In this phase II trial, we did not identify significant differences between urine output obtained with pH-neutral furosemide administered SC and that obtained by IV. This method of decongestion may allow treatment at home and reduced HF resources and warrants further investigation. (Sub-Q Versus IV Furosemide in Acute Heart Failure; NCT02579057).

It is reported that the mortality rate for combined coronary bypass grafting and mitral valve replacement is greater than for either isolated operation. To evaluate the effects of various predicting factors we analyzed the results of 67 consecutive patients undergoing combined mvr and CABG. The mean age was 61.3 +/- 7 years. There were 55 males and 12 females and the mean follow-up was 59.4 +/- 7 months. The hospital mortality rate was 13.4% (9/67). Preoperative NYHA functional class (p<0.05), left-ventricular motion score (increased scores indicating impaired function, (p<0.05), and aortic cross-clamp time (p<0.05) were associated with hospital mortality. There was no significant relationship of age (>60), cause of mitral valve disease, severity of mitral regurgitation, number of grafts, or previous myocardial infarction with hospital mortality. There were 7 late deaths, and survival at five years was 76.1%. Although there was a trend for preoperative NYHA class and aortic cross-clamp time to be associated with late survival, the only factor significantly related to late survival was global wall-motion score (p<0.05). Severity of mitral regurgitation and cause of mitral valve disease have been reported as being related to late survival, but we have found no such relationship. Our results indicate that both hospital and late mortality are strongly correlated with preoperative left ventricular function.

SUMMARY A 5 year old child, previously diagnosed as having tetralogy of Fallot, was admitted to hospital in severe congestive heart failure. The electrocardiogram showed left anterior hemiblock and incomplete right bundle-branch block, neither of which was previously present. The child died in intractable congestive heart failure and the necropsy showed a double outlet right ventricle with complete spontaneous closure of the subaortic ventricular septal defect by fibrous tissue. The possible mechanism involved in the production of this unusual complication of double outlet right ventricle is discussed, together with an explanation for the electrocardiographic changes.It is well known that an isolated ventricular septal defect can reduce in size spontaneously, and even close completely.'"3 Occasionally, this development has been described in patients with complex congenital heart disease, in whom the ventricular septal defect was physiologically advantageous such as the "classic" double outlet right ventricle, that is with bilateral conus,46 or tricuspid atresia.7 8 Conversely, complete spontaneous closure of a ventricular septal defect has never been described, to our knowledge, in patients with tetralogy of Fallot or with double outlet right ventricle and infundibular features of Fallot's tetralogy.We report the clinical and anatomical findings of a case of double outlet right ventricle with some infundibular features of Fallot's tetralogy, in which there was spontaneous closure of the ventricular septal defect.Case report A 5 year old girl was born with a cyanotic cardiac defect. She was admitted to our hospital in congestive heart failure.A heart murmur had been heard since birth.Cyanosis appeared when she was 5 months old. At 3 years of age she underwent a right heart catheterisation in another institution which disclosed tetralogy of Fallot. The electrocardiogram showed right ventricular hypertrophy including QRS right axis deviation (Fig. IA) There was oedema at the ankles, hepatomegaly, ascites, and bilateral pleural effusions. The precordium was hyperactive. The first heart sound was normal and the second sound was single. A 3/6 ejection systolic murmur and a third heart sound were heard in the third left intercostal space on the sternal border.The chest x-ray film showed cardiac enlargement, pulmonary venous congestion, bilateral pleural effusions, and a left aortic arch.The electrocardiogram recorded on admission (Fig. IB) showed normal sinus rhythm, PR interval 0-18 s, left atrial enlargement, QRS width 0-08 s, and QRS mean frontal axis -60°. The QRS pattern indicated left anterior hemiblock; QRS morphology was Qrs, QS, and rS in VI, V2, and V6, respectively, indicating a posterior, rightward, and counterclockwise inscription of the QRS forces in the transverse plane.Another electrocardiogram was recorded four days later (Fig. IC) and disclosed an incomplete right ventricular conduction defect (qR morphology in VI, with tall R wave and mild increase in QRS width). A more pronounced superior deviation...

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A modular numerical model is used to study the interaction, in t m of energetic relationships, between the cardiovascular system and a pneumatic left ventricle assist device (LVAD). m e experiments are pe@onned in two steps: in the first the left ventricle is characterized, with an open loop model of the circulatory system, computing External Work (Ew), Pressure Volume Area (PVA) and Cardiac Mechanical Eflciency (CME) as a function of atrial pressure and peripheral resistance.PVA is compared to EW and CME su@aces respectively. I n the second step the same variables are evaluuted, with a closed loop model, assisting synchronously the lefi ventricle with the LVAD and changing two of its control parameters: Driving Pressure (DP) and SystoleDiastole (SO) ratio. me path of the working point is related to the value of the arterial elastance, modijied by the LVAD, and only in few points the target to minimize PVA and EW and maximize CME is reached.