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Scientific Reports Apr 2022The identification of the fibrotic arrhythmogenic substrate as a means of improving the diagnosis and prediction of atrial fibrillation has been a focus of research for...
The identification of the fibrotic arrhythmogenic substrate as a means of improving the diagnosis and prediction of atrial fibrillation has been a focus of research for many years. The relationship between the degree of atrial fibrosis as a major component of atrial cardiomyopathy and the recurrence of arrhythmia after AF ablation can correlate. While the focus in identification and characterisation of this substrate has been centred on the atrial wall and the evaluation of atrial scar and extracellular matrix (ECM) expansion by late gadolinium-enhancement (LGE) on cardiac magnetic resonance imaging (CMRI), LGE cannot visualise diffuse fibrosis and diffuse extravasation of gadolinium. The atrial pericardium is a fine avascular fibrous membranous sac that encloses the atrial wall, which can undergo remodelling leading to atrial disease and AF. Nevertheless, little attention has been given to the detection of its fibrocalcification, impact on arrhythmogenesis and, most importantly, on the potential prothrombotic role of epi-pericardial remodelling in generation of emboli. We have recently reported that tracers against collagen I and IV can provide a direct assessment of the ECM, and thus can estimate fibrotic burden with high sensitivity. Here, we show the ability of these optical tracers to identify epi-pericardial fibrosis, as well as to demonstrate subtle interstitial fibrosis of the atrial wall in a mouse model of beta-2-adrenergic receptor (β-AR) cardiac overexpression.
Topics: Animals; Atrial Fibrillation; Catheter Ablation; Collagen; Contrast Media; Fibrosis; Gadolinium; Heart Atria; Magnetic Resonance Imaging; Mice; Pericardium
PubMed: 35383230
DOI: 10.1038/s41598-022-08688-x -
Forensic Science, Medicine, and... Jun 2023A 39-year-old woman who had undergone an uncomplicated elective cesarean section for a low-lying placenta collapsed and died the following day. At autopsy, there was...
A 39-year-old woman who had undergone an uncomplicated elective cesarean section for a low-lying placenta collapsed and died the following day. At autopsy, there was dissection of an aneurysmally-dilated thoracic aorta with 400 mls of fluid and clotted blood in the pericardial sac. There were no features of Marfan syndrome or other connective tissue disorders. Histology revealed thinning of the aortic wall with fragmentation of elastic fibers and no inflammation. Vessels elsewhere were normal. This case demonstrates a rare complication of pregnancy that may not present until after delivery with unexpected collapse and sudden death. Predisposing factors include an increased cardiac output, reduction in systemic vascular resistance, an increase in left ventricular muscle mass, and alterations in serum progesterone and estrogen levels which may cause structural changes to the aortic wall. The possibility of syndromic and familial connective tissue disorders should also be considered.
Topics: Humans; Pregnancy; Female; Adult; Aortic Aneurysm; Aortic Dissection; Cesarean Section; Death, Sudden; Postpartum Period
PubMed: 37020086
DOI: 10.1007/s12024-023-00606-5 -
Clinical Research in Cardiology :... Apr 2021Pericardial and pleural effusion are common findings in patients with cardiac amyloidosis (CA). It is not known, whether effusions correlate with right ventricular (RV)...
BACKGROUND
Pericardial and pleural effusion are common findings in patients with cardiac amyloidosis (CA). It is not known, whether effusions correlate with right ventricular (RV) function in these patients. Furthermore, data on the prognostic significance of pleural and pericardial effusion in CA is scarce.
METHODS
Patients with transthyretin (ATTR) and light chain (AL) CA were included in a clinical registry. All patients underwent transthoracic echocardiography at baseline. The presence of pericardial and pleural effusion was determined in every patient. The clinical endpoint was defined as cardiac death or heart failure hospitalization.
RESULTS
In total, 143 patients were analysed. Of these, 85 patients were diagnosed with ATTR and 58 patients with AL. Twenty-four patients presented with isolated pericardial effusion and 35 with isolated pleural effusion. In 19 patients, both pericardial and pleural effusion were found and in 65 patients no effusion was present at baseline. The presence of pleural effusion correlated well with poor RV function, measured by global RV free-wall strain (p = 0.007) in patients with AL, but not in ATTR. No such correlation could be found for pericardial effusion in either amyloidosis subtype. Patients with AL presenting with pleural effusion had worse outcomes compared to patients with pericardial effusion alone or no effusion at baseline. In the ATTR group, there was no difference in outcomes according to presence and type of effusion.
CONCLUSION
More than 50% of patients with CA presented with pleural and/or pericardial effusions. While pleural effusion was clearly associated with poor RV function in AL, we were not able to detect this association with pericardial effusion.
Topics: Aged; Aged, 80 and over; Amyloidosis; Biopsy; Cardiomyopathies; Echocardiography; Female; Follow-Up Studies; Heart Ventricles; Humans; Male; Middle Aged; Myocardium; Pericardial Effusion; Pleural Effusion; Prognosis
PubMed: 32914241
DOI: 10.1007/s00392-020-01698-7 -
Frontiers in Cardiovascular Medicine 2020Biventricular longitudinal strain has been recently demonstrated to be predictive of poor outcomes in various cardiovascular settings. Therefore, this study sought to...
Biventricular longitudinal strain has been recently demonstrated to be predictive of poor outcomes in various cardiovascular settings. Therefore, this study sought to investigate the prognostic implications of biventricular longitudinal strain in patients with coronavirus disease 2019 (COVID-19). We enrolled 132 consecutive patients with COVID-19. Left ventricular global longitudinal strain from the apical four-chamber views (LV GLS) and right ventricular free wall longitudinal strain (RV FWLS) were obtained using two-dimensional speckle-tracking echocardiography. Compared with patients without cardiac injury, those with cardiac injury had higher levels of coagulopathy and inflammatory biomarkers, higher incidence of complications, more mechanical ventilation therapy, and higher mortality. Patients with cardiac injury displayed decreased LV GLS and RV FWLS, elevated pulmonary artery systolic pressure, and higher proportion of pericardial effusion. Higher biomarkers levels of inflammation and cardiac injury, and the presence of pericardial effusion were correlated with decreases in LV GLS and RV FWLS. During hospitalization, 19 patients died. Compared with survivors, LV GLS and RV FWLS were impaired in non-survivors. At a 3-month follow-up after discharge, significant improvements were observed in LV GLS and RV FWLS. Multivariate Cox analysis revealed that LV GLS [hazard ratio: 1.41; 95% confidence interval [CI]: 1.08 to 1.84; = 0.011] and RV FWLS (HR: 1.29; 95% CI: 1.09-1.52; = 0.003) were independent predictors of higher mortality in patients with COVID-19. LV GLS and RV FWLS are independent and strong predictors of higher mortality in COVID-19 patients and can track improvement during the convalescent phase of their illness. Therefore, biventricular longitudinal strain may be crucial for risk stratification and serial follow-up in patients with COVID-19.
PubMed: 33537350
DOI: 10.3389/fcvm.2020.632434 -
Heart International 2022Coronavirus disease 2019 (COVID-19) has been associated with a wide spectrum of cardiovascular manifestations. Since the beginning of the pandemic, echocardiography has... (Review)
Review
Coronavirus disease 2019 (COVID-19) has been associated with a wide spectrum of cardiovascular manifestations. Since the beginning of the pandemic, echocardiography has served as a valuable tool for triaging, diagnosing and managing patients with COVID-19. More recently, speckle-tracking echocardiography has been shown to be effective in demonstrating subclinical myocardial dysfunction that is often not detected in standard echocardiography. Echocardiographic findings in COVID-19 patients include left or right ventricular dysfunction, including abnormal longitudinal strain and focal wall motion abnormalities, valvular dysfunction and pericardial effusion. Additionally, some of these echocardiographic abnormalities have been shown to correlate with biomarkers and adverse clinical outcomes, suggesting an additional prognostic value of echocardiography. With increasing evidence of cardiac sequelae of COVID-19, the use of echocardiography has expanded to patients with cardiopulmonary symptoms after recovery from initial infection. This article aims to highlight the available echocardiographic tools and to summarize the echocardiographic findings across the full spectrum of COVID-19 disease and their correlations with biomarkers and mortality.
PubMed: 36275350
DOI: 10.17925/HI.2022.16.1.28 -
Mediastinum (Hong Kong, China) 2022Major vessels of the mediastinum such as the superior vena cava (SVC) and bilateral innominate veins can occasionally become involved with aggressive tumors or the... (Review)
Review
Major vessels of the mediastinum such as the superior vena cava (SVC) and bilateral innominate veins can occasionally become involved with aggressive tumors or the mediastinum, including non-small cell lung cancer and thymoma. This may result in partial or complete obstruction. With presentation of these tumors symptoms can often be debilitating and would otherwise be treated with palliative therapy. A select population of patients are candidates for tumor resection. The ability to perform an adequate resection will depend on the ability to create a durable reconstruction of the SVC and bilateral innominate veins. Pre-operative and intra-operative considerations will allow for a safe surgery with few complications to the patient. Furthermore, depending on the extent of resection, there are a variety of techniques for reconstruction. These can range from a primary repair of a partial venous wall resection to a complex replacement of both the SVC and one or both innominate veins. Multiple options exist for the use of these conduits, such as polytetrafluoroethylene, homograft, autologous vein, and bovine or porcine pericardium. Depending on the type of conduit used, the post-operative outcomes will differ. In order to perform this operation safely, proper knowledge and experience is required. We review a variety of strategies used to manage these rare but complex scenarios.
PubMed: 36164357
DOI: 10.21037/med-20-70 -
European Heart Journal. Case Reports Apr 2023Primary cardiac lymphoma is an extremely rare malignancy involving the heart and pericardium. It is a disease that most commonly effects the right atrium and right...
BACKGROUND
Primary cardiac lymphoma is an extremely rare malignancy involving the heart and pericardium. It is a disease that most commonly effects the right atrium and right ventricle. Left untreated it carries a very poor prognosis. Recent advancements in therapy including early recognition and initiation of chemotherapy has led to improved survival.
CASE SUMMARY
A 78 year old female presented with weight loss, abdominal pain and distension. An ultrasound abdomen pre admission showed abdominal ascites. An echocardiogram performed during admission showed a large pericardial effusion with asymmetrical increase in left ventricular wall thickness and a new left atrial mass. Pericardial fluid analysis led to the diagnosis of diffuse large B cell non-Hodgkin's lymphoma. Positron Emission Tomography CT (PET-CT) shows avid fluorodeoxyglucose (FDG) uptake in cardiac muscle. Prompt treatment was initiated with a chemotherapy regimen involving Rituximab, Cyclophosphamide, doxorubicin, vincristine, and prednisolone (R-CHOP). An echocardiogram 3 months post initiation of treatment showed resolution of the pericardial effusion and left atrial mass as well as an improvement in left ventricular wall thickness. A PET-CT following completion of treatment showed complete metabolic response.
DISCUSSION
The diagnosis of primary cardiac lymphoma is uncommon and the presence of left rather than right heart involvement is rarer still. Multimodality imaging is key in diagnosis. Early recognition and treatment is vital in improving associated morbidity and mortality.
PubMed: 37090756
DOI: 10.1093/ehjcr/ytad175 -
Operative Orthopadie Und Traumatologie Jun 2021Surgical stabilization of patients with flail chest, dislocated serial rib and sternal fractures, posttraumatic deformities of the thorax, symptomatic non-unions of the...
OBJECTIVE
Surgical stabilization of patients with flail chest, dislocated serial rib and sternal fractures, posttraumatic deformities of the thorax, symptomatic non-unions of the ribs and/or sternum, and weaning failure to biomechanically stabilize the thorax and avoid respirator-dependent complications.
INDICATIONS
Combination of clinically and radiologically observed parameters, such as pattern of thoracic injuries, grade of fracture dislocation, pathological changes to breathing biomechanics, and failure of nonsurgical treatment.
CONTRAINDICATIONS
Acute hemodynamical instability and signs of systemic infection.
SURGICAL TECHNIQUE
Detailed preoperative planning. Open, minimally invasive reduction and osteosynthesis using precontoured, low-profile locking plates and/or intramedullary splints. Careful reduction drilling/implantation of screws due to proximity of the pleura, lungs and pericardium.
POSTOPERATIVE MANAGEMENT
Weaning from respirator as early as possible and early therapy of pneumothorax perioperatively. Removal of implants usually not necessary.
RESULTS
In a retrospective study, 15 polytraumatized patients with flail chest benefitted from an early interdisciplinary surgical treatment strategy within 24-48 h. Early osteosynthesis after severe thoracic trauma significantly reduced ventilator dependency and lowered the risk of pneumonia compared to patients who underwent surgery at a later time point. Patients with severe thoracic injury and life-threatening polytrauma, who meet the indication criteria for open reduction and surgical stabilization of the thorax, are in need of a throughly planned and interdisciplinary synchronized priorization and strategy. Longer intensive care unit stay, overall prolonged duration of admission in hospital, and higher level of respirator-associated complication should be expected in patients with life-threatening severe thoracic trauma (Abbreviated Injury Score (AIS) ≥ 3) compared to patients without thoracic trauma.
Topics: Flail Chest; Fracture Fixation, Internal; Humans; Retrospective Studies; Rib Fractures; Thoracic Wall; Treatment Outcome
PubMed: 33289872
DOI: 10.1007/s00064-020-00688-2 -
International Journal of Legal Medicine Nov 2023During autopsies, weighing the heart is a standard procedure. In addition to myocardial pathologies, heart size, and ventricular wall thickness, heart weight is a common...
During autopsies, weighing the heart is a standard procedure. In addition to myocardial pathologies, heart size, and ventricular wall thickness, heart weight is a common parameter to describe cardiac pathology and should be recorded as accurately as possible. To date, there exists no standard for recording heart weight at autopsy, although some authors recommend weighing the heart after dissection and removal of blood and blood clots. In the study presented, the hearts of 58 decedents were weighed after being dissected out of the pericardial sac (a), after dissection using the short-axis or inflow-outflow method with manual removal of blood and blood clots (b), and after rinsing and drying (c). Depending on the dissection method, the heart weight was 7.8% lower for the inflow-outflow method and 11.6% lower for the short-axis method after dissection compared to before and correspondingly 2.9% to 5% lower again after rinsing and drying respectively. Accordingly, the heart should be dissected, blood and blood clots removed, rinsed with water, and dried with a surgical towel after dissection, before weighing.
Topics: Humans; Autopsy; Female; Male; Organ Size; Middle Aged; Aged; Adult; Myocardium; Dissection; Heart; Aged, 80 and over; Forensic Pathology
PubMed: 37723344
DOI: 10.1007/s00414-023-03089-9 -
Brazilian Journal of Cardiovascular... May 2023Recurrent pericardial effusion is commonly encountered in neoplastic and infective disorders. Intervention is compulsory in patients with unstable hemodynamics and...
Recurrent pericardial effusion is commonly encountered in neoplastic and infective disorders. Intervention is compulsory in patients with unstable hemodynamics and tamponading effusion. Surgical options include: pericardiocentesis, subxiphoid pericardiostomy, and pericardial window. The latter has proved to have lower incidence of recurrence; however, the technique has been continuously refined to improve the recurrence-free survival and decrease postoperative morbidity. We herein present a novel simple modification to minimize recurrence by anchoring the free edges of pericardial fenestration overlying the superior vena cava and right atrium to the chest wall. Follow-up showed no recurrence compared to 3.5% in the conventional procedure.
Topics: Humans; Vena Cava, Superior; Pericardial Effusion; Pericardial Window Techniques; Hemodynamics; Heart Atria
PubMed: 36459477
DOI: 10.21470/1678-9741-2022-0017