Dynamic change in the NS3 protease domain in HIV/HCV-coinfected patients naïve to anti-HCV protease inhibitors.

The genetic analysis of THE natural protease inhibitors (PI) resistance of HCV genotype (GT)1 involves subtypes 1a and 1b. NS3 protease domain was sequentially analysed in 10 HIV/HCV GT1-coinfected individuals naïve to HCV treatment. Analysis at different time points showed that 2/3 GT1b patients were infected by a GT1a clade1 during follow-up. In one patient a switch from clade1 to clade2 and in one other patient a switch from clade2 to clade1 was revealed. Four out of ten patients had resistance-associated substitutions (RASs) at baseline. The dynamics of the dominant infecting subtype suggests the presence of mixed infection in some patients.

Echocardiographic evaluation of patients receiving a new left ventricular assist device: the Impella recover 100.

UNLABELLED: The aim of this study was to suggest a protocol for serial echocardiographic evaluations in patients undergoing circulatory support by a new miniaturized electric axial pump, the Impella recover 100 (IR 100). IR 100 is implanted through the ascending aorta into the left ventricle drawing blood from the left ventricle to the aorta. METHODS AND RESULTS: This protocol has been applied in eight patients receiving twelve IR 100 implants. Before implantation echocardiography was useful to rule out anatomic contraindications. During and after implantation echocardiography provided informations for correct positioning and evaluation of left ventricular filling necessary to optimize pump performance. During assistance it gave important informations to assess left and right ventricular function. CONCLUSION: Echocardiography has pivotal role in IR 100 management before, during and after implantation.

[Comorbidity in surgical myocardial revascularization: risk factors or contraindications for surgery]. / Comorbilità nella rivascolarizzazione miocardica chirurgica: fattori di rischio, controindicazioni.

BACKGROUND: The worsening evolution of patients undergoing surgical myocardial revascularization makes it difficult the stratification of the preoperative mortality risk, a correct evaluation of results and the comparison of results of different centers. The aim of the study was to evaluate the prognostic weight of comorbidity in surgical myocardial revascularization. METHODS: We evaluated the characteristics of preoperative morbidity in 4999 patients who underwent surgical myocardial revascularization during four different periods (1979-1980, 1991-1992, 1994-1998, 1999-2002). We also evaluated the in-hospital results. RESULTS: By comparing the four different periods, an increase in older age, female sex, comorbidity, three-vessel disease, and severe left ventricular dysfunction was observed. Surgical mortality decreased to 2.3%. Multivariate analysis of the 1999-2002 period showed that only renal insufficiency was a risk factor for in-hospital mortality. CONCLUSIONS: Although the preoperative risk is higher, nowadays hospital mortality is reduced thanks to new cardiac-surgical techniques and approaches that increasing the capacity of controlling comorbidity in the pre-, intra- and postoperative course. For a correct decision-making process it is crucial to assess how much comorbidity may influence the long-term follow-up in these patients independently of surgical myocardial revascularization.

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.

[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.