Background
Gastrointestinal bleeding (GIB) is a complication reported in patients post left ventricular assist device (LVAD) implantation that is associated with high mortality rates. Thalidomide is ...an anti-angiogenic compound that may offer a potential option for management of refractory LVAD-related GIB.
Methods
A single-center, retrospective review was conducted from January 2009 to October 2016 at a tertiary cardiology center. It included LVAD patients initiated on thalidomide for refractory GIB.
Results
All patients (n = 11) were started on thalidomide 50 mg nocte and there was resolution of GIB in all patients except one (90.9%) during initial thalidomide treatment.
The median duration of thalidomide therapy was 98 days (interquartile range: 34–215). The dose of thalidomide was reduced for 2 patients due to adverse effects. Thalidomide therapy was discontinued in 6 patients due to cessation of GIB (n = 4) and adverse effects (n = 2). Reported adverse effects included LVAD thrombosis (n = 2), somnolence (n = 1), neuropathy (n = 1), constipation (n = 1), and transaminitis (n = 1).
Recurrent GIB occurred in 4 patients (45.4%) post-discontinuation of thalidomide therapy, which led to the re-initiation of therapy.
Conclusions
Thalidomide appears to be a safe and effective option for management of refractory LVAD-related GIB. Monitoring for recurrent GIB should be performed closely following cessation of thalidomide therapy.
Fibrosis is a common pathology in cardiovascular disease. In the heart, fibrosis causes mechanical and electrical dysfunction and in the kidney, it predicts the onset of renal failure. Transforming ...growth factor β1 (TGFβ1) is the principal pro-fibrotic factor, but its inhibition is associated with side effects due to its pleiotropic roles. We hypothesized that downstream effectors of TGFβ1 in fibroblasts could be attractive therapeutic targets and lack upstream toxicity. Here we show, using integrated imaging-genomics analyses of primary human fibroblasts, that upregulation of interleukin-11 (IL-11) is the dominant transcriptional response to TGFβ1 exposure and required for its pro-fibrotic effect. IL-11 and its receptor (IL11RA) are expressed specifically in fibroblasts, in which they drive non-canonical, ERK-dependent autocrine signalling that is required for fibrogenic protein synthesis. In mice, fibroblast-specific Il11 transgene expression or Il-11 injection causes heart and kidney fibrosis and organ failure, whereas genetic deletion of Il11ra1 protects against disease. Therefore, inhibition of IL-11 prevents fibroblast activation across organs and species in response to a range of important pro-fibrotic stimuli. These results reveal a central role of IL-11 in fibrosis and we propose that inhibition of IL-11 is a potential therapeutic strategy to treat fibrotic diseases.
Key Clinical Message
Case report illustrates obstruction encountered in a patient with end‐stage dilated hypertrophic cardiomyopathy (HCM) who underwent LVAD implantation. The morphology reversed in ...early postoperative period to HCM. Pump replacement required coring of the ventricular muscle. Dilated end‐stage hypertrophic cardiomyopathy can revert back to the original morphology on decompression.
Case report illustrates obstruction encountered in a patient with end‐stage dilated hypertrophic cardiomyopathy (HCM) who underwent LVAD implantation. The morphology reversed in the early postoperative period to HCM. Pump replacement required coring of the ventricular muscle. Dilated end‐stage hypertrophic cardiomyopathy can revert back to the original morphology on decompression.
Abstract Human parainfluenza virus (HPIV) infection as an aetiology of acute viral myocarditis is rare, with only few cases reported in the literature to date. Here we report a case of fulminant ...HPIV-2 myocarditis in a 47 year-old man with viraemia who was successfully treated with intravenous ribavirin and intravenous immunoglobulin (IVIG). There are currently no recommendations on the treatment of HPIV myocarditis. We are, to our knowledge, the first to report a patient with a documented HPIV-2 viraemia that subsequently cleared after the initiation of antiviral therapy. Although it is difficult to definitively attribute the patient's clinical improvement to ribavirin or IVIG alone, our case does suggest that clinicians may wish to consider initiating ribavirin and IVIG in patients with HPIV myocarditis and persistent viraemia not responding to supportive measures alone.
Objective: For the surgical treatment of congenital heart disease and in Ross procedure a valved conduit is frequently required. Since homografts are not readily available in every country, a ...reliable alternative is needed. We developed a novel technique to construct a valved pulmonary conduit with single point attached commissures (SPAC) in a simple and fast way from a small strip of autologous pericardium, molded and briefly treated with glutaraldehyde. Methods: Autologous pericardial pulmonary conduit was constructed intraoperatively and implanted in pulmonary position in a beating heart in six sheep. The prosthesis size was 31 mm for all sheep and the construction time (including 10 min glutaraldehyde treatment) was 19.0 ± 3.3 min. Implantation time and cardiopulmonary by-pass was 27.3 ± 5.4 min and 40.5 ± 7.7 min, respectively. The sheep were euthanized after 6 months (222.7 ± 5.8 days) postoperatively. Results: In all sheep, the autologous pericardial valve was immediately competent. At sacrifice, the pericardial valve was pliable and competent in all cases with SPAC well anchored to the pericardial conduit wall. The maximum transvalvular gradient at implant and at sacrifice was 3.3 ± 2.8 mmHg and 3.3 ± 2.0 mmHg, respectively. Conclusions: This novel autologous pericardial pulmonary conduit with SPAC can be reliably produced in a very short time intraoperatively before cardiopulmonary by-pass. The simplicity of construction, biocompatibility and freedom of stenosis or thrombosis makes this autologous pulmonary conduit especially useful for patients at locations where homografts are not readily available.
Background Limited data exists on patients receiving therapeutic hypothermia during extracorporeal life support (ECLS). We investigated outcomes and prognostic factors in these patients. Methods A ...retrospective review was conducted for 225 consecutive adult patients treated with ECLS between July 2003 and January 2016. Extracorporeal life support was initiated for refractory cardiac arrest (>10 mins) in 79 patients (35.1%). Patient demographics, ECLS-related complications, in-hospital mortality and neurological outcomes were analysed. Results The mean age was 49.9 ± 12.4 years. Sixty-two patients (78.5%) were male. The mean duration of CPR and ECLS were respectively, 32.0 ± 23.3 mins and 5.4±4.0 days. Therapeutic hypothermia (34o C) was maintained for 24 hours in 14 patients (17.7%). Thirty-five patients (44.3%) were weaned off ECLS. Twenty-one patients (26.6%) survived to hospital discharge with 16 (20.3%) recovering good neurological function. Compared to ECLS at normothermia, neurologically favourable survival was higher in the hypothermia group (42.9% vs 15.4%, P =0.020). Multivariable analysis identified a non-shockable rhythm odds ratio (OR) 5.1, confidence interval (CI) 1.5–16.8, ischaemic hepatitis (OR 6.2, CI 1.1–33.6) and hypoxic ischaemic encephalopathy (OR 5.1, CI 1.5–17.1) as predictors of in-hospital mortality. Therapeutic hypothermia (OR 4.9, CI 1.2–20.4) and acute renal failure (OR 0.19, CI 0.05–0.70) were predictors of neurologically favourable survival. Conclusions In this report of patients treated with ECLS, in-hospital survival and survival with good neurological performance were 26.6% and 20.3% respectively. A non-shockable rhythm, ischaemic hepatitis and hypoxic ischaemic encephalopathy were predictors of in-hospital mortality. Therapeutic hypothermia during ECLS was associated with improved neurological outcomes.
Cardiac arrest with cerebral ischaemia frequently leads to severe neurological impairment. Extracorporeal life support (ECLS) has emerged as a valuable adjunct in resuscitation of cardiac arrest. ...Despite ECLS, the incidence of permanent neurological injury remains high. We hypothesize that patients receiving ECLS for cardiac arrest treated with therapeutic hypothermia at 34 °C have lower neurological complication rates compared to standard ECLS therapy at normothermia. Early results of this randomized study suggest that therapeutic hypothermia is safe in adult patients receiving ECLS, with similar complication rates as ECLS without hypothermia. Further studies are warranted to measure the efficacy of this therapy.
PDF
