Ventricular assist device implantation in a patient with systemic right ventricle and pectus excavatum

Systemic right ventricular failure is a common finding in patients with transposition of the great arteries. Some of these patients require ventricular assist device implantation. We describe the feasibility of HeartMate 3 [Abbott, Illinois, United States] implantation in a patient with transposition of the great arteries, high human leukocyte antigen sensitization, and severe pectus excavatum using a two-stage approach. Learning objectives: 1. To notice the challenges faced while implanting HeartMate 3 [Abbott, Illinois, United States] in patients with congenital heart disease and anatomical limitations. 2. To understand that despite the difficulties, HeartMate 3 implantation is possible, worthwhile, and sometimes the only choice in a patient with end-stage heart failure and congenital heart disease

Effects of ibopamine on the increase in plasma norepinephrine levels during exercise in congestive heart failure

Congestive heart failure (CHF) is accompanied by increased levels of plasma norepinephrine (PNE) at rest. During exercise, PNE levels increase rapidly in patients with CHF,1 causing skeletal vasoconstriction and muscle underperfusion. Because long-term sympathetic activation may be detrimental in patients with CHF,2 inhibition of this sympathetic drive would appear to be beneficial. The oral dopamine agonist ibopamine causes vasodilation and reduces PNE levels at rest in patients with CHF.3 However, the influence of ibopamine on peak oxygen consumption (VO2) and PNE levels during exercise in patients with CHF is unknown, and was investigated in this study

Effects of spirapril and captopril on regional blood flow in chronic congestive heart failure: A comparison between a short- and a long-acting angiotensin-converting enzyme inhibitor

Spirapril is a new angiotensin-converting enzyme (ACE) inhibitor with a long duration of action. To determine whether duration of inhibition of serum ACE activity may affect regional blood flow (RBF), we compared spirapril with captopril, an ACE inhibitor with a short duration of action. Both the short- and long-term effects were studied in patients with mild to moderate congestive heart failure (CHF). Calf, renal, and hepatic BF measurements were performed in the morning before intake of the study medication; 24 h after the previous dose of spirapril (n = 9 patients) and 12 h after the previous dose of captopril (n = 9 patients). Serum ACE activity after 1, 6, and 12 weeks was significantly reduced in patients receiving spirapril, but not in those receiving captopril. The decrease in mean arterial pressure (MAP) was more pronounced in the spirapril group. Calf BF showed a slight but not significant increase in both spirapril- and captopril-treated patients. Effective renal BF increased significantly only in patients treated with spirapril. Although filtration fraction (FF) tended to decrease in the spirapril group, the decrease was significant only in the captopril group. No changes were observed in hepatic BF. Cerebral BF (CBF) measurements were performed after intake of the first dose of study medication and after 12 weeks, immediately after drug intake. Significant reduction in MAP in the two treatment groups both after the first dose and after 12 weeks did not affect CBF. Despite a significantly prolonged decrease in MAP and serum ACE activity in spirapril-treated patients, no marked differences in RBF were noted between the two ACE inhibitors