Double-chambered left ventricle: An unusual finding in a middle-aged woman

Double-chambered left ventricle (DCLV) is a rare congenital abnormality and is characterized by the subdivision of the left ventricle into two separate chambers by an abnormal septum or muscle band. This rare congenital entity is usually diagnosed in the neonatal or pediatric age. Nevertheless, it can be asymptomatic and incidentally found in the adulthood. A comprehensive multimodality imaging approach is crucial for the correct final diagnosis.

Effect of acetazolamide on post-NIV metabolic alkalosis in acute exacerbated COPD patients

OBJECTIVE

Non-invasive ventilation (NIV) is an effective treatment in patients with acute exacerbation of COPD (AECOPD). However, it may induce post-hypercapnic metabolic alkalosis (MA). This study aims to evaluate the effect of acetazolamide (ACET) in AECOPD patients treated with NIV.

PATIENTS AND METHODS

Eleven AECOPD patients, with hypercapnic respiratory failure and MA following NIV, were treated with ACET 500 mg for two consecutive days and compared to a matched control group. Patients and controls were non invasively ventilated in a bilevel positive airway pressure (BiPAP) mode to a standard maximal pressure target of 15-20 cmH2O.

RESULTS

ACET intra-group analysis showed a significant improvement for PaCO2 (63.9 ± 9.8 vs. 54.9 ± 8.3 mmHg), HCO3- (43.5 ± 5.9 vs. 36.1 ± 5.4 mmol/L) and both arterial pH (7.46 ± 0.06 vs. 7.41 ± 0.06) and urinary pH (6.94 ± 0.77 vs 5.80 ± 0.82), already at day 1. No significant changes in endpoints considered were observed in the control group at any time-point. Inter-group analysis showed significant differences between changes in PaCO2 and HCO3- (delta), both at day 1 and 2. Furthermore, the length of NIV treatment was significantly reduced in the ACET group compared to controls (6 ± 8 vs. 19 ± 19 days). No adverse events were recorded in the ACET and control groups.

CONCLUSIONS

ACET appears to be effective and safe in AECOPD patients with post-NIV MA.

Effect of camptocormia on lung volumes in Parkinson's disease

Camptocormia is defined as an abnormal flexion of the thoracolumbar spine of 45°, or more, that typically increases during walking or standing and completely disappears in the supine position. Camptocormia may occur in patients with Parkinson's disease; when it does, it is usually associated with greater disease severity. Respiratory complications, which may be secondary to abnormal chest function, are one of the most frequent causes of death in patients with Parkinson's disease. No data on lung volumes are available for Parkinson's disease patients with camptocormia. The aim of this study was to evaluate the effect of camptocormia on lung function. Eleven patients with Parkinson's disease and camptocormia and ten age-matched healthy subjects underwent lung spirometry (in the standing position, inclining the trunk forward at approx. 45° and supine) measurement of arterial oxygen-hemoglobin saturation and heart rate. We found that Parkinson's disease with camptocormia is not associated with major clinical changes in lung volumes.

Effect of heliox on heart rate kinetics and dynamic hyperinflation during high-intensity exercise in COPD

Respiratory mechanical abnormalities in patients with chronic obstructive pulmonary disease (COPD) may impair cardiodynamic responses and slow down heart rate (HR) kinetics compared with normal resulting in reduced convective oxygen delivery during exercise. We reasoned that heliox breathing (79% helium-21% oxygen) and the attendant reduction of operating lung volumes should accelerate HR kinetics in the transition from rest to high-intensity exercise. Eleven male ambulatory patients with clinically stable COPD undertook constant work-rate cycle testing at 80% of each individuals' maximum work capacity while breathing room air (RA) or heliox (HX), randomly. Mean response time (MRT) for HR and dynamic end-expiratory lung volume (EELV) were measured. Resting EELV was not affected by HX breathing, while exercise EELV decreased significantly by 0.23 L at isotime during HX breathing compared with RA. During HX breathing, MRT for HR significantly accelerated (p = 0.002) by an average of 20 s (i.e., 17%). Speeded MRT for HR correlated with indices of reduced lung hyperinflation, such as EELV at isotime (r = 0.88, p = 0.03), and with improved exercise endurance time (r = -0.64, p = 0.03). The results confirm that HX-induced reduction of dynamic lung hyperinflation is associated with consistent improvement in indices of cardio-circulatory function such as HR kinetics in the rest-to-exercise transition in COPD patients.