Dipeptidyl Amino-Peptidase 3 (DPP3) as an Early Marker of Severity in a Patient Population with Cardiogenic Shock.

Dipeptidyl amino-peptidase 3 (DPP3) is an aminopeptidase that is released into circulation upon cell death. DPP3 is involved in the degradation of angiotensins, enkephalines, and endomorphines. It has been shown that circulating DPP3 (cDPP3) plasma concentration increases in cardiogenic shock (CS) patients and correlates with high mortality risk. Cardiogenic shock is a life-threatening syndrome associated with organ hypoperfusion. One of the common causes of CS is acute myocardial infarction (AMI). This study aimed to investigate if cDPP3 levels are associated with CS severity and the need for ventilation in patients suffering from CS. Fifteen patients with CS were included in this study. Six patients were invasively ventilated. The values of cDPP3 were higher in ventilated patients than in non-ventilated patients at admission, 3 h, and 24 h after admission in the intensive care unit. Patients with pulmonary hypertension at admission also showed high cDPP3 values at all time points. Furthermore, high cDPP3 levels were associated with reduced stroke volume. Our results suggest that cDPP3 could predict CS progression and guide therapy escalation.

Echocardiographic approach in a new left ventricular assist device: Impella Recover 100.

Echocardiographic evaluation represents a basic tool for the treatment of patients undergoing ventricular assist device implant. Impella Recover 100 is a new left intraventricular assist device proposed for short-term mechanical circulatory support to be implanted without cardiopulmonary bypass. We report our experience with echocardiographic monitoring on a patient with ischemic cardiomyopathy who underwent Impella Recover 100 implant as a bridge to heart transplant. During the surgical procedure echocardiography had an essential role for anatomic evaluation of the heart and correct intraventricular positioning of the device. Moreover, during the whole period of assistance, echocardiography contributed to assessment of patient-device interaction and to check the device when malfunction was suggested.

Acute respiratory insufficiency and giant coronary artery aneurysm with fistula.

Several causes of acute respiratory insufficiency have been reported in the literature. We describe a case in which it was caused by a rare combination of a giant right coronary artery aneurysm with fistula that occurred in a 56-year-old woman with concomitant congenital hypothyroidism. Diagnostic tools, differential diagnosis, surgical techniques, and follow-up at 1 year are discussed.

[Transesophageal and transthoracic echocardiography in the monitoring of a new endovascular left ventricle assist device]. / L'ecocardiografia transesofagea e transtoracica nel monitoraggio di un nuovo sistema endovascolare di assistenza ventricolare sinistra.

We report our experience with echocardiography to guide the placement of a new left ventricular assist device, the Impella Recover 100, and to monitor its functioning. We monitored the introduction of 4 Impella Recover 100 devices in 2 patients by means of the transesophageal approach in the operating room, and thereafter we monitored the functioning of the devices by means of the multisection transthoracic approach in the intensive coronary care unit. The first Impella placement was performed in a patient as a "bridge" to heart transplantation, whereas the other three placements were performed in a patient as "recovery" for acute myocarditis. In all patients transesophageal echocardiography turned out to be a valuable tool to monitor the introduction and the perioperative hemodynamic management of the Impella device. In the early postoperative phase, transthoracic echocardiography allowed us to assess any pump displacement, and optimize biventricular function and adequate inotropic support. In conclusion, transthoracic and transesophageal echocardiography resulted in a valuable method for monitoring the correct placement and functioning of the left ventricular assist device Impella Recover 100.