Ultrafiltration for the treatment of diuretic-resistant, recurrent, acute decompensated heart failure: experience in a single center.

PURPOSE OF STUDY: We report our experience with ultrafiltration to remove fluid overload in patients with diuretic-resistant, decompensated, congestive heart failure. METHODS: From 2005 to 2008, 42 patients with heart failure and left ventricular ejection fraction less than 40% were treated with ultrafiltration. Patients were hospitalized for acute decompensation. Mean age was 69 years (67% men). Cause of heart failure was ischemic in 52% of cases. New York Heart Association (NYHA) class was III (64%) or IV (36%). All patients were on optimal heart failure drugs. Average dose of furosemide before ultrafiltration was 250 mg. Exclusion criteria were contraindications to anticoagulants, hematocrit more than 50%, glomerular filtration rate less than 30 ml/min and cardiogenic shock. Ultrafiltration was performed using a venous femoral bilumen catheter and anticoagulation with heparin. RESULTS: Each patient underwent one to four ultrafiltration treatments (total 70). Mean duration of a treatment was 6 h. Eighty-six percent of treatments removed more than 4000 ml of fluids; 10% removed 2000-4000 ml; 4% removed less than 2000 ml (1600-6900 ml). One ultrafiltration was aborted because of persistent hypotension. Other complications include two cases of bleeding from vascular access and six cases of worsened renal function. One patients required dialysis. Six-month mortality after ultrafiltration was 26%. Hospitalization rate, 6 months after, was 30% (compared to 66% 6 months before). Average furosemide dose, 6 months after, was 125 mg. CONCLUSION: Ultrafiltration removed fluid overload in diuretic-resistant, severe, congestive heart failure in our single-center experience. Six months after ultrafiltration, hospitalization rates were reduced by 36% and furosemide dose was 50% lower, compared to the previous 6 months. Worsened renal function was the most common complication (14% of patients).

[A rare cardiac tumor: the malignant fibrous histiocytoma. Description of a case]. / Una rara neoplasia cardiaca: l'istiocitoma fibroso maligno. Descrizione di un caso.

The present report describes the case of a 61-year-old woman with malignant fibrous histiocytoma of the left atrium originating from the left atrial free wall, operated on in emergency for a suspected large left atrial myxoma that, at the echo scan, was consistently protruding through the left atrioventricular orifice at each diastole and was almost completely occluding the left ventricular inflow, causing signs of congestive heart failure and severe dyspnea. Surgery was performed as radically as possible, but the histological examination of the specimen revealed the exact diagnosis of the neoplasm. About 75% of primary tumors are benign and 75% of these are atrial myxomas. The malignant tumors consist of various sarcomas: myxosarcoma, liposarcoma, angiosarcoma, fibrosarcoma, leiomyosarcoma, osteosarcoma, synovial sarcoma, rhabdomyosarcoma, undifferentiated sarcoma, reticulum cell sarcoma, neurofibrosarcoma, and malignant fibrous histiocytoma. The long-term results for sarcomas are very poor and there are few survivors after several months from surgery due to the extent of local spread and invasion or because of the frequent distant metastases. Malignant fibrous histiocytoma constitutes about 2% of all cardiac malignancies, which might grow within several localized areas, occasionally in the heart. Echocardiography represents the best examination procedure for both diagnosis and follow-up of patients with cardiac tumors.

Effect of abciximab on prothrombin activation and thrombin generation in patients with acute myocardial infarction also receiving reteplase.

Fibrinolysis in acute myocardial infarction activates blood coagulation and may favor reocclusion or ischemic complications. The aim of the GUSTO V Italian Hematologic Substudy was to compare the effects of full-dose reteplase on coagulation activation markers with those of half-dose reteplase combined with full-dose abciximab, a platelet glycoprotein IIb/IIIa receptor antagonist, during the early phase after acute myocardial infarction.