenas um único estudo que tenha contemplado todos os critérios de elegibilidade, totalizando 44 indivíduos do sexo feminino, com média de idade de 50,5 anos (±6,3 anos), hipertensas com utilização de medicação, onde 22 foram submetidas ao pilates solo e 22 permaneceram no grupo controle. O estudo apresentou resultados positivos na frequência cardíaca (FC), pressão arterial (PA) e no duplo-produto (DP) em comparação ao grupo controle. Apesar do número limitado de manuscritos encontrados nesta revisão, os resultados das variáveis hemodinâmicas nos levam a considerar plausível a utilização do Mat pilates em pacientes com HAS. Entretanto, novos estudos devem ser realizados para a confirmação dos achados...(AU)


The aim this study was to raise in the current literature relevant studies that identify the possible hemodynamic responses found in hypertensive individuals practicing the Pilates Method. The systematic review conducted according to PRISMA recommendations in five electronic databases (PEDro, PubMed, SciELO, LILACS and Cochrane), available from the beginning of the databases until March 2019, with MESH descriptors as follows: [("Adult "OR" Young adult "OR" Middle Aged "OR" Aged "OR" Elderly ") AND (" Exercise Movement Techniques "OR" Pilates-Based Exercises "OR" Pilates Training ") AND (" Hemodynamics "OR" Heart Rate " OR "Cardiac Chronotropy" OR "Heart Rate Control" OR "Hypertension" OR "Blood Pressure" OR "High Blood Pressure" OR "Systolic Pressure" OR "Diastolic Pressure" OR "High Blood Pressure" OR "Pulse Rate Determination")] , later adjusted to the other bases. Manual complementary search in the references of the articles included in the search and Google Scholar. Intervention studies, 18 years of age or older were included; diagnosis of systemic arterial hypertension (SAH); submitted to solo pilates exercises and / or pilates apparatus as intervention method and included the description of analysis of hemodynamic variables of blood pressure (BP), heart rate (HR) and double product (SD). After the selection process, only one study was selected that met all the eligibility criteria, totaling 44 female individuals, with a mean age of 50.5 years (± 6.3 years), hypertensive with medication use, where 22 were submitted to solo pilates and 22 remained in the control group. The study showed positive results in heart rate (HR), blood pressure (BP) and double product (SD) compared to the control group. Despite the limited number of manuscripts found in this review, the results of hemodynamic variables lead us to consider the use of Mat pilates in patients with hypertension to be plausible. However, further studies should be performed to confirm the findings...(AU)


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Educação Física e Treinamento , Técnicas de Exercício e de Movimento , Hemodinâmica , Hipertensão , Exercício Físico , Débito Cardíaco Elevado , Exercícios de Alongamento Muscular , Pressão Arterial , Frequência Cardíaca
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