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Non-invasive methods of measuring cardiac performances are highly desirable in patient with heart failure. Cardiopulmonary exercise testing (CPET) and this change after cardiac rehabilitation provides not only important prognostic value, but also derived information about the stroke volume (SV) and

Aim: This study assessed hemodynamic changes and myocardial function after prolonged dynamic cold water immersions with hyperbaric hyperoxic exposure. Methods: Trained military divers were studied during 8-hour (6 subjects) and 12-hour (6 subjects) dives in a hyperbaric chamber (1.7 and 3 bar) in 18°C water. Subjects were breathing hyperoxic gas (100% oxygen or up to 1.7 bar PO2) and performed bouts of physical exercise. Conventional and speckle tracking transthoracic echocardiography (TTE) were performed before, immediately after, and 15 hours after dives. Results: We observed a decrease in left and right ventricular preloads, and lowered stroke volume immediately after dives. These parameters remained below baseline values 15h after dive termination. These changes were not significantly different between 8h and 12h dives. Speckle tracking analysis showed altered function of the left and right ventricles reflected by a transient decrease in ventricular parameters as measured by echography in the hour immediately after the end of immersion (table). Conclusion: Hemodynamic changes and transient alterations in strain and strain rate myocardial parameters were assessed immediately after 8 to 12 h dives. Immersion-linked changes in blood volume were likely involved in lowering cardiac preload and stroke volume. Altered ventricular strain and strain rates could be the result of lowered blood volume, hyperoxic breathing and increased cardiac pre- and after-load.

Background Repaired aortic coarctation (CoA) is associated with high long-term mortality and morbidity. Despite optimal early correction, patients with CoA remain at high risk of hypertension and death. We evaluated outcomes and follow-up of all patients who underwent CoA surgery, and alive at 30 days, between 1978 and 2012. Methods Retrospective cohort study in a single university teaching hospital. All data were obtained from medical records. Vital status, medical history and results of imaging were analyzed Results A total of 85 patients (63 men) were included. Median age (range) at surgery was 69 (2-13356) days; 19 (2-54) years at examination. Mean follow up was 15.8 years (1343 person-years). No deaths were observed. Reintervention was common (31%) and most often due to ReCoA (13 patients, 16%). In case of ReCoA, 8 patients had thoracic surgery, and 5 percutaneous angioplasty with stenting. Half (53%) had a bicuspid aortic valve, associated with aortic valve regurgitation (21 cases). Aneurysm of the ascending aorta was diagnosed in 8 patients, without surgical indication. Prevalence of hypertension was high (18 pts, 21%); no related complications were noted; 17 patients were being treated. All patients had normal LV ejection fraction, but half (56%) had increased LV mass. In total, 28 MRI were performed. MRI showed 22 Romanesque aortic arches, 2 Crenel arches and 1 Gothic arch. Regarding follow-up, 66% were followed as recommended by ESC guidelines. Only 4 patients were lost to follow up. There were 15 pregnancies (8 patients); no complications were noted. Conclusions Primary repair of CoA was performed with low rates of mortality and morbidity. However, prevalence of hypertension, aortic valve abnormalities and ascending aorta aneurysms remain high, confirming CoA as an overall vascular disease. Furthermore, many patients required further reoperation. These findings emphasize that patients with CoA need lifelong follow-up.