OBJECTIVETo report clinical application of Extracorporeal membrane oxygenation for severe acute respiratory and heart failure in a child with severe pneumonia.

METHODA seven-year old male patient with severe pneumonia complicated with heart and lung function failure was admitted to PICU in 28th of December, 2008.Veno-artery access was set up via euthyphoria cannulation in operative incision. Blood was drained from the right atrium through a cannula introduced via femoral veins, and returned via femoral artery. The inter-surface of the ECMO equipment system was completely coated with heparin-coating technique. Anticoagulation was maintained with heparin to keep the activated clotting time (ACT) between 150 and 200 seconds and heparin usage dose was 10 U/(kg.h), mean blood flow was 1/2-2/3 of 80-120 ml/(kg.min) during ECMO assistant period. During ECMO, ventilator settings were gradually reduced to allow lung rest, i.e. peak inspiratory pressure less than 25 cm H2O (1 cm H2O=0.098 kPa), end expiratory pressure 8-10 cm H2O, rate 10-15 breaths per minute and FiO2 30%-40%.

RESULTSIn management of ECMO, the incipient blood flow was set at 0.8 L/min, the radio of oxygen and blood flow was 1:1, FiO2 60%. After ten minutes of ECMO working, the blood oxygen saturation of radial artery increased from 40 mm Hg (1 mm Hg=0.133 kPa) to 177 mm Hg, Lac decreased from 3.5 mmol/L to 2.8 mmol/L. Four hours later, blood gas analysis of radial artery showed PaO2 202 mm Hg, PCO2 44 mm Hg, Lac 1.5 mmol/L, blood flow was set at 0.6 L/min, FiO2 60%, PaO2 kept above 150 mm Hg. 96 hours after ECMO supporting, the blood flow was set at 0.4 L/min [20 ml/(kg.min)], the results of blood gas analysis of radial artery was PaO2 190 mm Hg, PaCO2 36 mm Hg, SaO2 100%, Lac 0.9 mmol/L, then the child weaned off successfully from ECMO. Two days later, the child was successfully extubated. After two weeks treatment, the patient was discharged. The main complication associated with extracorporeal membrane oxygenation were bleeding.

CONCLUSIONECMO is an effective mechanical assistant therapy method for severe pulmonary and cardiac failure in a child.

Child ; Extracorporeal Membrane Oxygenation ; Heart Failure ; etiology ; therapy ; Humans ; Male ; Pneumonia ; complications ; physiopathology ; therapy ; Research Report ; Respiration Disorders ; etiology ; therapy

Animals ; Cardiac Resynchronization Therapy ; adverse effects ; Dogs ; Heart Failure ; therapy ; Tachycardia, Ventricular ; etiology

Heart Failure ; diagnosis ; etiology ; therapy ; Humans ; Integrative Medicine ; Medicine, Chinese Traditional ; Stroke Volume

Occurrence of dynamic left ventricular outflow tract (LVOT) obstruction is not infrequent in critically ill patients, and it is associated with potential danger. Here, we report a case of transient heart failure with hemodynamic deterioration paradoxically induced by extreme dehydration. This article describes clinical features of the patient and echocardiographic findings of dynamic LVOT obstruction and significant mitral regurgitation caused by systolic anterior motion of the mitral valve in a volume-depleted heart.
Cardiac Volume ; Dehydration/*complications ; Echocardiography/methods ; Female ; Heart Failure/*etiology/therapy ; Humans ; Middle Aged ; Mitral Valve Insufficiency/complications/*etiology ; Pulmonary Edema/etiology ; Ventricular Outflow Obstruction/*complications/etiology

OBJECTIVE: To explore the management of heart failure, the timing of delivery in pregnancy, and the influence on pregnant prognosis. METHODS: We retrospectively analyzed the incidence of heart failure, treatment results, pattern of termination, and time of termination in 356 cases of pregnancy with heart disease. RESULTS: One hundred and thirty-six (38.20%) cases were diagnosed as heart failure and 76 (55.88%) were moderate or severe heart failure. Heart failure tends to occur more easily in rheumatic heart diseases than in congenital heart diseases. Heart failure occurred more frequently in pregnancy with rheumatic heart diseases without the heart operation before pregnancy than that of pregnancy with congenital heart diseases. The occurence of the moderate and severe heart failure in pregnancy decreased in rheumatic heart diseases with surgical therapies compared with those without surgical therapies (P <0.05). Compared with pregnancy with heart failure controlled inadequately, pregnancy with effectively controlled heart failure had better tolerance during delivery and through the pregnancy, and puerperium. CONCLUSION Congenital heart diseases and rheumatic heart diseases are the chief causes of heart failure during the gestation. Therapy before pregnancy, especially surgery to the rheumatic heart diseases, may improve the cardiac function during pregnancy. Monitoring heart function and selecting the proper timing to terminate pregnancy after controlling the heart failure in late pregnant period will be helpful to improve the prognosis of pregnant and perineonate.
Adult ; Delivery, Obstetric ; Female ; Heart Defects, Congenital ; complications ; Heart Failure ; etiology ; therapy ; Humans ; Pregnancy ; Pregnancy Complications, Cardiovascular ; therapy ; Pregnancy Outcome ; Retrospective Studies ; Rheumatic Heart Disease ; complications ; Time Factors

One hundred and sixteen senile patients (older than 65 years) with chronic heart failure (CHF) were analyzed retrospectively in order to verify if old patients with CHF would benefit from long-term (one year) angiotension-converting enzyme inhibitor (ACEI) treatment. The frequency of drugs (including ACEI, digitalis and diuretic) used was stratified into four degrees accordingly. Development of the CHF was scored with regard to relapse rate and severity of this disease. Stepwise regression analysis was applied to explore the relationship between the scored outcome of CHF and the frequency of individual drug administration. A significant relationship of the scored outcome of CHF to the frequency of ACEI usage but not to digitalis nor to diuretics was found (partial coefficient of the correlation r = 0.42, P = 0.002). It was concluded that the long-term administration of ACEI improves the outcome of CHF in senile patients.
Angiotensin-Converting Enzyme Inhibitors/*administration & dosage ; Chronic Disease ; Heart Failure, Congestive/*drug therapy ; Heart Failure, Congestive/etiology ; Hypertension/complications ; Myocardial Ischemia/complications ; Retrospective Studies ; Treatment Outcome

OBJECTIVETo observe the effect of early bronchoscopic sputum suction in elderly patients with acute heart and lung failure due to aspiration pneumonia.

METHODSComprehensive treatments were administered for 52 elderly patients with acute heart and lung failure resulting from aspiration pneumonia, and in 27 of the patients, bronchoscopic sputum suction was performed with the other 25 serving as the control group. The indices of the heart and lung functions (central venous pressure, left ventricular ejection fraction, arterial blood partial pressures of oxygen and carbon dioxide) were measured after the treatment and compared between the two groups.

RESULTSPatients receiving bronchoscopic suction showed faster recovery of normal central venous pressure and left ventricular ejection fraction and more rapid increment of arterial partial pressure of oxygen and reduction of carbon dioxide partial pressure than those without the suction (P<0.01).

CONCLUSIONEarly bronchoscopic sputum suction can be one of the effective emergency measures for rescuing acute heart and lung failure due to aspiration pneumonia.

Aged ; Aged, 80 and over ; Bronchoscopy ; Cerebral Infarction ; complications ; Female ; Heart Failure ; etiology ; therapy ; Humans ; Male ; Middle Aged ; Pneumonia, Aspiration ; complications ; therapy ; Respiratory Insufficiency ; etiology ; therapy ; Sputum ; Suction ; methods

Cardiogenic unilateral pulmonary edema (UPE) is a rare clinical entity that is often misdiagnosed at first. Most cases of cardiogenic UPE occur in the right upper lobe and are caused by severe mitral regurgitation (MR). We present an unusual case of right-sided UPE in a patient with cardiogenic shock due to acute myocardial infarction (AMI) without severe MR. The patient was successfully treated by percutaneous coronary intervention and medical therapy for heart failure. Follow-up chest Radiography showed complete resolution of the UPE. This case reminds us that AMI can present as UPE even in patients without severe MR or any preexisting pulmonary disease affecting the vasculature or parenchyma of the lung.
Acute Disease ; Aged ; Coronary Angiography ; Diagnosis, Differential ; Heart Atria/ultrasonography ; Heart Failure/diagnosis/etiology ; Humans ; Male ; Mitral Valve Insufficiency/ultrasonography ; Myocardial Infarction/complications/*diagnosis/therapy ; Pulmonary Edema/*diagnosis/etiology/therapy ; Shock, Cardiogenic/*diagnosis/etiology/therapy ; Tomography, X-Ray Computed

OBJECTIVETo evaluate the efficacy and safety of percutaneous coronary intervention (PCI) combined cardiac resynchronization therapy (CRT) for refractory heart failure secondary to ischemic cardiomyopathy (ICM).

METHODSPCI and CRT were performed in 7 ICM patients confirmed by angiography with NYHA class IV, QRS duration >/= 130 ms in 6 of them, III degrees AVB in 1 patient, fast ventricular heart rate Af in 1 patient, ventricular fibrillation history in 2 patient. All of them had their LVEDD >/= 55 mm, and LVEF

RESULTSThe procedures of PCI and CRT were performed successfully in all patients. Five patients received right atrial and biventricular pacing, one patient with Af received biventricular pacing and atrial-ventricular node radiofrequency ablation at the same procedure, and the another one patient received CRTD. One out of seven patients died of re-AMI 4 months after the combination therapy, and the other 6 patients had been alive 5 - 41 (23.2 +/- 13.8) months during the follow-up period. The heart function of the 7 patients had further improved after PCI and CRT combined therapy compared to that of PCI or CRT only. Their NYHA class decreased from IV to II, 6-minute walking distance increased steadily, and mitral regurgitation reduced and QRS duration shortened significantly. The LVEDD decreased and LVEF increased significantly in 2 patients without ventricular aneurysm, and slight improvement or no change were in the other 5 patients.

CONCLUSIONFor patients with refractory heart failure secondary to ICM, the combination of PCI and CRT could obviously improve their heart function, quality of life and prognosis, which also very safe in perforation.

Adult ; Aged ; Angioplasty, Balloon, Coronary ; Cardiac Pacing, Artificial ; methods ; Combined Modality Therapy ; Female ; Heart Failure ; etiology ; therapy ; Humans ; Male ; Middle Aged ; Myocardial Ischemia ; complications ; therapy ; Treatment Outcome

Aged ; Antitubercular Agents ; adverse effects ; therapeutic use ; Heart Failure ; Humans ; Hypothermia ; diagnosis ; etiology ; Stevens-Johnson Syndrome ; diagnosis ; etiology ; Tuberculosis ; drug therapy