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Introduction: Virus associated hemophagocytic syndrome (VAHS) is severe complication of numerous viral infections that is associated with “cytokine storm” and the accumulation of activated T-lymphocytes and macrophages in various organs, frequently resulting in multiorgan failure and death1,2. We present a case report of VAHS caused by Influenza A infection. Case report: 50-years old, previously healthy male presented to Emergency Department with fever and respiratory failure. Initial arterial blood gases showed global respiratory failure with acidosis (pH < 6.8, pCO2 9.3 kPa, pO2 8.7 kPa, lactates 13.5 mmol/L, HCO3- unmeasurable). Computed tomography showed left sided pneumonia, and initial laboratory workup showed severe leukopenia, elevated C-reactive protein, and mild renal lesion (Table 1). Polymerase Chain Reaction (PCR) was positive for Influenza A, and Streptococcus Pyogenes was isolated from bronchoalveolar lavage. After initial workup patient arrested and cardiopulmonary reanimation (CPR) with intubation was performed. Post-CPR echocardiography showed severely reduced left ventricular systolic function (LVEF <15%) with suspected thrombus in left ventricle (Figure 1). Patient was hemodynamically unstable despite massive volume resuscitation, vasopressors, and inotropes so under ultrasound guidance veno-arterial extracorporeal membrane oxygenation (VA-ECMO) was placed. Hemodialysis with Oxyris filter was initiated. Because of severe pancytopenia bone marrow biopsy was performed which confirmed VAHS. Treatment included Pentaglobin and intravenous immunoglobulins supplementation, high doses of glucocorticoids and cyclosporin A. After 5 days ECMO configuration was changed to VAV ECMO because of suboptimal peripheral oxygenation. Bedside echocardiography was performed every day and gradual recovery of LVEF was verified and because of that, seven days after admission ECMO configuration was changed to VV ECMO. Total ECMO support time was 20 days. Because of prolonged mechanical ventilation percutaneous tracheotomy was performed. Treatment complications included multiple hospital acquired infections, cytomegalovirus reactivation, necrosis of all toes and two fingers, severe critical illness polyneuropathy, cachexia, acalculous cholecystitis. After 3 month of treatment patient is in process of weaning from mechanical ventilation. Conclusion: VAHS is one of rare and potentially lethal complications of Influenza A which can lead to multiorgan failure that can require mechanical circulatory support. Echocardiography plays crucial role in diagnostics and management of critical ill patients. [ABSTRACT FROM AUTHOR]

Introduction: Chronic aortic regurgitation (AR) results in left ventricular (LV) volume overload, leading to compensatory changes such as LV dilatation and hypertrophy. These adaptive mechanisms enable patients with severe AR to tolerate the increased blood volume for an extended period, even after the LV becomes enlarged and its function is reduced. In recent studies, aortic valve surgery has been shown to improve LV volumes. LV dimension can be used as a predictor of impaired left ventricular functional and structural recovery during follow-up after surgery. Furthermore, severe AR patients often present with coexisting tricuspid regurgitation (TR) and combined have a higher risk of adverse outcomes.1,2 The aim of this study was to explore the changes in LV end-diastolic volume (EDV), LV end-systolic volume (ESV), mean pulmonary artery pressure (PAP) and TR in patients with severe aortic regurgitation who underwent surgical treatment at the University Hospital Centre Zagreb. Patients and Methods: In this study 45 patients (87% male, 13% female) with severe AR that underwent aortic valve surgery were included. The average age was 54.8 year, and the average follow-up time was 38 months. The change in EF (%), EDV (ml), ESV (ml), PAP (mmHg) and TR was compared before and after aortic valve surgery. Results: The results show a statistically significant reduction in EDV (194.46± 80.51 vs. 142.55±56.94, p<0.001) and ESV (96.35±52.45 vs. 75.58±45.44, p<0.001) after AV surgery and change in pulmonary artery pressure (32.14 vs. 23.18). No significant differences were found in EF (53.26±10.92 vs. 52.40±12.53, p=0.612) or the degree of TR (p=0.785). The degree of TR was graded on a scale of 1-5. Prior to surgery, 13 patients (29%) had no TR (grade 0), 29 patients (64%) had grade 1 TR, 1 patient (2%) had grade 3 TR, and 2 patients (4%) had grade 4 TR, and none of the patients required surgical repair. Postoperatively, 12 patients (27%) had no TR (grade 0), 30 patients (67%) had grade 1(mild) TR, 2 patients (4%) had grade 2 (mild to moderate) TR, and 1 patient (2%) had grade 3 (moderate) TR. Conclusion: This study confirmed that EDV and ESV improved after surgery, as predictors of impaired LV functional and structural recovery. After successful AV surgery, mild TR does not worsen when there is no elevated PAP. However, the impact of TR on the outcomes of these patients requires further research in this area with larger and longer-term follow-up studies. [ABSTRACT FROM AUTHOR]