Postinfarction ventricular septal defect (VSD) is an uncommon but almost lethal complication. The optimal timing for VSD repair is matter of debate, and mechanical circulatory support (MCS) devices allow to hemodynamically support the patient and postpone the VSD closure until myocardial tissue is less friable and the patient’s condition is less compromised. However, data are lacking to guide the choice of the best types of MCS in case of VSD. We present a case of a large postinfarction VSD and the use of central venoarterial extracorporeal membrane oxygenation support to stabilize the patient until the VSD surgical repair. This case offers the opportunity to revise the indications and characteristics of different MCS, highlighting pros and cons of each one.

Epidemiological evidence shows that nephrolithiasis is associated with cardiovascular (CV) morbidities. The association between nephrolithiasis and CV disease is not surprising because both diseases share conditions that facilitate their development. Metabolic conditions, encompassed in the definition of metabolic syndrome (MS), and habits that promote nephrolithiasis by altering urine composition also promote clinical manifestations of CV disease. By inducing oxidative stress, these conditions cause endothelial dysfunction and increased arterial stiffness, which are both well-known predictors of CV disease. Furthermore, the subtle systemic metabolic acidosis observed in stone formers with CV disease may have a pathogenic role by increasing bone turnover and leading to reduced mineral content and osteoporosis/osteopenia. Heart valves and/or coronary artery and aortic calcifications are frequently associated with reduced mineral density. This is known as the ‘calcification paradox’ in osteoporosis and has also been observed in subjects with calcium nephrolithiasis. Evidence supports the hypothesis that osteoporosis/osteopenia is an independent risk factor for the development of CV calcifications. In the long term, episodes of renal stones may occur from the onset of metabolic derangements/MS to arterial stiffness/atherosclerosis and CV morbidities. These episodes should be considered a warning sign of an ongoing and silent atherosclerotic process. The evaluation of cardiometabolic risk factors and MS components should be routine in the assessment of renal stone formers. This would allow for treatment and prevention of the development of CV complications, which are much more severe for the patient and for public health.

The response of the right ventricle (RV) to the hemodynamic effects of veno-arterial extracorporeal membrane oxygenation (VA-ECMO) is currently unpredictable. We hypothesized that the presence of uni- or bi-ventricular failure before implantation and the cannulation strategy may influence this interaction. We sought to assess the RV performance during VA-ECMO support and identify RV-related predictors of successful weaning. Changes in RV size and function during VA-ECMO support by echocardiography were retrospectively analyzed in 87 consecutive adult patients between February 2008 and June 2017. Predictors of successful weaning due to myocardial recovery were evaluated by multivariable logistic regression. RV echocardiographic parameters did not vary significantly during VA-ECMO support and neither after stratification by the type of cannulation or the presence of isolated or biventricular failure. Successful weaning was conditioned by the absence of RV dysfunction before implantation (OR, 14.7; 95% CI, 13.3-140.3; p = 0.025) or in the last day of support (OR, 9.5; 95% CI, 1.6-54; p = 0.011) and was favored by a total or partial recovery of RV function during the assistance (OR, 6.2; 95%CI, 1.7-22.4; p = 0.005). RV improvement was more often observed in patients with acute RV failure and longer support, while VA-ECMO configuration, additional mechanical support, or pharmacological therapy had no effect. Preservation or improvement of RV function during VA-ECMO is essential for successful weaning. RV echocardiographic performance does not change significantly during VA-ECMO support and is not influenced by cannulation type or the presence of uni- or bi-ventricular failure before implantation.

Background: Heart failure (HF) is a complex syndrome affecting the whole body, kidneys included. The left ventricular assist device (LVAD) is a valid option for patients with very severe HF. Focusing on renal function, LVAD implantation could theoretically reverse the detrimental effects of HF syndrome on kidneys. However, implanting an LVAD is a high‐risk surgical procedure, and LVAD patients have higher risk of bleeding, device thrombosis, strokes, renal impairment, multi‐organ failure and infections. Furthermore, an LVAD has its own particular effects on the renal system.Methods: In this review, we provide a comprehensive overview of the complex interaction between LVAD and the kidneys from the pathophysiological and clinical perspectives. An analysis of the different effects of pulsatile‐flow and continuous‐flow LVAD is provided.Results: Despite their limitations, creatinine‐based estimated glomerular filtration rate (eGFR) formulas help to stratify patients by their post‐LVAD placement prognosis. Poor basal renal function, the onset of acute kidney injury or the need for renal replacement therapy after LVAD implantation negatively influences a patient's prognosis. LVAD can also prompt an improvement in renal function, however, with some counterintuitive effects on a patient's prognosis.Conclusion: It is still hard to say whether different trends in eGFR depend on different renal conditions before LVAD placement, on a patient's better overall status or on a particular patient management strategy before and/or after the device's implantation. Steps should be taken to solve this question because finding the best candidates for LVAD implantation is of paramount importance to ensure the best outcomes.

Background: Resistant hypertension is common in patients with end-stage kidney disease (ESKD) who are on dialysis. Experience with percutaneous renal denervation (RDN) in these patients is limited and generally has short follow-up periods, primarily focusing on blood pressure (BP) control. In particular, the effects of RDN on anaemia, chronic kidney disease–mineral and bone disorder (CKD-MBD) and dialysis tolerance remain unexamined. Methods: We report our experience with RDN in 14 dialysis patients [7 on haemodialysis (HD) and 7 on peritoneal dialysis (PD)] with a follow-up after RDN of 3–84 months. Six patients received kidney transplantation during follow-up. Results: BP and the number of antihypertensive drugs decreased (P = .008 and P = .018, respectively). RDN was equally effective in both HD and PD. In nearly all transplanted patients, BP normalized and the number of antihypertensive drugs was reduced after kidney transplantation. RDN did not alter treatment schedules for HD or PD and no episodes of acute intradialytic hypotension were reported. Additionally, there were no significant changes in treatments for anaemia or CKD-MBD. Only one patient had an RDN procedural complication. Conclusion: Our experience with RDN in dialysis patients suggests beneficial effects in both HD and PD. BP improved significantly, with no observed issues related to the typical clinical problems faced by these patients, such as anaemia, CKD-MBD and dialysis tolerance. Furthermore, in those patients who received a kidney transplant, we noted a further improvement in BP control.

Objectives: This study's primary purpose was to demonstrate the correlation of preoperative right ventricular free‐wall longitudinal strain (RVFWLS) and pre‐/postsurgical variation in strain (delta strain) with the clinical and echocardiographic diagnosis of right ventricular dysfunction. Its secondary purpose was to determine the correlation of RVFWLS and delta strain with length of stay (LOS) in the intensive care unit (ICU), ventilation days, trend of natriuretic peptide test. (NT‐proBNP) and lactate in the first 48 h, incidence of acute renal failure, and 28‐day mortality.Design: Prospective observational study.Setting: Cardio‐thoracic and Vascular Anaesthesia Department and ICU of the University Hospital Integrated Trust of Verona.Participants: Patients scheduled for mitral surgery.Interventions: None.Measurements and Main Results: All clinical and transoesophageal echocardiographic (TEE) parameters were collected at baseline, before surgery (T1) and at admission in the ICU postsurgery (T2). During the postoperative period, the clinical and echocardiographic diagnoses of right, left, or biventricular dysfunction were evaluated. TEE parameters were evaluated by a cardiologist offline. The patients were divided into two subgroups according to the development of any type of ventricular dysfunction. No statistically significant differences emerged between the two groups. According to a logistic regression model, a T1‐RVFWLS value of −15% appeared to predict biventricular dysfunction (sensitivity: 100%; specificity: 91.3%). No correlation between T1‐ or T2‐RVFWLS and creatinine, hours of ventilation or ICU LOS was found.Conclusions: Our study introduces a new parameter that could be used in perioperative evaluations to identify patients at risk of postoperative biventricular dysfunction.