Italian heart journal. Supplement : official journal of the Italian Federation of Cardiology最新文献

Heart transplantation is a curative surgical-medical procedure capable of radically modifying the prognosis of patients in the terminal phase who are non-responsive to other treatments and whose life expectancy is < 1 year, thus greatly increasing survival and distinctly improving their quality of life. The authors illustrate the numerous welfare and social security services, guaranteed by our Social Security System for such patient categories, with an overview of damage parameters within the medical-legal field, encompassing areas of civil responsibility. They therefore illustrate the changes, determined by the graft, on the patient's quality of life, while considering both the psycho-physical aspect and the family, social and working relationships before finally elaborating medical-legal guidelines for the assessment of such patients, for both biological damage and in their capacity for work, based on the pathophysiology of the transplanted heart.

In the last years the industry has created echocardiographic portable machines of reduced size, available for a growing number of operators. After the first experiences of the '70s, hand-held echocardiography (HHE) is earned interesting commercial positions. The transportability of these machines allows to perform examinations outside the echo-lab and provides diagnostic information in heterogeneous locations such as intensive care unit, emergency room and outpatient structures, at the bedside and even in ambulance. HHE can be useful for detection of several pathologies including aortic aneurysms and left ventricular hypertrophy, regional wall motion abnormalities, pericardial and pleural effusion. To date, four main kinds of HHE can be distinguished: a first, high-cost variety, including miniaturized machines, equipped with instrumentations of standard echocardiography and even new softwares for tissue Doppler and myocardial contrast echocardiography; a second kind of machines of high level but not miniaturized; a third (intermediate level and low cost), and a fourth one (basic level and very low cost), including "cardioscopes" corresponding to the ultrasound stethoscope, able to complete efficaciously the clinical examination. The introduction of HHE opens controversy about its diagnostic accuracy, the opportunity to establish the clinical scenario where it should be utilized and the identification of the potential users and the needed competence level. Preliminary experiences show the possibility of improving and anticipating the diagnosis of several cardiac diseases but also the need to plan specific ultrasound training to avoid inappropriate use of HHE.

Apelin, an endogenous peptide, is the ligand of APJ receptors. Although initially it was identified in the gastrointestinal tract, later its presence was found in several organs and tissues. On the cardiovascular system apelin induces an increase in myocardial contractility and a reduction of vasomotor tone. While the increase in contractility seems to depend on an activation of Na+/H+ and Na+/Ca2+ exchangers, vasodilation is attributed to a release of nitric oxide from the vascular endothelial cells. Apelin-induced vasodilation leads to a reduction of mean filling pressure which in turn causes a decrease of afterload and preload. When apelin is given acutely, the decrease in preload favors the reduction of stroke volume and cardiac output in spite of an increased contractility. On the contrary, when the peptide is administered for 2 weeks, cardiac output increases significantly without the occurrence of cardiac hypertrophy. It is not excluded that hypertrophy might occur after a longer administration.

Background: Antihypertensive therapy aims to reduce long-term morbidity and mortality. Drugs characterized by controlled release show a better pharmacokinetic and pharmacodynamic profile compared to standard formulations.

Methods: The present study evaluated the effects of nifedipine controlled release (0.33, 0.66 and 1.32 mg/kg per os), nifedipine standard (0.08, 0.165 and 0.33 mg/kg per os) and amlodipine (0.08, 0.165 and 0.33 mg/kg per os) on mean arterial blood pressure, heart rate and pressure rate index of spontaneously hypertensive rats (SHR). These were treated by gastric gavage, and analyzed after 30 min, 1, 3, 6, 12, and 24 hours. Moreover, plasma levels of nifedipine and amlodipine were also assayed by high-performance liquid chromatography.

Results: Nifedipine controlled release showed a longer antihypertensive effect when compared with standard formulation and with amlodipine. The highest dose of nifedipine controlled release decreased blood pressure soon after 1 hour with a maximum decrease (-20 mmHg) at 3 hours. The effect was still significant 24 hours later (p < 0.05). Amlodipine antihypertensive effect lasted 12 hours with a maximum decrease of 18 mmHg at 6 hours. The treatment of SHR rats with nifedipine controlled release, at each of the tested doses, did not cause any significant alterations in heart rate recorded at the beginning of the experiments. Nifedipine standard (0.165 and 0.33 mg/kg) and amlodipine (0.33 mg/kg) increased heart rate in SHR rats. Interestingly enough, pressure rate index was slightly affected by nifedipine standard release and amlodipine whereas it was remarkably reduced by nifedipine controlled release (p < 0.01 vs vehicle until 9 hours). All the compounds showed maximum plasma concentrations paralleled by maximum antihypertensive effects, as evidenced at high-performance liquid chromatography method.

Conclusions: Nifedipine controlled release showed more pronounced antihypertensive effects and longer pharmacokinetic properties with respect to nifedipine standard release and amlodipine.

Patients with severe calcific aortic stenosis are occasionally not amenable to surgery because of advanced age or severe co-morbidities. Percutaneous aortic valve dilation is used but has only limited time relief. While preclinical evidence on percutaneous aortic valve replacement seems promising, only very limited clinical data are available worldwide. We hereby present the first case of percutaneous aortic valve replacement successfully performed in Italy in a 74-year-old high-risk female. This case emphasizes the technical challenges inherent to this procedure and its promising role in selected very high-risk patients with severe aortic stenosis, notwithstanding the early and long-term risk of adverse events.

The incidence of heart valve disease associated with aortic coarctation is 40% in patients < 30 years and 27% in younger patients. This report describes the case of a 41-year-old man, admitted for severe mitral and tricuspid valve incompetence, causing impairment of left ventricular function and pulmonary hypertension. During hospitalization an occasional finding of aortic coarctation was diagnosed. The optimal management of aortic coarctation associated with atrioventricular valve regurgitation remains a matter of debate. In this report the proper decision-making and the management are discussed.

Pulmonary embolism is a common disease process associated with a high mortality rate. In patients with massive pulmonary embolism, systemic thrombolysis is considered to be the treatment of choice, but surgical or catheter thrombectomy may be alternative emergency treatments. A 36-year-old woman with massive pulmonary embolism and contraindications to thrombolytic therapy was treated with catheter thrombectomy using the Angiojet thrombectomy system. The procedure was successfully performed with an excellent immediate angiographic result at the site of the rheolytic thrombectomy. The clinical improvement was maintained while in-hospital and during a 4-month follow-up period, with a decrease to a normal level of the peak systolic pulmonary pressure. Our case report indicates that in patients with contraindications to systemic thrombolysis, catheter thrombectomy for massive pulmonary embolism may constitute a life-saving intervention.