ABSTRACT
Coexistence of aortic disease is an uncommon finding in end-stage heart failure patients requiring left ventricular assist device (LVAD) placement. A 38-year-old man with non-ischemic dilated cardiomyopathy was admitted in stage D heart failure. Preoperative computed tomography demonstrated multiple saccular aneurysms of the ascending aorta and sinus of valsalva. We successfully performed complex aortic surgery and the implantation of a continuous-flow LVAD (HeartWare HVAD) (HeartWare International, Framingham, MA). The postoperative course was uneventful. The patient is currently listed for heart transplantation.
Subject(s)
Aortic Aneurysm/surgery , Cardiomyopathies/surgery , Heart Failure/surgery , Heart Transplantation , Heart-Assist Devices , Sinus of Valsalva/surgery , Adult , Humans , Male , Treatment OutcomeSubject(s)
Brachiocephalic Veins/injuries , Embolism/diagnostic imaging , Foreign-Body Migration/diagnostic imaging , Wounds, Gunshot/diagnostic imaging , Brachiocephalic Veins/surgery , Echocardiography, Transesophageal/methods , Embolism/etiology , Embolism/surgery , Foreign-Body Migration/surgery , Heart Ventricles/diagnostic imaging , Humans , Male , Wounds, Gunshot/surgery , Young AdultABSTRACT
HeartWare continuous flow ventricular assist devices (HVAD) configured as biventricular assist devices maintain diurnal flow variation, lead to end-organ recovery, and provide for a successful bridge-to-heart transplantation in the first successful North American use of continuous flow biventricular assist devices.
Subject(s)
Heart Transplantation/methods , Heart-Assist Devices , Shock, Cardiogenic/diagnosis , Shock, Cardiogenic/surgery , Ventricular Remodeling/physiology , Adult , Critical Illness , Emergency Treatment/methods , Equipment Design , Equipment Safety , Follow-Up Studies , Humans , Male , Risk Assessment , Time Factors , Treatment Outcome , Waiting ListsABSTRACT
BACKGROUND & AIMS: A serotonin (5-HT)(3) receptor antagonist relieves symptoms in women with diarrhea-predominant irritable bowel syndrome (D-IBS). 5-HT undergoes reuptake by a transporter protein (SERT). Polymorphisms in the promoter for synthesis of SERT (SERT-P) influence response to serotonergic medications in depression. Our hypothesis is that polymorphisms of the promoter region for the SERT influence colonic transit in response to treatment with alosetron in D-IBS. METHODS: Thirty patients (15 men, 15 women) with D-IBS received 1 mg twice a day alosetron for 6 weeks; colonic transit was measured by scintigraphy at baseline and at the end of treatment. Twenty-three patients consented to provide blood DNA samples. Long, short, and heterozygous SERT polymorphisms were identified by polymerase chain reaction-based restriction fragment length polymorphisms and confirmed by direct sequencing. We sought pharmacogenomic association of long, short, and heterozygote polymorphisms with a change in colonic transit and with an a priori-defined, clinically meaningful change in transit at 24 hours (>1.1 colonic regions). RESULTS: SERT polymorphisms tended to be associated with colonic transit response (P = 0.075); there was a greater response in those with long homozygous than heterozygous polymorphisms (P = 0.039). Slowing of transit by >1.1 colonic region was observed in 9 women and 3 men and was more frequent in long homozygous than heterozygous patients (P = 0.024). Age, gender, and duration of IBS were not significantly different in the 3 groups. CONCLUSIONS: Genetic polymorphisms at the SERT promoter influence response to a 5-HT(3) antagonist in D-IBS and may influence benefit-risk ratio with this class of compounds.
