*Thrombocytopenia and thromboembolism(s) may develop in heparin immune-mediated thrombocytopenia (HIT) patients after reexposure to heparin. At the Onassis Cardiac Surgery Center, 530 out of 17,000 patients requiring heart surgery over an 11-year period underwent preoperative HIT assessment by ELISA and a threepoint heparin-induced platelet aggregation assay (HIPAG). The screening identified 110 patients with HITreactive antibodies, out of which 46 were also thrombocytopenic (true HIT). Cardiac surgery was performed in HIT-positive patients under heparin anticoagulation and iloprost infusion. A control group of 118 HITnegative patients received heparin but no iloprost during surgery. For the first 20 patients, the dose of iloprost diminishing the HIPAG test to 5% was determined prior to surgery by in vitro titration using the patients' own plasma and donor platelets. In parallel, the iloprost "target dose" was also established for each patient intraoperatively, but before heparin administration. Iloprost was infused initially at 3 ng/kg/mL and further adjusted intraoperatively, until ex vivo aggregation reached 5%. As a close correlation was observed between the "target dose" identified before surgery and that established intraoperatively, the remaining 90 patients were administered iloprost starting at the presurgery identified "target dose." This process significantly reduced the number of intraoperative HIPAG reassessments needed to determine the iloprost target dose, and reduced surgical time, while maintaining similar primary clinical outcomes to controls. Therefore, infusion of iloprost throughout surgery, under continuous titration, allows cardiac surgery to be undertaken safely using heparin, while avoiding life-threatening iloprost-induced hypotension in patients diagnosed with HIT-reactive antibodies or true HIT.

P Pu ur rp po os se e: : Severe pulmonary hypertension (PH) is a major cause of right ventricular (RV) dysfunction. Various iv vasodilator modalities have been used with limited results because of lack of pulmonary selectivity. The aim of the present controlled study was to evaluate the efficacy of inhaled iloprost, a synthetic prostacyclin analogue, in patients with elevated pulmonary vascular resistance (PVR) immediately after separation from cardiopulmonary bypass (CPB).M Me et th ho od ds s: : Twelve patients with persistent PH after discontinuation of CPB were included in the study. In all patients standard hemodynamic monitoring was used. Inhaled iloprost was administered via nebulized aerosol at a cumulative dose of 0.2 µg·kg -1 for a total duration of 20 min. Complete sets of hemodynamic measurements were performed before inhalation (baseline), during and after cessation of the inhalation period. Echocardiographic monitoring of RV function was also used.R Re es su ul lt ts s: : Inhaled iloprost induced a reduction in the transpulmonary gradient at the end of the inhalation period in comparison to baseline (9.33 ± 3.83 mmHg vs 17.09 ± 6.41 mmHg, P < 0.05). The mean pulmonary artery pressure to systemic artery pressure ratio decreased over this period (0.28 ± 0.08 vs 0.45 ± 0.17, P < 0.05). A statistically significant decrease of the PVR to systemic vascular resistance ratio was also observed (0.15 ± 0.05 vs 0.21 ± 0.05, P < 0.05). Improved indices of RV function were observed in echocardiographic monitoring.C Co on nc cl lu us si io on n: : Inhaled iloprost appears to be a selective pulmonary vasodilator and may be effective in the initial treatment of PH and the improvement of RV performance in the perioperative setting. (9,33 ± 3,83 mmHg vs 17,09 ± 6,41 mmHg, P < 0,05). Le ratio de la pression artérielle pulmonaire moyenne sur la pression artérielle systémique a diminué pendant cette période (0,28 ± 0,08 vs 0,45 ± 0,17, P < 0,05). Une baisse statistiquement significative du ratio de la RVP sur la résistance vasculaire générale a été aussi observée (0,15 ± 0,05 vs 0,21 ± 0,05, P < 0,05 Objectif : L'hypertension pulmonaire sévère (HP) est une cause majeure de dysfonction du ventricule droit (VD). Diverses modalités vasodilatatrices iv ont été utilisées et ont donné des résultats limités, étant donné le manque de sélectivité pulmonaire. Notre but était d'é-valuer l'efficacité de l'inhalation d'iloprost, un analogue de la prostacycline synthétique, chez des patients qui présentent une résistance vasculaire pulmonaire (RVP) élevée immédiatement après le sevrage de la circulation extracorporelle (CEC). Méthode : Douze patients présentant une HP persistante après l'interruption de la CEC ont été inclus dans l'étude. Une surveillance standard des paramètres hémodynamiques a été utilisée pour tous les patients. L'administration d'iloprost a été faite à l'aide d'un nébuliseur Résultats : L'iloprost inhalé a provoqué une réduction du gradient transpulmonaire à la fin de l'inhalation, en comparaison avec les m...

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The unloaded failing myocardium responded to physical training by enhancing thyroid hormone signalling. This response was associated with an up-regulation of Akt and suppression of JNK activation.