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Panminerva Medica 2002 March;44(1):23-5

Copyright © 2009 EDIZIONI MINERVA MEDICA

lingua: Inglese

Treatment of heart failure and ascites with ultrafiltration in patients with intractable alcoholic cardiomyopathy

Bilora F., Petrobelli F., Boccioletti V., Pomerri F.

From the Department of Medical and Surgery Science *Institute of Radiology University of Padua, Padua, Italy


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Background. In West­ern coun­tries the ­excess of alco­hol ­intake caus­es, sec­on­dary, non ischaem­ic car­di­om­yo­pa­thy and cir­rho­sis. Frequently, ther­a­py is not effec­tive so ultra­fil­tra­tion was ­tried on ­patients affect­ed, ­with pos­i­tive ­effects on ­life qual­ity. We ­tried to ver­i­fy util­ity and tol­er­ance to per­i­to­neal ultra­fil­tra­tion in a ­group of sub­jects affect­ed by ­heart fail­ure sec­on­dary to alco­hol­ic car­di­om­yo­pa­thy, refrac­tary to con­ven­tion­al ther­a­py.
Methods. Sixteen ­patients (14 ­males, 2 ­females) ­with ­heart fail­ure and ­ascites affect­ed by alco­hol­ic car­di­om­yo­pa­thy ­were stud­ied. All sub­jects ­were in IV ­class ­NYHA (New York Heart Association); ejec­tion frac­tion (EF) was eval­u­at­ed by ech­o­car­di­o­gram and ­ascites by abdom­i­nal ultra­sound. Patients ­were sub­mit­ted to clin­i­cal ­exam, ­body ­weight, abdom­i­nal cir­cum­fer­ence, diu­re­sis and rou­tine bio­hu­mo­ral ­exams, elec­tro­car­di­o­gram and ­chest X-ray. Subsequently ­they under­went inter­mit­tent noc­tur­nal per­i­to­neal dial­y­sis ­with a chang­ing ­cycle of 6-12 ­hours per ses­sion. After 5 ­days, sub­jects ­were ­checked ­through ech­o­car­di­o­gram and abdom­i­nal ultra­sound.
Results. The ­patients ­mean age was 56.7±3.2 ­years. After ultra­fil­tra­tion, all sub­jects ­showed ­decreased ­body ­weight, abdom­i­nal cir­cum­fer­ence and ­urea; ­there was an ­increase of diu­re­sis and Natriuria. Fifteen sub­jects ­entered III ­NYHA ­class with­out vari­a­tion of EF; all of ­them ­showed clin­i­cal and ech­o­graph­ic reduc­tion of ­ascites. Mean ultra­fil­tra­tion quan­tity was 6.084 ml ­with ­mean dial­y­sis ­hours 20; 7.36% of ­patients had ­fever ­that dis­ap­pared with­in 24 ­hours ­with anti­bi­o­tic ther­a­py. All sub­jects ­referred to ­feel ­well and the ­mean hos­pi­tal­iza­tion peri­od was of 7 day in ­spite of the usu­al 22 ­days.
Conclusions. We sug­gest per­i­to­neal dial­y­sis for ­patients ­with con­ges­tive ­heart fail­ure and ­ascites ­caused ­from alco­hol­ic car­di­om­yo­pa­thy refrac­to­ry to con­ven­tion­al ther­a­py.

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