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Query: UMLS:C0018801 (heart failure)
 72,216 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We have tested a new percutaneous circulatory support device in seven anesthetized calves with induced left ventricular failure. The device is based on a flexible catheter with a foldable propeller and cage at the distal end. The rotation of the propeller (1,000-15,000 rpm) is transmitted from a drive unit at the proximal end to the propeller by way of a rotating wire inside the catheter. This also contains an umbrella-like mechanism to open the pump head from the folded (diameter 4.6 mm) to the active position. The rotation of the propeller creates a pressure drop in front of the propeller and a pressure rise behind. Heart failure was induced with metoprolol and verapamil in combination with a VVI pacemaker to create a left atrial pressure greater than 20 mm Hg. A centrifugal pump was used to bypass the right ventricle and to ensure a sufficient filling of the left ventricle. After baseline recordings, the pump was run at 14,000 rpm, and the hemodynamic response was compared with the baseline. A 24 +/- 10 mm Hg pressure gradient was generated across the pump, resulting in a drop in the right carotid artery mean pressure from 80 +/- 11 to 71 +/- 13 mm Hg (p = 0.008) and a drop in the left ventricular systolic pressure from 109 +/- 17 to 100 +/- 19 mm Hg (p = 0.004). The pressure in the left atrium decreased from 25 +/- 3 to 20 +/- 5 mm Hg (p = 0.008). The mean femoral pressure increased from 78 +/- 10 to 95 +/- 20 mm Hg (p = 0.005). A moderate reduction in the right carotid flow was observed (15%, p = 0.029), whereas no significant changes were found in the coronary flow, the flow in the right femoral artery, or in the left kidney. The device showed a significant unloading of the left ventricle and an increased perfusion pressure for the lower part of the body. The moderate changes in flow were probably caused by still active autoregulation, and this needs to be tested with more pronounced circulatory failure.
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PMID:Hemodynamic effects of a new percutaneous circulatory support device in a left ventricular failure model. 1465 44

Osteomyelitis of the sternum is a dreaded complication after sternotomy and is related to high mortality. Control of infection by radical debridement is the key to successful treatment. Instability of the thoracic cage can lead to a high complication rate. 16 Patients with an infected and unstable sternum underwent radical debridement with resection of the sternum and adjacent ribs. 6 Patients (group A) received an immediate defect coverage with a pedicled muscle flap. 10 Patients (group B) were treated with a vacuum-assisted closure (V.A.C.)-therapy until stabilization of their general condition and underwent defect coverage in a second operation. Healing of the flaps was uneventful in all cases despite minor problems. 5 patients of group A had severe complications with pulmonary or cardiac failure and thoracic instability which lead to prolonged periods of mechanical ventilation. 2 patients of this group died due to multi organ failure. All patients of group B survived and there were no major complications. All of the patients were free of recurrence from their osteomyelitis during follow-up. V.A.C.-therapy after radical resection of sternum osteomyelitis proved to be an effective measure to bridge time while optimizing the status of the patient and it's wound. With this approach we believe to have lowered the rate of major complications in this multi-morbid patient group by reducing the burden of one large operation and by improving thoracic stability.
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PMID:[Value of V.A.C.-therapy in the treatment of sternal infections]. 1657 61

Mechanical prosthetic valves (PV) are prone to thrombosis which may result in death or cripple hood due to PV blockade and embolisation (EM). In most pts with clinical symptoms of PV thrombosis (TPV) and in pts with a history of EM transthoracic echocardiography (TTE) and Doppler echocardiography are sufficient in diagnosing but not in stating the exact mechanism of PV stenosis. Transesophageal echocardiography (TEE) is a method of choice in the therapeutic decision making in this group of pts. PV replacement is indicated in pts with a thrombus floating in the left atrium (LA), large, peduncle-like thrombus in LA, TPV in mitral or aortic position with blockade of the disc and symptoms of heart failure < III NYHA, TPV with a high risk of spontaneous or post-thrombolytic EM (large thrombus on the PV annulus >5 mm or >0.8 cm2, highly mobile thrombus, history of EM). Thrombolysis is recommended in tricuspid TPV, TPV in mitral or aortic position with blockade of the disc and symptoms of heart failure III/IV NYHA. Intravenous heparin infusion can be effective as a short-term bridging to PV replacement or an alternative for thrombolysis in case of TPV with no signs of disc blockade. The results of thrombolysis and heparin infusion should be controlled by TEE. In pts with proper function of PV on clinical examination and negative history of EM, TTE/TEE should be considered if the risk factors of EM are present: incorrect INR control, atrial fibrillation, left ventricular dysfunction, III/IV NYHA, diabetes, certain types of PV cage PV, pivoting-disc PV other than Medtronic-Hall valve.
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PMID:[Thrombo-embolic events in patients with mechanical prosthetic valves--echocardiography in diagnostic and therapeutic decision making]. 1708 Jul 42

Doxorubicin (DOX) is a potent antitumor agent for different types of cancer, but the cumulative, dose-related cardiotoxicity limits its clinical use. The incidence of abnormal cardiac function after treatment with DOX appears to increase with time. Therefore, late cardiotoxicity is-especially in young surviving patients-a major concern. The aim of this study was to evaluate in mice whether the semisynthetic flavonoid 7-monohydroxyethylrutoside (monoHER) also protected against DOX-induced cardiotoxicity after a long period of follow-up. Four groups of 6 Balb/c mice were treated weekly during 6 weeks with saline, DOX alone (4 mg/kg i.v.), DOX preceded by monoHER (500 mg/kg i.p.), or DOX preceded by monoHER followed by long-term weekly monoHER injections during the observation period of 6 months. Half of the mice treated with DOX only developed DOX-induced heart failure and died within 6 months of observation. Two mice co-treated with monoHER showed weight loss and shortness of breath, whereas one mouse was found dead in its cage known with weight loss. The group receiving DOX plus long-term repeated doses of monoHER started to lose weight. Five out of six mice in this group developed shortness of breath and died before the end of the study with symptoms of cardiac failure induced by DOX. Statistical comparison of the histological heart damage between the different experimental groups was not possible, because the animals died at different time-points in the observation period and DOX-induced cardiotoxicity progressed with time. Nevertheless, it was clear that the initial cardioprotective effect of monoHER was not prolonged during the half-year observation period. It was even suggested that addition of repeated doses of monoHER tended to aggravate DOX-induced cardiotoxicity. It cannot be excluded that the dose and frequency of monoHER administration is crucial in obtaining an optimal antioxidant activity without a pro-oxidant activity of monoHER.
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PMID:Long-term effects of 7-monohydroxyethylrutoside (monoHER) on DOX-induced cardiotoxicity in mice. 1717 67

The incidence of diastolic heart failure increases dramatically with age. We investigated the impact of long-term exercise training on age-related diastolic dysfunction. Old (25-month-old) male Fischer 344 rats were studied after 12 weeks of treadmill exercise training or sedentary cage life (N=7, in each group). We determined cardiac performance using a pressure-volume conductance catheter and magnetic resonance imaging. Collagen volume fraction (CVF) and myocardial collagen solubility by pepsin as an index of advanced glycation end products (AGEs) cross-linked collagen were measured. The maximal slope of systolic pressure increment (+dP/dt) and the slope of end-systolic pressure-volume relation were higher, and end diastolic volume (EDV), Delta EDV (the percentage of the EDV increment-to-baseline EDV) and the slope of end-diastolic pressure-volume relation were lower in training group. The maximal slope of diastolic pressure decrement (-dP/dt) and time constant of LV pressure decay (tau) had no difference. AGEs cross-linked collagen, not CVF was reduced by exercise training. Long-term exercise training appears to attenuate age-related deterioration in cardiac systolic function and myocardial stiffness and could be reduce in pathologic AGEs cross-linked collagen in myocardium.
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PMID:Long-term exercise training attenuates age-related diastolic dysfunction: association of myocardial collagen cross-linking. 1927 Aug 10

According to the European recommendations rodents should be provided with a nest box if there is insufficient nesting material to build a complete, covered nest. Rats are generally poor nest builders; hence an additional structure is needed. Optimally, housing refinement may be combined with better science; at least it should not detract from the scientific integrity. In order to evaluate these options, there is a need to assess the items used in individual research projects. Studies investigating molecular mechanisms of cardiac hypertrophy and heart failure are typically long-lasting studies; therefore, refinement of the housing of rats in these studies is important. The aim of this study was to evaluate in rats whether a wooden tube has any impact on cardiac morphology or on basal gene expression of atrial natriuretic peptide (ANP) and brain natriuretic peptide (BNP); known markers of cardiac overload, hypertrophy and heart failure. The experimental protocol simulated cardiovascular studies, but without any surgical operations. A total of 42 male Hsd:SD rats were used in an eight-week experiment. After weaning, the experimental group was provided with a rectangular aspen tube and nesting material, and the control group with only nesting material. ANP and BNP gene expression were measured from the left ventricles with Northern blot analysis postmortem along with the absolute weights of the whole heart, left and right atria and left and right chambers. The weights of the whole heart and left chamber were also analysed in relation to body weight. No statistically significant differences were observed in any of these variables. The inter-individual variation was also unchanged by the cage item. In conclusion, the aspen tube does not disrupt research results or alter the number of animals needed and can therefore be recommended for enrichment purposes in cardiovascular studies.
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PMID:The effects of intra-cage aspen tube on cardiac morphology and gene expression. 2014 39

Noninvasive positive pressure ventilation (NIPPV) has been used in outpatients with sleep apnea, sleep disorders associated with heart failure, restrictive pulmonary diseases (subsuming neuromuscular diseases and thoracic cage deformities), severe stable chronic obstructive pulmonary disease, and the obesity-hypoventilation syndrome. NIPPV in these settings has resulted in significant physiologic benefits, improved quality of life, and in some cases longer survival. We discuss the modes of NIPPV, current indications, and potential benefits.
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PMID:Noninvasive positive pressure ventilation for stable outpatients: CPAP and beyond. 2088 8

Malignant ascites are the cancer-associated accumulation of fluids in the peritoneal cavity. The neoplasms most frequently associated with ascites are ovarian, breast, colon, stomach and pancreas adenocarcinomas. Symptoms are abdominal distention, nausea, vomiting, anorexia, dyspnea and limbs oedemas. Several pathophysiological mechanisms might be implicated such as peritoneal carcinomatosis, lymphatic vessels' obstruction, portal hypertension or heart failure. Its diagnosis is most often performed in a context of already known neoplasia. Malignant ascites are associated with a pejorative evolution. Ascites which cannot be mobilized or show early recurrence and cannot be prevented by medical treatment are defined as refractory ascites. Therefore, management of refractory malignant ascites takes place in the context of palliative care and aims at improving the quality of life of these patients. This review lists the current data reported on the pathophysiology of malignant ascites and describes the present and future options for refractory malignant ascites management.
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PMID:[Pathogenesis and management of refractory malignant ascites]. 2163 46

Mouse models are a valuable tool for studying acute injury and chronic remodeling of the myocardium in vivo. With the advent of genetic modifications to the whole organism or the myocardium and an array of biological and/or synthetic materials, there is great potential for any combination of these to assuage the extent of acute ischemic injury and impede the onset of heart failure pursuant to myocardial remodeling. Here we present the methods and materials used to reliably perform this microsurgery and the modifications involved for temporary (with reperfusion) or permanent coronary artery occlusion studies as well as intramyocardial injections. The effects on the heart that can be seen during the procedure and at the termination of the experiment in addition to histological evaluation will verify efficacy. Briefly, surgical preparation involves anesthetizing the mice, removing the fur on the chest, and then disinfecting the surgical area. Intratracheal intubation is achieved by transesophageal illumination using a fiber optic light. The tubing is then connected to a ventilator. An incision made on the chest exposes the pectoral muscles which will be cut to view the ribs. For ischemia/reperfusion studies, a 1 cm piece of PE tubing placed over the heart is used to tie the ligature to so that occlusion/reperfusion can be customized. For intramyocardial injections, a Hamilton syringe with sterile 30 gauge beveled needle is used. When the myocardial manipulations are complete, the rib cage, the pectoral muscles, and the skin are closed sequentially. Line block analgesia is effected by 0.25% marcaine in sterile saline which is applied to muscle layer prior to closure of the skin. The mice are given a subcutaneous injection of saline and placed in a warming chamber until they are sternally recumbent. They are then returned to the vivarium and housed under standard conditions until the time of tissue collection. At the time of sacrifice, the mice are anesthetized, the heart is arrested in diastole with KCl or BDM, rinsed with saline, and immersed in fixative. Subsequently, routine procedures for processing, embedding, sectioning, and histological staining are performed. Nonsurgical intubation of a mouse and the microsurgical manipulations described make this a technically challenging model to learn and achieve reproducibility. These procedures, combined with the difficulty in performing consistent manipulations of the ligature for timed occlusion(s) and reperfusion or intramyocardial injections, can also affect the survival rate so optimization and consistency are critical.
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PMID:Coronary artery ligation and intramyocardial injection in a murine model of infarction. 2167 49

Were evaluated individuals divided into two groups: we studied chronic heart failure (CHF) (19 patients with CHF plus cardiomegaly) and control (12 healthy volunteers) during performance of inspiratory loaded breathing (ILB). We evaluated: spirometry, functional capacity through the six-minute walk test (6MWT), and distribution of thoracoabdominal volumes via optoelectronic plethysmography (OEP), namely volume variations of pulmonary rib cage (Vrc,p), abdominal rib cage (Vrc,a), and abdomen (Vab). In each compartment, the percentage contributions of right and left sides were also calculated. During ILB, patients with heart failure were characterized by a significant reduction of the Vrc,a volume variations compared to the control group. Correlations were found between left %Vrc,a on the left side measured during ILB and left ventricular ejection fraction (r=0.468; p=0.049), and dyspnea after the 6MWT (r=-0.878; p<0.01).Then, patients with CHF and cardiomegaly are characterized by a reduced mobility in left part of the lower part of the rib cage, that contributes leading to increased perception of dyspnea during submaximal exercise.
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PMID:Chest wall regional volume in heart failure patients during inspiratory loaded breathing. 2219 37


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