The stimulatory effects of an infusion of amino acids on glomerular filtration rate has previously been used to measure renal functional reserve and detect glomerular hyperfiltration. Thirty four patients with mild to moderate essential hypertension and seemingly normal renal function and 22 healthy controls were given infusions of amino acids to investigate whether renal functional reserve is reduced in essential hypertension and to detect patients at risk of renal damage. Although basal creatinine clearance increased after the infusion of amino acids in the controls (mean 27·9 ml/min; 95% confidence interval 18·2 to 37·6), the overall change was lower in the patients (mean 13·4 ml/min; 8·3 to 18·5), 11 of the 34 showing no increase at all. In these 11 non-responders the mean systolic blood pressure was higher than that in the 23 others (178·5 mm Hg v 157 mm Hg, respectively). Mean urinary albumin excretion was abnormal in the patients (93·3 mg/24 h; 44·2 to 142·4); eight of the 11 non-responders had an albumin excretion above the normal range (>20 mg/24 h). In the 11 patients without renal functional reserve a positive correlation was found between basal creatinine clearance and albumin excretion (r=0·695). As consumed renal reserve and albuminuria are markers of glomerular hyperfiltration studying renal function before and after infusion of amino acids can detect hypertensive patients at risk of progressive renal damage.

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Twenty-three patients with mild heart failure (I-II NYHA classes) on digitalis and diuretics were assigned to the following treatment in a random and double-blind fashion: ibopamine-captopril, ibopamine-placebo, captopril-placebo, and placebo-placebo. The doses of captopril and ibopamine were respectively 25 mg t.i.d. and 100 mg t.i.d. The incremental exercise time (until exhaustion) and the peak VO₂ (oxygen consumption) the indexes of left ventricular function (by echo and nuclear stethoscope) and ventricular arrhythmias (evaluated by prolonged Holier monitoring) were assessed before randomization, at 45 days and at 3 months. Ejection fraction, exercise time, peak VO₂, ventricular arrhythmias and heart rate (at rest and during exercise) appeared to be equally unaffected by each treatment. Our results show that ibopamine exerts no significant effects on either heart rate or ventricular arrhythmias and that indexes of left ventricular function are not modified by any treatment in mild congestive heart failure.

Rupture of the interventricular septum is a rare and life-threatening complication of acute myocardial infarction. Postmyocardial infarction, ventricular septal defect is associated with very high morbidity and mortality. The therapy of this complication is the surgical closure. The Amplatzer occluder is currently used to close percutaneously atrial septal defect, patent foramen ovale, and selected congenital ventricular septal defect. Few cases are described regarding transcatheter closure of a postinfarction ventricular septal defect. Here we report a case of a large postinfarction ventricular septal defect successfully closed with Amplatzer multifenestrated atrial septal defect occluder device because of its peculiar anatomical characteristics.

Patients with severe depression of left ventricular ejection fraction and high-risk coronary lesions are at risk of developing complications during percutaneous coronary interventions (PCI). Intra-aortic balloon pump (IABP) is a support that helps the interventionalist in such hemodynamic complications during high-risk PCI, but it does not offer complete circulatory support. Instead, TandemHeart (Cardiac Assist, Pittsburg, PA, USA) is a percutaneous left ventricular assist device (pLVAD) that gives total left circulatory support and can be used for patients in cardiogenic shock or for elective PCI at high-risk. TandemHeart is a percutaneous transseptal ventricular assist device that allows a rapid percutaneous left ventricular support without the need for surgical implantation. Between November 2003 and April 2005, 6 patients admitted to our coronary care unit (CCU) underwent either emergency (n = 3) or elective (n = 3) placement of the TandemHeart device before a high-risk procedure. From our initial experience we conclude that the percutaneous transseptal ventricular assist device, TandemHeart, can be easily and rapidly deployed either in emergency or in elective high-risk PCI to achieve complete cardiac assistance.