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The Journal of Thoracic and... Nov 2021
Topics: Heart Ventricles; Humans; Hypoplastic Left Heart Syndrome; Models, Statistical; Pulmonary Artery
PubMed: 33589314
DOI: 10.1016/j.jtcvs.2021.01.018 -
International Journal of Molecular... Dec 2019Pulmonary arterial hypertension (PAH) is a debilitating and progressive disease that predominantly develops in women. Over the past 15 years, cumulating evidence has... (Review)
Review
Pulmonary arterial hypertension (PAH) is a debilitating and progressive disease that predominantly develops in women. Over the past 15 years, cumulating evidence has pointed toward dysregulated metabolism of sex hormones in animal models and patients with PAH. 17β-estradiol (E2) is metabolized at positions C2, C4, and C16, which leads to the formation of metabolites with different biological/estrogenic activity. Since the first report that 2-methoxyestradiol, a major non-estrogenic metabolite of E2, attenuates the development and progression of experimental pulmonary hypertension (PH), it has become increasingly clear that E2, E2 precursors, and E2 metabolites exhibit both protective and detrimental effects in PH. Furthermore, both experimental and clinical data suggest that E2 has divergent effects in the pulmonary vasculature versus right ventricle (estrogen paradox in PAH). The estrogen paradox is of significant clinical relevance for understanding the development, progression, and prognosis of PAH. This review updates experimental and clinical findings and provides insights into: (1) the potential impacts that pathways of estradiol metabolism (EMet) may have in PAH; (2) the beneficial and adverse effects of estrogens and their precursors/metabolites in experimental PH and human PAH; (3) the co-morbidities and pathological conditions that may alter EMet and influence the development/progression of PAH; (4) the relevance of the intracrinology of sex hormones to vascular remodeling in PAH; and (5) the advantages/disadvantages of different approaches to modulate EMet in PAH. Finally, we propose the three-tier-estrogen effects in PAH concept, which may offer reconciliation of the opposing effects of E2 in PAH and may provide a better understanding of the complex mechanisms by which EMet affects the pulmonary circulation-right ventricular interaction in PAH.
Topics: Animals; Disease Models, Animal; Estradiol; Female; Heart Ventricles; Humans; Male; Pulmonary Arterial Hypertension; Vascular Remodeling
PubMed: 31877978
DOI: 10.3390/ijms21010116 -
Cardiology Clinics May 2020Right ventricular dysfunction is increasingly being recognized as a marker of poor prognosis in a variety of cardiovascular diseases. Hence, identification and accurate... (Review)
Review
Right ventricular dysfunction is increasingly being recognized as a marker of poor prognosis in a variety of cardiovascular diseases. Hence, identification and accurate quantification of the degree of impairment is crucial. Although echocardiography remains the mainstay for right ventricular evaluation, multimodality noninvasive cardiac imaging provides additional useful corroborative assessment. Cardiac MRI is particularly useful for accurate quantification of right ventricular volumes and function, as well as myocardial tissue characterization. This article outlines the clinically useful applications of multimodality imaging for comprehensive assessment of the right heart and associated structures in the setting of right ventricular failure.
Topics: Echocardiography; Heart Failure; Heart Ventricles; Humans; Magnetic Resonance Imaging, Cine; Multimodal Imaging; Ventricular Function, Right
PubMed: 32284097
DOI: 10.1016/j.ccl.2020.01.006 -
Anesthesiology Clinics Dec 2019This article reviews transesophageal echocardiography-based assessment of perioperative right ventricular function and failure, including catheter-based methods,... (Review)
Review
This article reviews transesophageal echocardiography-based assessment of perioperative right ventricular function and failure, including catheter-based methods, three-dimensional echocardiography, and their combination to make pressure-volume loops. It outlines right ventricular pathophysiology, multiple assessment methods, and their relationship to analogous transthoracic echocardiogram measurements. technologies used and developed for transthoracic or left ventricular assessment show significant limitations when applied to transesophageal assessment of the right ventricle. The article provides an overview of right ventricular assessment modalities that can be used in transesophageal echocardiography. Ultimately, clinicians must know limitations of measurements, synthesize information, and assess it in the clinical context.
Topics: Cardiac Surgical Procedures; Echocardiography; Echocardiography, Transesophageal; Heart Ventricles; Humans; Perioperative Care; Ventricular Function, Right
PubMed: 31677685
DOI: 10.1016/j.anclin.2019.08.011 -
Future Cardiology Sep 2023The right ventricle (RV) remains the 'forgotten chamber' in the clinical assessment of cancer therapy-related cardiac dysfunction (CTRCD). We aimed to review the role... (Review)
Review
The right ventricle (RV) remains the 'forgotten chamber' in the clinical assessment of cancer therapy-related cardiac dysfunction (CTRCD). We aimed to review the role that various cardiac imaging modalities play in RV assessment as part of the integrative management of patients undergoing cancer therapy. RV assessment remains challenging by traditional 2D echocardiography. In this review we discuss other parameters such as right atrial strain, and other echocardiographic modalities such as 3D and stress echocardiography. We also elaborate on the specific role that cardiac magnetic resonance imaging and equilibrium radionuclide angiocardiography can play in assessing the RV. Biventricular function should be monitored following chemotherapy for early detection of subclinical CTRCD and possible solitary RV changes.
Topics: Humans; Heart Ventricles; Echocardiography; Heart Diseases; Neoplasms; Heart Atria; Stroke Volume
PubMed: 37830360
DOI: 10.2217/fca-2022-0024 -
Journal of Cardiothoracic and Vascular... Jul 2023Double-chamber right ventricle repair surgery requires the excision of anomalous obstructive muscular or fibromuscular bundles in the right ventricular outflow tract....
Double-chamber right ventricle repair surgery requires the excision of anomalous obstructive muscular or fibromuscular bundles in the right ventricular outflow tract. Because of the close proximity of key structures in the right ventricular outflow tract, the surgery is extremely challenging and requires precise resection. Underresection of the muscle bands can lead to significant residual gradients in the postoperative period, whereas overenthusiastic resection can cause iatrogenic injury to surrounding structures. Various techniques like Hegar sizing by the surgeons, direct chamber pressure measurement, transesophageal echocardiography, and epicardial echocardiography can guide the surgeons about the adequacy of repair. Transesophageal echocardiography is crucial at each step, as it can precisely determine the exact site of obstruction in the preoperative period. Postoperatively, it helps determine the adequacy of surgical repair and identification of inadvertent iatrogenic complications.
Topics: Humans; Echocardiography, Transesophageal; Heart Ventricles; Echocardiography; Iatrogenic Disease
PubMed: 36990803
DOI: 10.1053/j.jvca.2023.02.031 -
Seminars in Thoracic and Cardiovascular...Aorto-right ventricular tunnel (ARVT) is a rare cardiac congenital anomaly where an extracardiac channel connects the ascending aorta above the sinutubular junction to... (Review)
Review
Aorto-right ventricular tunnel (ARVT) is a rare cardiac congenital anomaly where an extracardiac channel connects the ascending aorta above the sinutubular junction to the right ventricle. This defect is caused by an abnormal development of the cushions of the aorto-pulmonary outflow tract. A case series and literature review are described. Two cases of ARVT are described. A literature review was conducted, in which 31 cases were reported. In our 2 cases, both ARVTs connected the ascending aorta above the left aortic sinus to the right ventricle (one to the right ventricular outflow tract and one to the right ventricular apex). Both patients underwent successful surgical correction by patch closure of both tunnel orifices, with uneventful postoperative course. Of the 31 ARVT cases described in our review, only 10 patients (32.3%) had an anatomy similar to the 2 cases described. Coronary artery anomalies can be associated, as reported in our 2 patients and in 16 cases (51.6%) in the review. Surgical correction can be achieved by direct closure or, more often, by patch closure of one or both tunnel orifices, depending mostly on coronary anatomy. Two cases of transcatheter device closure were described in literature, in favorable anatomy cases. Careful attention is required during repair to avoid coronary lesions, due to the high incidence of comorbid coronary anomalies.
Topics: Aorta; Aortico-Ventricular Tunnel; Heart Defects, Congenital; Heart Ventricles; Humans; Sinus of Valsalva
PubMed: 32428576
DOI: 10.1053/j.semtcvs.2020.05.004 -
Journal of Cardiac Surgery Mar 2022The clinical data of coronary artery disease in patients with double-chambered right ventricle are limited. We report an adult double-chambered right ventricle case with...
BACKGROUND AND AIMS
The clinical data of coronary artery disease in patients with double-chambered right ventricle are limited. We report an adult double-chambered right ventricle case with three-vessel coronary artery disease that was successfully treated with concomitant double-chambered right ventricle repair and coronary artery bypass grafting.
MATERIALS AND METHODS
The patient case data was extracted from hospital records.
RESULTS
The patient was the case of a 60-year-old man with a double-chambered right ventricle and three-vessel coronary artery disease. He underwent concomitant surgery comprising double-chambered right ventricle repair and coronary artery bypass grafting. Achieving cardiac arrest allowed us to obtain a good surgical view of the heavy and severely hypertrophied heart. Postoperative computed tomography revealed a feasible running course of the sequential graft, indicating that the path of the sequential graft should be clockwise (aorto-right coronary-left circumflex artery) in this unusual anatomical condition.
DISCUSSION AND CONCLUSION
We report this rare disease combination and highlight the need for careful preoperative planning in such cases.
Topics: Adult; Coronary Artery Bypass; Coronary Stenosis; Heart Septal Defects, Ventricular; Heart Ventricles; Humans; Male; Middle Aged; Tomography, X-Ray Computed
PubMed: 34996125
DOI: 10.1111/jocs.16215 -
Seminars in Thoracic and Cardiovascular... 2021
Topics: Heart Ventricles; Humans; Transposition of Great Vessels; Ventricular Function, Right
PubMed: 33171245
DOI: 10.1053/j.semtcvs.2020.09.033 -
European Heart Journal. Cardiovascular... Aug 2020
Topics: Heart Ventricles; Humans; Reproducibility of Results; Ventricular Function, Right
PubMed: 32504092
DOI: 10.1093/ehjci/jeaa126