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2 3 4 5 5 6 Mayo Clinic, Rochester, MN, Rochester, MN, Mayo Clinic, Rochester MN, Rochester, MN, Mayo Clinic, Rochester, Brown University, 1 2 3 4 Providence, RI, Mayo Clinic Rochester, Rochester, MN, Mayo Clinic, Rochester, MN 5 6Corresponding author's email: tsapenko.mykola@mayo.eduManagement of patients with pulmonary hypertension (PH) complicated by severe sepsis or septic shock is a clinical Introduction: challenge and often associated with high mortality. We reviewed contemporary treatment and outcome of severe sepsis or septic shock in patients with PH managed at a tertiary care institution.We identified 82 consecutive patients with an established diagnosis of non-cardiac (non-Group 2 by WHO Classification) PH Methods: who were treated for severe sepsis and septic shock in four ICUs between July 2004 and July 2007. Patients with left ventricular ejection fraction <50%, diastolic dysfunction, pericardial effusion and significant mitral valve disease were excluded. Descriptive statistics included demographic data, major comorbidities, source of sepsis, main causes and severity of PH, and utilization of specific treatment strategies including mechanical ventilation, pulmonary artery catheterization, renal replacement therapy and the use of vasoactive medications. Outcome measures included hospital and one year mortality, duration of ventilatory support, length of hospital and ICU stay.The major cause of the PH was chronic obstructive pulmonary disease (24 patients, 29%), followed by interstitial lung disease (15 Results: pat., 18%), end stage liver disease (i.e. portopulmonary hypertension, 12 pat., 15%) and sleep disordered breathing (11 pat., 13%). Only 5 patients had idiopathic PH. Twelve patients had more then one etiologic factor involved in the development of PH. PH was classified as mild in 46 patients (56%), moderate in 21(26%) and severe in 15(18%). All but 13 patients (84%) required vasopressor treatment within the first 48h of admission: norepinephrine was the agent most commonly used (53 patients, 65%), followed by vasopressin (43 patients, 52%) and dopamine (22 patients, 27%); 51 patients (62%) were treated with more than one agent. Sixty seven (82%) patients were mechanically ventilated, and 33 (40%) required renal replacement therapy. Pulmonary artery catheterization was used in 28 (34%) patients. Forty three patients (52%) survived to hospital discharge and 23 of them (28%) were alive at one year follow up. Hospital mortality increased proportionally to the severity of PH: from 28% in mild PH, to 67% in moderate PH and 80% in severe PH. Non-survivors were more likely to develop atrial fibrillation (46% vs.12%, p=0.0006) and required longer duration of vasopressor support (5.3 days vs.2.6 days, p=0.0035).The severity of PH, development of atrial fibrillation, and the longer duration of vasopressor support are associated with Conclusions: poor outcome of patients with pre-existing PH who develop severe sepsis or sepsis shock. This abstract is funded by: N/A Am J Respir Crit Care Med 183;2011:A46...

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Angiosarcoma of the heart is a rare malignancy that can present in many ways. It is an important diagnosis to consider in patients presenting with otherwise unexplained tamponade-type symptoms. Here we present a case of a young male who presented with hemorrhagic tamponade and underwent resection of a large angiosarcoma of the right atrium. In this case, we describe the rare presentation of angiosarcoma with its diagnostic approaches, hospital course, clinical management, and discussion.