Project description:Liver disease resulting from heart failure (HF) has generally been referred as "cardiac hepatopathy". One of its main forms is congestive hepatopathy (CH), which results from passive venous congestion in the setting of chronic right-sided HF. The current spectrum of CH differs from earlier reports with HF, due to ischemic cardiomyopathy and congenital heart disease having surpassed rheumatic valvular disease. The chronic passive congestion leads to sinusoidal hypertension, centrilobular fibrosis, and ultimately, cirrhosis ("cardiac cirrhosis") and hepatocellular carcinoma after several decades of ongoing injury. Contrary to primary liver diseases, in CH, inflammation seems to play no role in the progression of liver fibrosis, bridging fibrosis occurs between central veins to produce a "reversed lobulation" pattern and the performance of non-invasive diagnostic tests of liver fibrosis is poor. Although the clinical picture and prognosis is usually dominated by the underlying heart condition, the improved long-term survival of cardiac patients due to advances in medical and surgical treatments are responsible for the increased number of liver complications in this setting. Eventually, liver disease could become as clinically relevant as cardiac disease and further complicate its management.
Project description:Computed tomography (CT) is the most reliable method to evaluate the progression of COVID-19 pneumonitis. However, in a pandemic, transportation of critically ill invasively ventilated patients to radiology facilities is challenging, especially for those on extracorporeal membrane oxygenation (ECMO). Notably, lung ultrasound (LUS) is a favored alternative imaging modality due to its ease of use at the point of care, which reduces the infectious risk of exposure and transmission; repeatability; absence of radiation exposure; and low cost. We demonstrated that serial LUS compares favorably with other imaging modalities in terms of usefulness for evaluating lung aeration and recovery in an ECMO-managed COVID-19 patient.
Project description:Prognosis for cardiogenic shock patients under ECMO was our study goal. Success defined as survived more than 7 days after ECMO installation and failure died or had multiple organ failure in 7 days. Total 34 cases were enrolled, 17 success and 17 failure. Peripheral blood mononuclear cells collected at ECMO installation were used analyzed.
Project description:Prognosis for cardiogenic shock patients under ECMO was our study goal. Success defined as survived more than 7 days after ECMO installation and failure died or had multiple organ failure in 7 days. Total 34 cases were enrolled, 17 success and 17 failure. Peripheral blood mononuclear cells collected at ECMO installation 0, 2 hours and removal were analyzed.
Project description:Prognosis for cardiogenic shock patients under ECMO was our study goal. Success defined as survived more than 7 days after ECMO installation and failure died or had multiple organ failure in 7 days. Total 34 cases were enrolled, 17 success and 17 failure. Peripheral blood mononuclear cells collected at ECMO installation 0hr, 2hr and removal were used analyzed.
Project description:Extracorporeal membrane oxygenation (ECMO) is an advanced form of life support technology whereby venous blood is oxygenated outside of the body and returned to the patient. ECMO was initially used as last-resort rescue therapy for patients with severe respiratory failure. Over the last four decades, it has developed into a safe, standard therapy for newborns with progressive cardiorespiratory failure, as a resuscitation therapy after cardiac arrest, and in combination with other treatments such as hypothermia and various blood filtration therapies. ECMO has also become routine for children and adults with all forms of cardiogenic shock and is also routine in early graft failure after transplantation. The one area of ongoing debate is the role of ECMO in adults with hypoxemic respiratory failure. As ECMO equipment becomes safer, earlier use improves patient outcomes. Several modifications of the two basic venovenous and venoarterial ECMO systems are now occurring, as are many minor variations in cannulation strategies and systems of care for patients receiving ECMO. The indications and situations in which ECMO have been tried continue to change, and ECMO for sub-acute and chronic illnesses is now commonplace, as is the use of ECMO in patients with clinical problems previously regarded as contraindications, such as sepsis, malignancy, and immunosuppression.
Project description:Heart failure and liver disease often coexist because of systemic disorders and diseases that affect both organs as well as complex cardio-hepatic interactions. Heart failure can cause acute or chronic liver injury due to ischaemia and passive venous congestion, respectively. Congestive hepatopathy is frequently observed in patients with congenital heart disease and after the Fontan procedure, but also in older patients with chronic heart failure. As congestive hepatopathy can evolve into cirrhosis and hepatocellular carcinoma, screening for liver injury should be performed in patients with chronic cardiac diseases and after Fontan surgery. Fibrosis starts in the centro-lobular zone and will extend progressively to the portal area. Chronic liver injury can be reversible if heart function improves. However, in the case of terminal heart failure, uncontrolled by medical resources or by assistive device support, the combination of heart and liver transplants must be discussed in patients with chronic advanced liver fibrosis. In this review of the literature, we will focus on congestive hepatopathy and its complications, such as liver fibrosis and hepatocellular carcinoma, with the aim of improving the management and surveillance of patients experiencing these complications.