Nematic phase transitions in mixtures of thin and thick colloidal rods

We report experimental measurements of the phase behavior of mixtures of thin (charged semiflexible fd virus) and thick (fd-PEG, fd virus covalently coated with polyethylene glycol) rods with diameter ratio varying from 3.7 to 1.1. The phase diagrams of the rod mixtures reveal isotropic-nematic, isotropic-nematic-nematic, and nematic-nematic coexisting phases with increasing concentration. In stark contrast to predictions from earlier theoretical work, we observe a nematic-nematic coexistence region bound by a lower critical point. Moreover, we show that a rescaled Onsager-type theory for binary hard-rod mixtures qualitatively describes the observed phase behavior.

Computer simulation study of the global phase behavior of linear rigid Lennard-Jones chain molecules: Comparison with flexible models

The global phase behavior (i.e., vapor-liquid and fluid-solid equilibria) of rigid linear Lennard-Jones (LJ) chain molecules is studied. The phase diagrams for three-center and five-center rigid model molecules are obtained by computer simulation. The segment-segment bond lengths are L = sigma, so that models of tangent monomers are considered in this study. The vapor-liquid equilibrium conditions are obtained using the Gibbs ensemble Monte Carlo method and by performing isobaric-isothermal NPT calculations at zero pressure. The phase envelopes and critical conditions are compared with those of flexible LJ molecules of tangent segments. An increase in the critical temperature of linear rigid chains with respect to their flexible counterparts is observed. In the limit of infinitely long chains the critical temperature of linear rigid LJ chains of tangent segments seems to be higher than that of flexible LJ chains. The solid-fluid equilibrium is obtained by Gibbs-Duhem integration, and by performing NPT simulations at zero pressure. A stabilization of the solid phase, an increase in the triple-point temperature, and a widening of the transition region are observed for linear rigid chains when compared to flexible chains with the same number of segments. The triple-point temperature of linear rigid LJ chains increases dramatically with chain length. The results of this work suggest that the fluid-vapor transition could be metastable with respect to the fluid-solid transition for chains with more than six LJ monomer units.

Cardiac defects in chromosomally normal fetuses with increased nuchal translucency at 10-14 weeks of gestation

OBJECTIVE

To examine the prevalence, distribution and spectrum of cardiac defects in chromosomally normal fetuses with increased nuchal translucency thickness.

PATIENTS AND METHODS

During a 4-year period, targeted fetal echocardiography was used in 353 chromosomally normal fetuses with increased nuchal translucency thickness at 10-14 weeks' gestation. The cardiac scan was performed at 18-22 weeks. In the last 138 cases enrolled, an additional scan at 12-16 weeks was carried out. The follow-up included the findings at necropsy or in the pediatric examination. A complete follow-up was achieved in 97%.

RESULTS

Cardiac defects were present in 32 (9.1%) cases, increasing from 5.3% in those with a nuchal translucency thickness of > or = 95th centile (3.9 mm) to 24% when thickness > or = 6 mm (p < 0.001). In 31 cases (97%), the cardiac defect was diagnosed antenatally; in 24 cases (77%) this diagnosis was confirmed later. In the remaining seven cases, the autopsy examination was not available. A wide range of cardiac defects was observed, with the most common being atrioventricular septal defect and tricuspid atresia.

CONCLUSIONS

Euploid fetuses with increased nuchal translucency thickness have a significantly increased risk of cardiac defects. This is a marker of different types of heart anomalies and constitutes an additional indication for targeted fetal echocardiography. Most of the cardiac defects can be detected by fetal echocardiography.

Ordering transitions, biaxiality, and demixing in the symmetric binary mixture of rod and plate molecules described with the Onsager theory

The phase behavior of a liquid-crystal forming binary mixture of generic hard rodlike and platelike particles is studied with the theory of Onsager [L. Onsager, Ann. N. Y. Acad. Sci. 51, 627 (1949)] for nematic ordering. The mixture is chosen to be symmetric at the level of the second virial theory, so that the phase behavior of the two pure components is identical. A parameter q is used to quantify the effect of the unlike rod-plate excluded volumes on the phase behavior; a value of q>1 indicates that the unlike excluded volume is greater than the like excluded volume between the rods or plates, and a value of q<1 corresponds to a smaller unlike excluded volume. Two methods are used to solve the excluded volume integrals: the approximate L2 model [A. Stroobants and H. N. W. Lekkerkerker, J. Phys. Chem. 88, 3669 (1984)], in which a second-order Legendre polynomial is used; and a numerical method where the integrals are solved exactly. By varying the unlike excluded volume interaction q, the isotropic phase is seen to be stabilized (small q) or destabilized (large q) with respect to the nematic phase for both models. Isotropic-isotropic demixing is also observed for the largest values of q due to the unfavorable contribution of the unlike excluded volume to the entropy of the system. A second-order nematic-biaxial nematic phase transition is observed for small values of q in the L2 approximation, and for all q in the exact calculation; in the latter case the stability of the biaxial phase is enhanced by increasing q, while in the L2 approximation nematic-nematic phase separation is favored. This result is the most striking difference between the two methods, and is in contrast with the results of previous studies. We show that the accuracy of the L2 expansion is particularly poor for parallel and perpendicular particle orientations.

Early prenatal diagnosis of major cardiac anomalies in a high-risk population

OBJECTIVE

To examine the accuracy of early fetal echocardiography performed in a high-risk population combining transvaginal and transabdominal routes.

METHODS

A series of 330 high-risk pregnancies were screened by transvaginal and transabdominal scan at 12-17 weeks' gestation in a prospective multicentre trial in Spain between September 1999 and May 2001. A total of 334 fetal heart examinations were performed, including four twin pregnancies. Maternal age ranged from 17 to 46 years (mean 33 years with 36% of women over 34 years). The median gestational age at scan was 14.2 weeks (range 12-17 weeks). For each fetus, visualization of the four-chamber view, the origin of the great arteries, aortic and ductal arches and systemic venous return was attempted in a segmental approach. B-mode and colour/pulsed Doppler flow imaging were used in all cases. The duration of complete heart examination was less than 30 minutes. The examinations were performed by three experienced operators. Reliability was assessed by conventional transabdominal echocardiography at 20-22 weeks, by postnatal follow-up in the first three months of life, and/or by autopsy in cases of termination of pregnancy.

RESULTS

The rate of successful visualization of the fetal heart was 94.6% (316/334). In 48 out of 334 (14.4%) fetuses the final diagnosis was abnormal. In 38 out of 48 (79.2%) cases with heart defects the diagnosis was suspected at early echocardiography. In the group with congenital heart defects, 27 cases had an abnormal karyotype (56.3%) and 31 cases showed extracardiac anomalies (64.6%). There were 10 false-negative cases at early scan. There were no false-positive diagnoses.

CONCLUSIONS

This experience stresses the usefulness of early fetal echocardiography when performed by expert operators on fetuses specifically at risk for cardiac disease. The high rate of successful visualization of the fetal heart provides a reliable diagnosis of major cardiac defects at this early stage of pregnancy.

Synergistic interaction of diazepam with 3',5'-cyclic adenosine monophosphate-elevating agents on rat aortic rings

We investigated the effect of the phosphodiesterase type 4 (PDE4) inhibitory activity of diazepam on the arterial wall. To this purpose, we examined the interaction of diazepam with 3',5'-cyclic adenosine monophosphate (cyclic AMP)-elevating agents on vasodilatation and cyclic AMP levels in rat aortic rings precontracted with phenylephrine. The involvement of benzodiazepine receptors was also studied. Diazepam (5-100 microM) produced a relaxation of this preparation which was neither mimicked by gamma-aminobutyric acid (GABA), nor antagonized by flumazenil and 1-(2-chlorophenyl)-N-methyl-N-(1-methylpropyl)-3-isoquinolinecarboxamide (PK 11195), inhibitors of central or peripheral type benzodiazepine receptors, respectively. The diazepam-induced relaxation was potentiated by the presence of isoprenaline (10 nM), forskolin (50 nM) or milrinone (0.1 microM). Furthermore, diazepam increased the enhancement of cyclic AMP levels induced by these three agents in this tissue. Our results demonstrate a functional and biochemical synergistic interaction of diazepam with cyclic AMP-elevating agents on rat aortic rings.

[Applied neurophysiology in the deep brain stimulation treatment of multiple sclerosis tremor]

INTRODUCTION

Many patients with multiple sclerosis (MS) develop tremors that may involve one or both lower and/or upper extremities, head and/or voice. In the last few years, chronic high frequency deep brain stimulation of the ventral intermedious (Vim) thalamic nucleus (Vim-DBS, deep brain stimulation) seems to be gradually replacing Vim-thalamotomy in surgical treatment of tremor. The thalamotomy is a destructive procedure of the whole neural components, whereas Vim-DBS has shown to be a selective neurophysiological procedure to block a specific group of neural components, in particular large, fast and low threshold ones. MS is a disease of uncertain etiology characterized by demyelinating plaques in central nervous system. The neurophysiological intraoperative targeting applied to this pathology identifies demyelinated plaques and the functional state of Vim, reduces pitfalls and increases accuracy. Methods included spontaneous and induced multiunit activity recording, semimicroelectrode and tetraelectrode thalamic evoked potentials recording and micro/macro stimulation techniques.

Melatonin disrupts circadian rhythms of glutamate and GABA in the neostriatum of the aware rat: a microdialysis study

The purpose of this study was to investigate possible circadian changes in extracellular concentrations of glutamate (GLU) and gamma-aminobutyric acid (GABA). and the influence of melatonin on the levels of these neurotransmitters in the neostriatum of awake rats using in vivo microdialysis. At the same time, the concentrations of the amino acids taurine (TAU), glutamine (GLN) and arginine (ARG), as well as dopamine (DA) and its metabolites 3, 4-dihydroxyphenyl acetic acid (DOPAC) and homovanillic acid (HVA), were measured in the extracellular fluid. When dialysates were collected over a 24-hr period (6 hr dark, 12 hr light, 6 hr dark), both GLU and GABA, without the infusion of melatonin, exhibited statistically significant rhythms, with higher levels of these constituents during the dark and lower levels during the day. Perfusion with melatonin (for 19 consecutive hours) prevented the daytime reductions in both GLU and GABA. Of the amino acids measured in the dialysates collected from the neostriatum of non-perfused rats, only ARG exhibited a significant change during the light:dark cycle; again, lowest concentrations were measured during the day. While melatonin perfusion did not statistically significantly influence neostriatal levels of TAU and ARG, GLN levels continued to drop during the infusion of the indoleamine. Dialysate concentrations of DA, DOPAC and HVA exhibited circadian rhythms which were not influenced by melatonin perfusion. The findings indicate there are differential effects of melatonin on extracellular neurotransmitter concentrations in the neostriatum of the awake rat. The results also suggest that the day:night variations in GLU and GABA may relate to daily changes in endogenous melatonin production, while DA and its metabolites are minimally influenced by this secretory product.

Use of OKT3 for acute myocarditis in infants and children

Acute viral myocarditis triggers an autoimmune phenomenon that aggressive immunosuppressive therapy with monoclonal OKT3 may suppress. We treated 5 patients, aged 15 months to 16.5 years, who had acute viral myocarditis and left ventricular ejection fraction (LVEF) of 5% to 20%, with a combination immunosuppressive regimen that included OKT3, intravenous immunoglobulin, methylprednisone, cyclosporine, and azathioprine. Within 2 weeks of therapy, all patients demonstrated normalization of LVEF to 50% to 74%, and on mid-term follow-up, we have found no recurrence of heart failure or progression to dilated cardiomyopathy. In patients with severe acute myocarditis, aggressive immunosuppressive regimen based on OKT3 is safe and may inhibit or reverse the immune response, resulting in dramatic improvement in myocardial function.

[The debate on the organization, functions and efficiency of nursing in primary care: apropos of a qualitative study]

OBJECTIVE

To show the opinions that doctors and nurses express on the organisation and competences of primary care nursing, and on inter-professional relations.

DESIGN

Qualitative research study based on the group discussion technique known as Philips 66.

SETTING AND PARTICIPANTS

Three discussion groups, one of nurses, one of doctors and a third mixed, with 6 components each, half from Cáceres and the rest from other provinces, and all involved in primary care health delivery.

MEASUREMENTS AND MAIN RESULTS

In the discussions, the three groups coincided in the importance given to nursing clinics and home visits, in the organisational advantages that the attachment as a norm of the population to a nursing clinic would bring, in the ability of nurses to perform the techniques they have habitually used, and in defence of one sole clinical record per patient. They blamed each other mutually for making few home visits. Doctors attributed to nurses under-use of records and nurses alleged doctors took no notice of their notes. On the question of their relations, doctors thought that nurses did not take on joint responsibility for the work-loads in health centres; and nurses thought that doctors did not wish to share tasks, but rather delegate or order them.

CONCLUSIONS

The attachment of the population to nursing clinics would favour the extension of care, the commitment to the population and the real delivery of services, as well as professional autonomy and recognition.

Cardiac electron-beam CT in children undergoing surgical repair for pulmonary atresia

PURPOSE

To study whether electron-beam computed tomography (CT) is as accurate as conventional angiocardiography for the characterization of the true pulmonary arteries and the aortopulmonary collateral vessels in children undergoing surgical correction for pulmonary atresia.

MATERIALS AND METHODS

Twenty-three children with pulmonary atresia underwent 48 cardiac-triggered dynamic contrast material-enhanced electron-beam CT studies. Correlation was made with surgical findings in all patients and with 34 cineangiocardiograms. Data from reconstructed electron-beam CT images and cineangiocardiograms were reviewed for the presence, caliber, and origin of true pulmonary arteries and aortopulmonary collateral vessels; for stenosis; for thrombosis; and for the patency of vascular conduits and shunts.

RESULTS

Electron-beam CT was more sensitive than angiography in the identification of hypoplastic and/or nonconfluent branch pulmonary arteries, coronary anomalies, conduit and shunt thrombosis, and other postoperative complications, but it was less sensitive in the demonstration of stenoses at collateral vascular origins and anastomoses. Overall test parameters for electron-beam CT and angiography to characterize pulmonary vascularity were similar (sensitivity, 0.94 vs 0.90; specificity, 0.99 for both; accuracy, 0.97 vs 0.95). Three-dimensional reconstructions, although they were helpful in conveying electron-beam CT findings to referring cardiologists and surgeons, did not add diagnostic information to that displayed on images of the transverse sections.

CONCLUSION

Electron-beam CT complements conventional diagnostic angiocardiography in preoperative evaluation, especially in the detection of hypoplastic pulmonary arteries. It is well suited for postoperative shunt surveillance.

Endogenous GABA potentiates the potassium-induced release of dopamine in striatum of the freely moving rat: a microdialysis study

Using microdialysis, a study was made of the effects of an increase of endogenous GABA on basal and potassium-stimulated release of dopamine in striatum of the awake rat. The dopamine metabolites DOPAC and HVA were also measured. Extracellular concentrations of GABA were increased by inhibiting its uptake with nipecotic acid. TTX (10 microM) reduced basal extracellular concentrations of dopamine, and dopamine metabolites, but not GABA. Nipecotic acid (200, 500, and 1000 microM) produced a dose-related increase in basal extracellular concentrations of GABA, but did not change basal extracellular concentrations of dopamine and dopamine metabolites. However, nipecotic acid significantly enhanced the dopamine release produced by perfusion of potassium (50 mM) and also enhanced the extracellular increase of GABA produced by high potassium. These results suggest that an increase of endogenous GABA is facilitating the stimulated release, but not the basal release, of dopamine in the striatum of the awake rat.

Three-dimensional helical CT of pulmonary arteries in infants and children with congenital heart disease

OBJECTIVE

The purpose of our study was to determine the value of three-dimensional reconstructed helical CT in the assessment of the pulmonary arteries in infants and children with complex congenital heart disease.

MATERIALS AND METHODS

Twenty patients were examined with contrast-enhanced helical CT. Three-dimensional reconstructions were performed with multiplanar reformations, maximum intensity projection, and shaded-surface display. Correlation was made with 19 echocardiograms and 14 cineangiocardiograms. All imaging studies were reviewed independently for the following parameters: the caliber of the main and branch pulmonary arteries and their confluence, the presence of stenosis, the number and caliber of aortopulmonary collaterals, and the patency of vascular shunts and conduits. Surgical confirmation, which was used as the reference standard, was available in all patients.

RESULTS

Helical CT was as accurate as angiocardiography in revealing stenotic and nonconfluent central pulmonary arteries and in revealing aortopulmonary collaterals (overall CT test parameters: sensitivity, 90%; specificity, 100%; accuracy, 93%).Three-dimensional rendition did not improve the accuracy of CT. The patency of shunts was shown equally well with CT as with angiography, but CT showed thrombosis more directly. Echocardiography was the least accurate technique in revealing pulmonary artery anatomy (accuracy, 65%), primarily because a relatively large number of studies were technically unsatisfactory to assess the study parameters.

CONCLUSION

Helical CT angiocardiography with three-dimensional reconstruction is superior to echocardiography for the noninvasive assessment of pulmonary artery anatomy in patients with complex congenital heart disease. Helical CT may be used as a complementary technique and occasionally as a substitute for the diagnostic imaging portion of cardiac catheterization with cineangiocardiography.

Bubble contrast echocardiography in detecting pulmonary arteriovenous shunting in children with univentricular heart after cavopulmonary anastomosis

OBJECTIVES

We sought to compare bubble contrast echocardiography and pulmonary angiography in detecting pulmonary arteriovenous malformation (PAVM) in children with cavopulmonary anastomosis (CPA), and to examine anatomic and physiologic variables associated with the development of PAVM.

BACKGROUND

Development of PAVM in patients with CPA may cause profound cyanosis. Pulmonary arteriovenous malformation has been traditionally diagnosed by pulmonary angiography with reported incidence of 20% to 25% in patients with CPA.

METHODS

Fourteen patients (age 1.1 to 12.6 years) with any forms of CPA and normal pulmonary venous drainage formed the study population. All patients underwent cardiac catheterization and pulmonary angiography. Bubble contrast echocardiographic studies were performed with injection of 10 ml of agitated saline solution into branch pulmonary arteries. Transthoracic echocardiograms using an apical view were performed to assess the appearance of bubble contrast in the systemic ventricles. We compared the results of pulmonary angiograms and contrast echocardiograms, and findings of contrast echocardiograms between lungs with hepatic venous blood flow and lungs without hepatic venous blood.

RESULTS

Ten of the 14 patients (71%) had positive contrast echocardiographic studies, compared with three (21%) detected by pulmonary angiograms (p = 0.01). No difference was found in pulmonary artery pressure, transpulmonary gradient or presence of heterotaxy syndrome between patients with positive contrast echocardiographic studies and patients with negative studies. However, patients with positive contrast echocardiograms tended to have lower oxygen saturation (81%) and higher hemoglobin (16.4 g/dl) compared with patients with negative studies (88% and 14.7 g/dl, p = 0.10 and p = 0.18 respectively). Patients with Glenn shunt or unidirectional Fontan had higher incidence of PAVM (10/11) compared with patients with classic or lateral tunnel Fontan (0/3, p = 0.01). All 12 lungs with no perfusion of hepatic venous blood had positive contrast echocardiographic studies. Lungs with no hepatic venous blood flow were more likely to develop PAVM compared with lungs with hepatic venous blood flow (12/12 and 3/16 respectively, p < 0.01).

CONCLUSIONS

Bubble contrast echocardiography is more sensitive in detecting PAVM compared with pulmonary angiography. The prevalence of PAVM in patients with CPA may be much higher than what had been reported previously. Lungs with no hepatic venous blood flow are more likely to develop PAVM than lungs with hepatic venous blood flow.

[Stereotactic target identification for neurosurgery of Parkinson disease]

INTRODUCTION

The use of applied neurophysiological methods to improve the stereotactic localization of devices in the deep human brain is a high and systematic technology in Parkinson's neurosurgery today. The available standard equipment for clinical neurophysiology practice may constitute the basic set for high tech functional neurosurgery. Free run and event related multiunit recording, naturalistic and electrical evoked potentials, and deep brain microstimulation responses are the basic methodological set to neurophysiological target localization.

DEVELOPMENT AND CONCLUSIONS

This article is concerned with the topic: set out a high technology using low cost equipment. So our 41 cases experienced in pallidal and thalamic nucleolisis and thalamus and subthalamus DBS results suggest that the proposed equipment and methods are the required to assure accuracy and safety for target location.

Isolated isobutyryl-CoA dehydrogenase deficiency: an unrecognized defect in human valine metabolism

A 2-year-old female was well until 12 months of age when she was found to be anemic and had dilated cardiomyopathy. Total plasma carnitine was 6 microM and acylcarnitine analysis while receiving carnitine supplement revealed an increase in the four-carbon species. Urine organic acids were normal. In vitro analysis of the mitochondrial pathways for beta oxidation, and leucine, valine, and isoleucine metabolism was performed in fibroblasts using stable isotope-labeled precursors to these pathways followed by acylcarnitine analysis by tandem mass spectrometry. 16-2H3-palmitate was metabolized normally down to the level of butyryl-CoA thus excluding SCAD deficiency. 13C6-leucine and 13C6-isoleucine were also metabolized normally. 13C5-valine incubation revealed a significant increase in 13C4-isobutyrylcarnitine without any incorporation into propionylcarnitine as is observed normally. These same precursors were also evaluated in fibroblasts with proven ETF-QO deficiency in which acyl-CoA dehydrogenase deficiencies in each of these pathways was clearly identified. These results indicate that in the human, there is an isobutyryl-CoA dehydrogenase which exists as a separate enzyme serving only the valine pathway in addition to the 2-methyl branched-chain dehydrogenase which serves both the valine and the isoleucine pathways in both rat and human.

Benefits of early surgical repair in fixed subaortic stenosis

OBJECTIVES

We sought to determine whether early resection can improve outcome in fixed subaortic stenosis.

BACKGROUND

The diagnosis of subaortic stenosis (SAS) is often made before significant gradients occur. Whereas resection is the accepted treatment, it remains uncertain whether surgical intervention at this early stage can reduce the incidence of recurrence or influence the progression of aortic valve damage.

METHODS

Follow-up was available for 75 of 83 consecutive patients operated on for fixed SAS; the average duration of follow-up was 6.7 years. The lesion was discrete in 68 patients (91%) and of a tunnel type in 7, with associated ventricular septal defect in 28 (37%). All underwent transaortic resection.

RESULTS

There were no deaths. There were 18 recurrences of SAS in 15 patients (20%). Thirteen patients (17%) underwent 17 reoperations for recurrence or aortic valve disease. The cumulative hazard of recurrence was 8.9%, 16.1% and 29.4% +/- 2.3% (mean +/- SEM), and the hazard of events, including recurrence and reoperation, was 9.2%, 18.4% and 35.1% +/- 3.5% at 2, 5 and 10 years, respectively. Residual end-operative left ventricular outflow tract (LVOT) gradients (> 10 mm Hg, n = 8) and tunnel lesions were univariate predictors of recurrence (p = 0.0006 and p = 0.003, respectively). Multivariate predictors included higher preoperative LVOT gradient (p < 10(-4)) and younger patient age (p = 0.002). Only two recurrences (0.87 per 100 patient-years of follow-up) were noted in patients with a preoperative peak LVOT gradient < or = 40 mm Hg (n = 40), whereas higher gradients (n = 35) were associated with a greater than sevenfold recurrence rate (6.45 events per 100 patient-years, p = 0.002). The aortic valve required concomitant repair in 17 cases in the high gradient group (48.6%) but in only 8 in the low gradient group (20%, p = 0.018). Despite relief of the obstruction, progressive aortic regurgitation was noted at follow-up after 14 procedures in the high gradient group (40%) but after only 5 procedures in the low gradient group (12.5%, p = 0.014).

CONCLUSIONS

The data suggest that surgical resection of fixed subaortic stenosis before the development of a significant (> 40 mm Hg) outflow tract gradient may prevent recurrence, reoperation and secondary progressive aortic valve disease.

Temporary mechanical support with the BVS 5000 assist device during treatment of acute myocarditis

BACKGROUND

Ventricular support with the BVS 5000 (Abiomed) has been used as temporary circulatory assist for the failing heart. Our purpose is to summarize four cases illustrating the role of mechanical unloading in acute myocarditis.

METHODS

Four patients aged 16- to 33-year old presented with congestive heart failure 4 to 20 days after a flu-like syndrome. All patients were in severe cardiogenic shock +/- renal and liver dysfunction. Ejection fraction ranged from 5% to 26%. Indications for ventricular assist were failure of maximal medical treatment with > or = two inotropes +/- intra-aortic balloon pump. Myocardial biopsy revealed acute myocarditis in three patients and severe edema in one despite a characteristic clinical course. Two patients received immunotherapy with OKT3. Biventricular assist was used in three patients and left ventricular assist only was used in one. Mean support time was 8.3 days (7 to 11).

RESULTS

All patients had recovery of myocardial function and were discharged from the hospital in good condition.

CONCLUSION

The BVS 5000 device provides a safe, simple, and effective method to support the circulation during acute myocarditis. We hypothesize that this may facilitate myocardial recovery by decompressing the distended ventricle. Ventricular assist devices should be used early in the presence of hemodynamic deterioration on maximal medical therapy.