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Hemodynamic Improvement (hemodynamic + improvement)
Selected AbstractsRest and exercise hemodynamics before and after valve replacement-A combined doppler/catheter studyCLINICAL CARDIOLOGY, Issue 1 2000G. Inselmann M.D. Abstract Background: Hemodynamic improvement is a common finding following valve replacement. However, despite a normally functioning prosthesis and normal left ventricular ejection fraction, some patients may show an abnormal hemodynamic response to exercise. Methods: In a combined catheter/Doppler study, rest and exercise hemodynamics were evaluated in 23 patients following aortic (n = 12) (Group 1) or mitral valve (n = 11) (Group 2) replacement and compared with preoperative findings. Patient selection was based on absence of coronary artery disease and left ventricular failure as shown by preoperative angiography. Cardiac output, pulmonary artery pressure, pulmonary capillary pressure, and pulmonary resistance were measured by right heart catheterization, whereas the gradient across the valve prosthesis was determined by Doppler echocardiography. Postoperative evaluation was done at rest and during exercise. The mean follow-up was 8.2 ± 2.2 years in Group 1 and 4.2 ± 1 years in Group 2. Results: With exercise, there was a significant rise in cardiac output in both groups. In Group 1, mean pulmonary pressure/capillary pressure decreased from 24 ± 9/18 ± 9 mmHg preoperatively to 18 ± 2/12 ± 4 mmHg postoperatively (p < 0.05), and increased to 43 ± 12/30 ± 8 mmHg with exercise (p < 0.05). The corresponding values for Group 2 were 36 ± 12/24 ± 6 mmHg preoperatively, 24 ± 7/17 ± 6 mmHg postoperatively (p < 0.05), and 51 ± 2/38 ± 4 mmHg with exercise (p < 0.05). Pulmonary vascular resistance was 109 ± 56 dyne·s·cm -5 preoperatively, 70 ± 39 dyne·s·cm -5 postoperatively (p < 0.05), and 70 ± 36 dyne·s·cm -5 with exercise in Group 1. The corresponding values for Group 2 were 241 ± 155 dyne·s·cm -5, 116 ± 39 dyne·s·cm -5 (p < 0.05), and 104 ± 47 dyne·s·cm -5. There was a significant increase in the gradients across the valve prosthesis in both groups, showing a significant correlation between the gradient at rest and exercise. No correlation was found between valve prosthesis gradient and pulmonary pressures. Conclusion: Exercise-induced pulmonary hypertension and abnormal left ventricular filling pressures seem to be a frequent finding following aortic or mitral valve replacement. Both hemodynamic abnormalities seem not to be determined by obstruction to flow across the valve prosthesis and may be concealed, showing nearly normal values at rest but a pathologic response to physical stress. [source] Thrombelastometry-guided thrombolytic therapy in massive pulmonary artery embolismACTA ANAESTHESIOLOGICA SCANDINAVICA, Issue 9 2010A. PLOPPA We report a case of a patient who suffered a massive pulmonary embolism with cardiac arrest on post-operative day 4 after a Whipple operation. Despite thrombolytic therapy with the recommended maximal bolus of 50 mg recombinant tissue type plasminogen activator (rt-PA), thrombelastometry showed no signs of fibrinolysis and cardiogenic shock persisted, after only a transient hemodynamic improvement. Not until a repeat bolus of 25 mg rt-PA and an infusion of 50 mg/h did thrombelastometry demonstrate complete fibrinolysis. Although only residual emboli were seen on computed tomography, the patient died secondary to refractory right heart failure. This demonstrates that the standard dosing of thrombolytics may fail in a subgroup of patients, and suggests that thrombelastometry may be useful for early dose adjustment when standard dosing regimens fail. [source] Biventricular Pacing and Left Ventricular Pacing in Heart Failure:JOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 12 2004Similar Hemodynamic Improvement Despite Marked Electromechanical Differences Introduction: We conducted an acute echocardiographic study comparing hemodynamic and ventricular dyssynchrony parameters during left ventricular pacing (LVP) and biventricular pacing (BVP). We sought to clarify the mechanisms responsible for similar hemodynamic improvement despite differences in electrical activation. Methods and Results: Thirty-three patients underwent echocardiography prior to implantation with a multisite pacing device (spontaneous rhythm [SR]) and 2 days after implantation (BVP and LVP). Interventricular dyssynchrony (pulsed-wave Doppler), extent of myocardium displaying delayed longitudinal contraction (%DLC; tissue tracking), and index of LV dyssynchrony (pulsed-wave tissue Doppler imaging) were assessed. Compared to SR, BVP and LVP caused similar significant improvement of cardiac output (LVP: 3.2 ± 0.5, BVP: 3.1 ± 0.7, SR: 2.3 ± 0.6 L/min; P < 0.01) and mitral regurgitation (LVP: 25.1 ± 10, BVP: 24.7 ± 11, baseline: 37.9 ± 14% jet area/left atria area; P < 0.01). LVP resulted in a smaller index of LV dyssynchrony than BVP (29 ± 10 vs 34 ± 14; P < 0.05). However, LVP exhibited a longer aortic preejection delay (220 ± 34 vs 186 ± 28 msec; P < 0.01), longer LV electromechanical delays (244.5 ± 39 vs 209.5 ± 47 msec; P < 0.05), greater interventricular dyssynchrony (56.6 ± 18 vs 31.4 ± 18; P < 0.01), and higher%DLC (40.1 ± 08 vs 30.3 ± 09; P < 0.05), leading to shorter LV filling time (387 ± 54 vs 348 ± 44 msec; P < 0.05) compared to BVP. Conclusion: Although LVP and BVP provide similar hemodynamic improvement, LVP results in more homogeneous but substantially delayed LV contraction, leading to shortened filling time and less reduction in postsystolic contraction. These data may influence the choice of individual optimal pacing configuration. [source] Effects of protein A immunoadsorption in patients with advanced chronic dilated cardiomyopathy,JOURNAL OF CLINICAL APHERESIS, Issue 4 2009Andreas O. Doesch Abstract Objectives: The objective of this study was to investigate functional effects of immunoadsorption (IA) in severely limited study patients with chronic nonfamilial dilated cardiomyopathy (DCM), and to analyze the prevalence of Troponin I (TNI) autoantibodies. Background: Immunoadsorption (IA) has been shown to induce early hemodynamic improvement in patients with nonfamilial DCM. Methods: We performed IA using Immunosorba columns on five consecutive days in 27 patients with chronic DCM, congestive heart failure of NYHA class ,II, left ventricular ejection fraction below 40%, and mean time since initial diagnosis of 7.2 ± 6.8 years. Results: Immediately after IA, IgG decreased by 87.7% and IgG3 by 58.5%. Median NT-pro BNP was reduced from 1740.0 ng/L at baseline to 1504.0 ng/L after 6 months (P = 0.004). Mean left ventricular ejection fraction (LVEF) was not significantly improved overall (24.1 ± 7.8% to 25.4 ± 10.4% after 6 months, P = 0.38), but LVEF improved ,5% (absolute) in 9 of 27 (33%) patients. Bicycle spiroergometry showed a significant increase in exercise capacity from 73.7 ± 29.4 Watts to 88.8 ± 31.1 Watts (P = 0.003) after 6 months while VO2max rose from 13.7 ± 3.8 to 14.9 ± 3.0 mL/min kg after 6 months (P = 0.09). Subgroup analysis revealed a higher NT-pro BNP reduction in patients with shorter disease duration (P = 0.03) and without TNI autoantibodies at baseline (P = 0.05). All 9 patients with an absolute increase of LVEF of ,5.0% were diabetic (P = 0.0001). Conclusions: In this study, on severely limited heart failure patients with nonfamilial DCM, IA therapy moderately improved markers of heart failure severity in a limited subgroup of patients. This may be due to the selected study population with end-stage heart failure patients and the lower reduction of IgG3 compared to previous studies. Future blinded multicenter studies are necessary to identify those patients that benefit most. J. Clin. Apheresis 2009. © 2009 Wiley-Liss, Inc. [source] A New Approach to Assist Postoperative Heart Failure in an Animal Model: Juxta-Aortic CounterpulsationARTIFICIAL ORGANS, Issue 10 2002Edmundo I. Cabrera Fischer Abstract: Aortic counterpulsation is a useful technique frequently used in postcardiotomy heart failure. An acute heart failure model in open chest sheep was chosen to evaluate hemodynamic improvement with a counterpulsation balloon pump in juxta-aortic position. This was achieved with a manufactured Dacron prosthesis and a balloon pump placed between the prosthesis and the aorta. Juxta-aortic balloon pump counterpulsation in acute experimental heart failure resulted in a significant improvement of hemodynamic parameters: increase of cardiac output (from 0.86 ± 0.04 to 1.29 ± 0.09 L/min, p < 0.05) and cardiac index (from 0.03 ± 0.01 to 0.04 ± 0.01 L/min per kg, p < 0.05), and decrease of systemic vascular resistance (from 89.76 ± 6.69 to 66.56 ± 6.02 mm Hg/L per min, p < 0.05). The extent of aortic diastolic pressure change evaluated through the diastolic and systolic areas beneath the aortic pressure curve (DABAC/SABAC) index before cardiac failure induction showed a significant increase compared with unassisted values (from 0.81 ± 0.10 to 1.12 ± 0.09, p < 0.05). Assisted values of DABAC/SABAC index after heart failure induction also showed a significant increase compared with unassisted values (from 0.78 ± 0.21 to 1.17 ± 0.38, p < 0.05). Treatment of experimental acute heart failure by juxta-aortic balloon pump counterpulsation allows an effective hemodynamic improvement in open chest sheep. [source] | ||||||||||