Management of Hepatic Hemangioendotheliomas of Infancy by Transarterial Embolization: A Report of Two Cases

Hepatic hemangioendotheliomas are uncommon vascular tumors which present as abdominal masses, unexplained jaundice, bleeding disorders, or congestive heart failure.1-3 Death often results from congestive heart failure despite appropriate treatment with digoxin and diuretics.4 Verification of hepatic vascular malformations rests on selective angiography,5 hepatic scintigraphy,6 computed tomography,7 and abdominal ultrasonography.8 Successful treatment of heart failure depends on elimination of the malformation's left-to-right shunt and its adverse cardiac effects. Present theapeutic recommendations for symptomatic patients remain divided. Treatment options include surgical excision of localized lesions,9 hepatic artery ligation,10 radiation,11 and glucocorticoid therapy12,13, often combinations of these programs are used.

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Role of ETA receptors in the regulation of vascular reactivity in rats with congestive heart failure

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.2000.279.2.h844 ◽

2000 ◽

Vol 279 (2) ◽

pp. H844-H851 ◽

Cited By ~ 12

Author(s):

Eric Thorin ◽

Martin Lucas ◽

Peter Cernacek ◽

Jocelyn Dupuis

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Smooth Muscle ◽

Vascular Reactivity ◽

Cerebral Arteries ◽

No Synthase ◽

Cerebrovascular Reactivity ◽

Coronary Artery Ligation ◽

Artery Ligation ◽

Endothelial Denudation

Endothelium-derived nitric oxide (NO) and endothelin (ET)-1 interact to regulate vascular tone. In congestive heart failure (CHF), the release and/or the activity of both factors is affected. We hypothesized that the increased ET-1 production associated with CHF may result in a reduced smooth muscle sensitivity to NO. The aim of this study was to evaluate the effects of a chronic treatment with the ETA-receptor (ET receptor A) antagonist LU-135252 (LU) on cerebrovascular reactivity to sodium nitroprusside (SNP) in the rat infarct model of CHF. Rats were subjected to coronary artery ligation and were treated for 4 wk with placebo ( n = 24) or LU (50 mg · kg−1 · day−1, n = 29). CHF was associated with a decreased ( P < 0.05) efficacy of SNP to induce relaxation of isolated middle cerebral arteries. Furthermore, neither NO synthase inhibition with N ω-nitro-l-arginine (l-NNA) nor endothelial denudation affected the efficacy of SNP. Thus the endothelium no longer influences smooth muscle sensitivity to SNP. LU treatment, however, normalized ( P < 0.05) smooth muscle sensitivity to SNP. Sensitivity of ET-1-induced contraction was increased in CHF only in the presence of l-NNA, whereas contraction induced by ETB receptor (receptor B) stimulation was increased ( P < 0.05) in endothelium-denuded vessels. LU treatment restored these changes in reactivity and revealed a significant endothelium-dependent ETB-mediated relaxation after NO synthase inhibition. In conclusion, CHF decreases and uncouples cerebrovascular smooth muscle sensitivity to SNP from endothelial regulation. The observation that chronic ETAblockade restored most of the changes associated with CHF suggests that activation of the ET-1 system importantly contributes to the alteration in vascular reactivity observed in experimental CHF.

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Cavernous Hemangioma of the Tongue

International Journal of Head and Neck Surgery ◽

10.5005/jp-journals-10001-1235 ◽

2015 ◽

Vol 6 (3) ◽

pp. 109-111 ◽

Cited By ~ 1

Author(s):

Jatin P Shah ◽

Ivana Petrovic ◽

Ben Roman

Keyword(s):

Cavernous Hemangioma ◽

Soft Tissues ◽

Vascular Malformations ◽

Surgical Excision ◽

Vascular Anomalies ◽

Preoperative Imaging ◽

Vascular Tumors ◽

Adult Onset ◽

Complete Excision ◽

Intramuscular Hemangioma

ABSTRACT Background Vascular anomalies are divided into vascular tumors, hemangiomas being the most common, and vascular malformations. Most vascular anomalies are noticed at birth or occur during infancy, and generally involve skin or subcutaneous soft tissues. Adult onset hemangiomas are rare, and intramuscular location is extremely rare. Surgical excision is recommended for hemangiomas in adults, if they are symptomatic, or manifest growth. Materials and methods We report a rare case of a 51-year-old woman, with an intramuscular hemangioma of the tongue, presenting as a submental mass. Preoperative imaging for assessment of tumor extent was followed by a successful surgical excision. Results Postoperative course was uneventful with primary healing of the wound, and with no functional deficit of tongue function. Conclusion Although a variety of treatment approaches are reported for childhood hemangiomas, surgical excision is the preferred treatment for adult onset symptomatic hemangiomas. Preoperative work up should include imaging preferably with contrast enhanced magnetic resonance imaging (MRI). Embolization may be considered for larger lesions. Intraoperative hypotension should be avoided to ensure identification of the entire lesion to ensure complete excision. How to cite this article Petrovic I, Roman B, Shah JP. Cavernous Hemangioma of the Tongue. Int J Head Neck Surg 2015;6(3):109-111.

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Pulmonary Edema I: Cardiogenic Pulmonary Edema

10.2310/fm.1371 ◽

2017 ◽

Author(s):

Annette Esper ◽

Greg S Martin ◽

Gerald W. Staton Jr

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Pulmonary Edema ◽

Clinical Characteristics ◽

Distress Syndrome ◽

Capillary Permeability ◽

Treatment Options ◽

Experimental Models ◽

Lung Mechanics ◽

Cardiogenic Pulmonary Edema

There are two categories of pulmonary edema: edema caused by increased capillary pressure (hydrostatic or cardiogenic edema) and edema caused by increased capillary permeability (noncardiogenic pulmonary edema, or acute respiratory distress syndrome). This review focuses on cardiogenic pulmonary edema and describes the general approach to patients with suspected cardiogenic pulmonary edema. The pathogenesis, diagnosis, treatment, and outcome of cardiogenic pulmonary edema are reviewed. Figures include chest scans showing pulmonary edema and noncardiogenic pulmonary edema, an illustration of the differences between cardiogenic and noncardiogenic edema, and a chart comparing lung mechanics and other variables in experimental models of cardiogenic pulmonary edema and noncardiogenic edema. Tables show clinical characteristics of patients with cardiogenic pulmonary edema and treatment options. This review contains 3 figures, 4 tables, and 24 references. Key words: cardiogenic pulmonary edema, congestive heart failure, pulmonary edema, Starling’s law

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Short- and mid-term effects of covered stent implantation on extremity findings and heart failure in Parkes Weber syndrome: a case report

European Heart Journal - Case Reports ◽

10.1093/ehjcr/ytaa046 ◽

2020 ◽

Vol 4 (2) ◽

pp. 1-4

Author(s):

Zeydin Acar ◽

Abdulkadir Kırış ◽

Hüseyin Bektaş ◽

Tuncay Erden

Keyword(s):

Heart Failure ◽

Upper Limb ◽

Stent Implantation ◽

Vascular Malformations ◽

Surgical Excision ◽

Covered Stent ◽

Limb Amputation ◽

Initial Examination ◽

Arteriovenous Fistulas ◽

Weber Syndrome

Abstract Background Parkes Weber syndrome (PWS) is a congenital disease characterized by vascular malformations, such as arteriovenous fistulas (AVFs). It frequently presents with overgrowth of a lower limb and high-output heart failure. The main treatment is to close vascular malformations. Surgical excision or endovascular coil insertion was performed in a few patients with AVFs. However, vascular covered stent implantation has not been used for treating PWS. Case summary A 15-year-old male patient with PWS presented to our hospital because of dyspnoea and massive left upper limb swelling. After initial examination and left upper limb angiography, his symptoms and findings were attributed to the presence of high-flow large AVFs despite the presence of many coils previously inserted. We decided to implant a covered stent along the AVFs between the subclavian and axillary arteries. After stent implantation, the patient’s complaints and findings improved during the early term but they relapsed at the 6th month after percutaneous intervention. Discussion Here, we report for the first time the use of covered stent implantation and its short and 6 months results in a patient with PWS. Although initial improvements were noted, the clinical outcome at 6 months after stent implantation was poor. This was probably associated with the presence of widespread subtle AVFs or collateral connections among the existing AVFs. Based on our result, we propose that closure of large AVFs is not useful and more definitive interventions, such as limb amputation may be required earlier.

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Population level risk stratification of hypertensive patients by predictive modeling

10.1101/2021.04.27.21256198 ◽

2021 ◽

Author(s):

Sricharan Bandhakavi ◽

Zhipeng Liu ◽

Sunil Karigowda ◽

Jasmine McCammon ◽

Farbod Rahmanian ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Risk Stratification ◽

Predictive Modeling ◽

Early Identification ◽

Beta Blockers ◽

Treatment Options ◽

Population Level ◽

Treatment Patterns ◽

Channel Blockers

Objective We recently reported that hypertension (HTN) patients having at least three rounds of distinct treatment options (atl_three_roto) in a 12-month window have elevated risk of next-year complications. However, early identification of these challenge to treat patients is non-trivial and drivers of complications in these vs remaining HTN patients are not fully defined. To address these challenges/gaps, we present predictive models for preceding outcomes, delineate their drivers, and highlight value of their integration for population level risk stratification/management of HTN patients. Materials and Methods 2.47 million HTN patients enrolled through 2015-2016 were selected from a nation-wide commercial claims database. Features associated with their treatment patterns, comedications, and comorbidities were extracted for 2015 and used to model/predict 2016 outcomes of atl_three_roto status and/or HTN complications. Logistic regression-derived odds-ratios were used to delineate drivers of each outcome. Results Prior year treatment patterns, specific hypertension drugs (anti-hypertensives, calcium channel blockers, beta blockers), and congestive heart failure most increased future odds of atl_three_roto status. Regardless of prior year atl_three_roto status, specific comorbidities (renal disease, congestive heart failure, myocardial infarction, vascular disease, diabetes with chronic complications) and comedications (beta blockers, cardiac agents, anti-lipidemics) most increased future odds of HTN complications. Proof-of-concept analysis with an independent dataset demonstrated that integrating these model predictions/drivers thereof can be leveraged for risk stratification/management of HTN patients. Discussion Integrating predictions and their drivers from above models supports early identification and targeted management of at-risk HTN patients. Conclusion We have developed a predictive modeling based approach for risk stratification and management of HTN patients.

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Pericardial effusion and congestive heart failure in a horse with multicentric lymphoma

Veterinary Record Case Reports ◽

10.1136/vetreccr-2018-000631 ◽

2018 ◽

Vol 6 (3) ◽

pp. e000631

Author(s):

Laura Hargreaves ◽

Lara Gosling ◽

Jonathon J Dixon

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Pericardial Effusion ◽

Acute Onset ◽

Histological Evaluation ◽

Renal Neoplasm ◽

Abdominal Ultrasonography ◽

Definition Of ◽

The Right ◽

Multicentric Lymphoma

A 20-year-old Warmblood mare was evaluated for acute-onset tachycardia and a one-week history of lethargy and ventral oedema. Haematology revealed leucocytosis with neutrophilia. Ultrasonographic examination revealed pericardial effusion and cardiac tamponade consistent with right-sided congestive heart failure. Abdominal ultrasonography demonstrated loss of definition of the right kidney and a structure adjacent to the kidney suggestive of a renal neoplasm. A tentative antemortem diagnosis of multicentric neoplasia, most likely lymphoma, was made. The horse was subjected to euthanasia due to a grave prognosis. Postmortem examination and histological evaluation were consistent with lymphoma, including infiltration of the cardiac muscle with neoplastic cells. Although lymphoma has been reported to affect the heart, congestive heart failure due to cardiac and pericardial neoplastic infiltration has not been previously reported as the presenting complaint. This case report describes the diagnostic approach to pericardial effusion and congestive heart failure in a mare with lymphoma.

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Peripheral vascular tumors and vascular malformations: imaging (magnetic resonance imaging and conventional angiography), pathologic correlation and treatment options

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-012-0106-5 ◽

2012 ◽

Vol 29 (2) ◽

pp. 379-393 ◽

Cited By ~ 13

Author(s):

Fadi El-Merhi ◽

Deepak Garg ◽

Marco Cura ◽

Ola Ghaith

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Vascular Malformations ◽

Treatment Options ◽

Vascular Tumors ◽

Peripheral Vascular ◽

Resonance Imaging ◽

Conventional Angiography ◽

Pathologic Correlation

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Chronic blockade of brain "ouabain" prevents sympathetic hyper-reactivity and impairment of acute baroreflex resetting in rats with congestive heart failure

Canadian Journal of Physiology and Pharmacology ◽

10.1139/y99-115 ◽

1999 ◽

Vol 78 (1) ◽

pp. 45-53

Author(s):

Bing S Huang ◽

Baoxue Yuan ◽

Frans HH Leenen

Keyword(s):

Heart Failure ◽

Heart Rate ◽

Congestive Heart Failure ◽

Venous Pressure ◽

Control Group ◽

Coronary Artery Ligation ◽

Artery Ligation ◽

Sympathetic Hyperactivity ◽

Air Jet ◽

Baroreflex Function

In rats with congestive heart failure (CHF) post myocardial infarction (MI) acute blockade of brain "ouabain" reverses sympathetic hyperactivity and chronic blockade prevents the desensitization of baroreflex function. This study was conducted to determine: i) if chronic blockade of brain "ouabain" maintains normal sympathetic reactivity; andii) if acute baroreflex resetting (another parameter of baroreflex function) also becomes impaired, and if so, does brain "ouabain" contribute to impairment in acute baroreflex resetting. CHF post MI was induced by acute coronary artery ligation in Wistar rats. Animals were treated with 200 µg·day-1 i.c.v. or i.v. Fab fragments (which bind brain "ouabain" with high affinity), or treated with 200 µg·day-1 i.c.v. gamma-globulins (control group). The length of treatment was 0.5-8 weeks or 4-8 weeks post MI. At 8 weeks mean arterial pressure (MAP), central venous pressure (CVP), heart rate (HR), and renal sympathetic nerve activity (RSNA) were recorded in concious rats at rest and in response to: i) air-jet stress, ii) i.c.v. guanabenz (an α2-adrenoceptor agonist), and iii) a 30 min i.v. infusion of nitroprusside (NP). Excitatory responses to air stress and inhibitory responses to guanabenz of MAP, HR, and RSNA were significantly enhanced in rats with CHF versus the sham-operated treated group. This enhancement was prevented in the CHF group treated with i.c.v., but not i.v., Fab. Nitroprusside induced a sustained decrease in MAP (~ 25 mmHg) and a transient decrease in CVP. Heart rate and RSNA increased significantly within 1 min of beginning the infusion. The peak increases as well as the product of changes in MAP-HR and RSNA-HR were significantly smaller in rats with CHF treated with gamma-globulins versus sham rats and versus CHF rats treated with i.c.v. Fab. In sham-operated rats and CHF rats treated with i.c.v. Fab, RSNA and HR began to decrease within 3-4 min of beginning the NP infusion and had returned to baseline by 20 min. In contrast, RSNA and HR remained increased throughout the infusion in the CHF rats treated with gamma-globulins. These data indicate that in rats with CHF acute resetting of the arterial baroreflex in response to a lower BP becomes impaired, and chronic blockade of brain "ouabain" prevents both this change in baroreflex resetting as well as sympathetic hyperactivity.Key words: heart failure, acute baroreflex resetting, sympathetic hyperactivity, nitroprusside.

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Therapeutic alternatives for vein of Galen vascular malformations

Journal of Neurosurgery ◽

10.3171/jns.1993.78.3.0438 ◽

1993 ◽

Vol 78 (3) ◽

pp. 438-445 ◽

Cited By ~ 70

Author(s):

Pedro Lylyk ◽

Fernando Viñuela ◽

Jacques E. Dion ◽

Gary Duckwiler ◽

Guido Guglielmi ◽

...

Keyword(s):

Heart Failure ◽

Congestive Heart Failure ◽

Vascular Malformations ◽

Clinical Status ◽

Severe Congestive Heart Failure ◽

Type I ◽

Vein Of Galen ◽

Content Type ◽

Type Iv ◽

Fine Print

✓ From September, 1986, to March, 1990, the authors treated 28 children harboring a vein of Galen vascular malformation. Eleven (39.3%) of the patients were neonates, 13 (46.4%) were 1 to 2 years old, and four (14.3%) were more than 2 years old. Fifteen patients (53.6%) presented with severe congestive heart failure, six (21.4%) had seizures, four (14.3%) had hydrocephalus, and three (10.7%) presented with intraventricular hemorrhage. Based on the Yaşargil classification of malformations, 10 lesions (35.7%) were Type I, seven (25%) were Type II, eight (28.6%) were Type III, and three (10.7%) were Type IV. In 11 patients (39.3%), a combined transfemoral, transarterial, and transvenous embolization of the vein of Galen malformation was performed. A pure transtorcular approach was utilized in eight patients (28.6%), and postembolization surgical clipping of arterial feeders was performed in two cases with intractable congestive heart failure. Complete anatomical occlusion of the galenic malformation was achieved in 13 patients (46.4%). An immediate postembolization improvement in the patient's clinical status was obtained in 23 (82.1%) of 28 patients and a good long-term clinical outcome was seen in 17 patients (60.7%). Five deaths (17.9%) occurred in this series of 28 patients; three (10.7%) were related to a transtorcular embolization and two (7.1%) to the unchanged natural history of the disease.

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