Twin reverse arterial perfusion sequence occurs in approximately one percent of monochorionic twins. This condition is always fatal for the recipient twin and carries a high mortality rate for the pump twin. Various treatment options are described, but management is continually evolving with the publication of new data. We report an acardiac acephalic monochorionic twin who was diagnosed at 31 ...

Objective: Baclofen (β-p-chlorophenyl-GABA) selectively activates the GABAB subtype of γ-aminobutyric acid (GABA) receptors, a group of receptors known to provide inhibitory neurotransmission in the central nervous system. Available for over thirty years in oral form for the treatment of skeletal muscle spasticity, its availability now includes continuous intrathecal infusion via an internally ...

BACKGROUND Renal dysfunction is a well-recognized complication following coronary artery bypass grafting (CABG). Coronary revascularization without cardiopulmonary bypass (CPB) has been shown to minimize renal injury in patients with normal preoperative renal function who undergo elective procedures. The purpose of this study was to define the effect of an off-pump revascularization strategy on...

Heart failure is characterized by the inability of the heart to maintain sufficient cardiac output (CO) to meet the metabolic demands of the body. Reduced CO activates compensatory mechanisms directed towards reestablishing CO, thereby initiating a cycle which can lead to cardiomyopathy. Therapeutic strategies for addressing heart failure have been developed primarily based on studies of male p...

BACKGROUND Ventricular assist device (VAD) support with pulsatile first generation pumps is a well-established therapy for bridging to transplantation. Shortcomings of this technology include limited applicability to small patients, noise, and high incidence of infection and pump malfunction. A second generation of pumps, spearheaded by the axial flow MicroMed DeBakey VAD, is in clinical trials...

The Na/K-ATPase or Na, K-pump utilizes the free energy of hydrolysis of ATP to actively transport Na and K ions across mammalian cell membranes. This function underlies essentially all of mammalian cell physiology. For example, in the kidney the Na, K-pump controls body Na and K balance, extracellular volume and blood pressure. The Na/K-ATPase is the receptor of digitalis steroids used to treat...

Left ventricular assist devices (LVADs) using rotary blood pump technology led to significant improvement of results in left ventricular failure. However, patients with concomitant right ventricular failure have not benefited from this new technology so far. We report on the first successful use of 2 HeartWare HVAD centrifugal pumps (HeartWare International, Inc, Framingham, Mass) in biventricu...

Patients with acute kidney failure (AKF) and chronic kidney failure (CKF) require an appropriate vascular access for hemodialysis [1]. Vascular access is needed to allow blood flow through an extracorporeal circulation system with a blood pump connected to a hemodialysis monitor driving the blood through a dialysis filter (dialysator). Satisfactory levels of blood flow range between 300 and 400...

Right ventricular failure caused by myocardial infarction may be refractory to treatment designed to support the systemic ventricle. A new type of right ventricular assist device driven by an impeller pump was successfully used for 79 hours after emergency revascularisation after right coronary occlusion. Despite renal failure requiring haemofiltration the patient has now fully recovered.

The authors present the case of a 62-year-old male patient with an implantable cardioverter-defibrillator and end-stage heart failure supported with an intra-aortic balloon pump. Implantation of a triple-site cardiac resynchronization system and complex heart failure treatment brought a significant improvement, return to home activity and 17-month survival. The patient died due to heart failure...