Aspiration Thrombectomy in a Patient with Suprarenal Inferior Vena Cava Thrombosis

DVT has rarely been observed in the inferior vena cava (IVC). Pulmonary embolism (PE), which can be life-threatening, often occurred in patients with IVC thrombosis. Therefore, an IVC filter is frequently used in those patients for the prevention of PE. A case of successful endovascular treatment of an IVC thrombus in a patient with relative contraindications to implantation of an IVC filter is presented. This case report shows that aspiration of thrombi caught in the removable IVC filter may be an alternative to surgery in high-risk patients with catheter-related suprarenal inferior vena cava thrombosis

Elevated plasma beta-endorphin levels in patients with congestive heart failure

AbstractRecent experimental studies show that the opioid system is important to the pathophysiology of cardiovascular impairment in congestive heart failure. Plasma beta-endorphin levels were measured in 37 patients with congestive heart failure and compared with those of 21 age- and gender-matched normal subjects. The relation of plasma beta-endorphin levels and cardiac function at rest and exercise capacity was assessed in 17 of the patients with dilated cardiomyopathy. Exercise capacity was determined by symptom-limited maximal treadmill exercise with expired gas analysis. Plasma beta-endorphin levels were elevated and correlated with the patients' New York Heart Association functional cardiac status (control: 14.0 ± 4.4 pg/ml; class II: 17.9 ± 3.6 pg/ml; class III: 28.3 ± 8.8 pg/ml; class IV: 46.7 ± 14.6 pg/ml, mean ± SD). No relation was found between plasma beta-endorphin levels and left ventricular systolic performance as assessed by M-mode and Dopler echocardiography. Plasma beta endorphin levels were negatively correlated with cardiac output determined by Doppler echocardiography and positively correlated with systemic vascular resistance (r = −0.733, r = 0.747, respectively, both p < 0.001), but not correlated with calf blood flow as measured by a plethysmography. A good correlation was found between plasma beta-endorphin levels at rest and exercise capacity. The correlations with peak oxygen consumption, anaerobic threshold, and peak rate-pressure product were r = −0.721, −8.672, and −0.674, respectively (p < 0.01).The data show that plasma beta-endorphin levels are elevated in patients with congestive heart failure and reflect, to some degree, the severity of the disease

Reduced cardiopulmonary baroreflex sensitivity in patients with hypertrophic cardiomyopathy

Objectives. We sought to assess baroreflex function in patients with hypertrophic cardiomyopathy (HCM). Background. We have previously demonstrated a specific abnormality in the afferent limb of the cardiopulmonary baroreflex in patients with vasovagal syncope. Patients with HCM exhibit abnormal control of their vasculature during exercise and upright tilt; we therefore hypothesize a similar abnormality in the afferent limb of the cardiopulmonary baroreflex arc. Methods. We investigated 29 patients with HCM and 32 control subjects. Integrated baroreceptor sensitivity was assessed after administration of phenylephrine. Cardiopulmonary baroreceptor sensitivity was assessed by measuring forearm vascular resistance (FVR) during lower body negative pressure (LBNP). Carotid artery baroreflex sensitivity was assessed by measuring the in RR interval during manipulation of carotid artery transmural pressure. The integrity of the efferent limb of the reflex arc was determined by studying responses to both handgrip and peripheral alpha-receptor sensitivity. Results. During LBNP, FVR increased by only 2.36 ± 9 U in patients, compared with an increase of 12.3 ± 8.76 U in control subjects (p = 0.001). FVR paradoxically fell in eight patients, but in none of the control subjects. Furthermore, FVR fell by 4.9 ± 5.6 U in patients with a history of syncope, compared with an increase of 4.7 ± 7.2 U in those without syncope (p = 0.014). Integrated and carotid artery baroreflex sensitivities were similar in patients and control subjects (14 ± 7 vs. 14 ± 6 ms/mm Hg, p = NS and -3 ± 2 vs. -4 ± 2 ms/mm Hg, p = NS, respectively). Similarly, handgrip responses and the dose/response ratio to phenylephrine were not significantly different. Conclusions. This study suggests that patients with HCM have a defect in the afferent limb of the cardiopulmonary reflex arc

Peripheral Perfusion Index as an Early Predictor for Central Hypovolemia in Awake Healthy Volunteers

In healthy volunteers, we investigated the ability of the pulse oximeter-derived peripheral perfusion index (PPI) to detect progressive reductions in central blood volume. Twenty-five awake, spontaneously breathing, healthy male volunteers were subjected to progressive reductions in central blood volume by inducing stepwise lower body negative pressure (LBNP) with 20 mm Hg for 5 minutes per step, from 0 to -20, -40, -60, and back to 0 mm Hg. Throughout the procedure, stroke volume (SV), heart rate (HR), and mean arterial blood pressure were recorded using volume-clamp finger plethysmography. Assessment of the PPI was done by pulse oximetry. Additionally, the forearm-to-fingertip skin-temperature gradient was measured. Data are presented as mean±SE. PPI underwent log transformation and is presented as median (25th-75th). Of the 25 subjects, one did not complete the study because of cardiovascular collapse. After the first LBNP step (-20 mm Hg), PPI decreased from 2.2 (1.6-3.3) to 1.2 (0.8-1.6) (P=0.007) and SV decreased from 116±3.0 mL to 104±2.6 mL (P=0.02). The magnitude of the PPI decrease (41%±6.0%) was statistically different from that observed for SV (9%±1.3%) and HR (3%±1.9%). During progression of LBNP, SV decreased and HR increased progressively with the increased applied negative pressure, whereas the PPI remained low throughout the remainder of the protocol and returned to baseline values when LBNP was released. At -60 mm Hg LBNP, SV decreased and HR increased by 36%±0.9% and 33%±2.4% from baseline, respectively. Mean arterial blood pressure remained in the same range throughout the experiment. These results indicate that the pulse oximeter-derived PPI may be a valuable adjunct diagnostic tool to detect early clinically significant central hypovolemia, before the onset of cardiovascular decompensation in healthy volunteer