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JACC. Cardiovascular Imaging Aug 2019
Topics: Atrial Fibrillation; Atrial Function, Right; Heart Atria; Heart Failure; Humans; Stroke Volume
PubMed: 30343068
DOI: 10.1016/j.jcmg.2018.08.019 -
Open Heart May 2021Recent studies suggest left atrial (LA) dysfunction in cryptogenic stroke. We studied the dynamics of right atrium (RA) and right atrial appendage (RAA) in young adults...
BACKGROUND
Recent studies suggest left atrial (LA) dysfunction in cryptogenic stroke. We studied the dynamics of right atrium (RA) and right atrial appendage (RAA) in young adults with cryptogenic stroke. We hypothesised that bi-atrial dysfunction and blood stagnation might contribute to thrombosis formation in patients with patent foramen ovale (PFO), as deep venous thrombosis is detected only in the minority of patients.
METHODS
Thirty patients (aged 18-49) with a first-ever cryptogenic stroke and 30 age-matched and sex-matched stroke-free controls underwent cardiac magnetic resonance (CMR) imaging. An approach to estimate the RAA volume was developed, using crista terminalis and pectinate muscles as anatomical landmarks. Atrial expansion indices were calculated as (maximal volume - minimal volume) ×100%/minimal volume. Total pulmonary to systemic blood flow ratio (Qp/Qs) was based on phase contrast CMR. Right-to-left shunt (RLS) was evaluated with transoesophageal echocardiography in 29 patients and transcranial Doppler in 30 controls, moderate-to-severe RLS considered as clinically significant.
RESULTS
We found that RA and RAA volumes were similar between patients and controls. Also, RA expansion index was similar, but RAA (95.6%±21.6% vs 108.7%±25.8%, p=0.026) and LA (126.2%±28% vs 144.9%±36.3%, p=0.023) expansion indices were lower in patients compared with controls. Seven (24%) of 29 patients had an RLS compared with 1 (3%) of 30 controls (p=0.012). Among 59 study subjects, RLS was associated with lower RA (81.9%±15.9% vs 98.5%±29.5%, p=0.030), RAA (84.7%±18% vs 105.6%±24.1%, p=0.022), LA (109.8%±18.6% vs 140.1%±33.7%, p=0.017) and LAA (median 102.9% (IQR 65.6%-121.7%) vs 229.1% (151.8%-337.5%], p=0.002) expansion indices and lower Qp/Qs ratio (0.91±0.06 vs 0.98±0.07, p=0.027).
CONCLUSIONS
This study suggests bi-atrial dysfunction in young adults with cryptogenic stroke, associated with moderate-to-severe RLS. Dysfunction of the atria and atrial appendages may be an additional mechanism for PFO-related stroke.
TRIAL REGISTRATION NUMBER
NCT01934725.
Topics: Adolescent; Adult; Atrial Appendage; Atrial Function, Right; Case-Control Studies; Echocardiography, Transesophageal; Female; Heart Atria; Humans; Ischemic Stroke; Magnetic Resonance Imaging, Cine; Male; Middle Aged; Ultrasonography, Doppler, Transcranial; Ventricular Dysfunction, Right; Young Adult
PubMed: 34006504
DOI: 10.1136/openhrt-2021-001596 -
Journal of the American College of... Aug 2023Precapillary pulmonary hypertension (precPH) patients have altered right atrial (RA) function and right ventricular (RV) diastolic stiffness.
BACKGROUND
Precapillary pulmonary hypertension (precPH) patients have altered right atrial (RA) function and right ventricular (RV) diastolic stiffness.
OBJECTIVES
This study aimed to investigate RA function using pressure-volume (PV) loops, isolated cardiomyocyte, and histological analyses.
METHODS
RA PV loops were constructed in control subjects (n = 9) and precPH patients (n = 27) using magnetic resonance and catheterization data. RA stiffness (pressure rise during atrial filling) and right atrioventricular coupling index (RA minimal volume / RV end-diastolic volume) were compared in a larger cohort of patients with moderate (n = 39) or severe (n = 41) RV diastolic stiffness. Cardiomyocytes were isolated from RA tissue collected from control subjects (n = 6) and precPH patients (n = 9) undergoing surgery. Autopsy material was collected from control subjects (n = 6) and precPH patients (n = 4) to study RA hypertrophy, capillarization, and fibrosis.
RESULTS
RA PV loops showed 3 RA cardiac phases (reservoir, passive emptying, and contraction) with dilatation and elevated pressure in precPH. PrecPH patients with severe RV diastolic stiffness had increased RA stiffness and worse right atrioventricular coupling index. Cardiomyocyte cross-sectional area was increased 2- to 3-fold in precPH, but active tension generated by the sarcomeres was unaltered. There was no increase in passive tension of the cardiomyocytes, but end-stage precPH showed reduced number of capillaries per mm accompanied by interstitial and perivascular fibrosis.
CONCLUSIONS
RA PV loops show increased RA stiffness and suggest atrioventricular uncoupling in patients with severe RV diastolic stiffness. Isolated RA cardiomyocytes of precPH patients are hypertrophied, without intrinsic sarcomeric changes. In end-stage precPH, reduced capillary density is accompanied by interstitial and perivascular fibrosis.
Topics: Humans; Myocytes, Cardiac; Hypertension, Pulmonary; Atrial Fibrillation; Heart Atria; Atrial Appendage
PubMed: 37587582
DOI: 10.1016/j.jacc.2023.05.063 -
JACC. Cardiovascular Imaging Mar 2023
Topics: Humans; Atrial Fibrillation; Clinical Relevance; Predictive Value of Tests; Heart Atria; Echocardiography
PubMed: 36889848
DOI: 10.1016/j.jcmg.2023.01.010 -
Medicine May 2017Adrenocortical cancer (ACC) is rare but frequently fatal malignancy. Tumor extension into the inferior vena cava signifies an advanced stage (stage III) of the disease... (Review)
Review
CONTEXT
Adrenocortical cancer (ACC) is rare but frequently fatal malignancy. Tumor extension into the inferior vena cava signifies an advanced stage (stage III) of the disease and is frequently associated with high risk of recurrence and short-term survival.
OBJECTIVE
To present the surgical and medical management of an unusual case of ACC with IVC invasion up to the right atrium. He has the longest reported tumor-free survival of such a situation. We also reviewed and summarized the literature of similar cases.
PATIENT
We present a 15-year old boy who presented with an 11 cm ACC extending into the IVC up to the right atrium and causing the Budd Chiari syndrome. He had complete surgical excision under cardiopulmonary bypass of a large ACC followed by Mitotane adjunctive therapy for 5 years. He is alive and free of any clinical or radiological signs of recurrence 98 months after surgery. This is the longest tumor-free survival reported in the literature of similar cases.
CONCLUSION
Significant invasion of the IVC up to the right atrium by ACC should not preclude surgery with the intent of complete resection. Cardiopulmonary bypass significantly aids this surgical procedure and Mitotane therapy should be instituted postoperatively. Long-term free-survival is possible in such a situation.
LESSONS
our patient and the literature review strongly suggest that complete surgical extirpation is the primary choice for patients with ACC invading the IVC, including those reaching the right atrium.
Topics: Adolescent; Adrenal Cortex Neoplasms; Antineoplastic Agents, Hormonal; Cardiopulmonary Bypass; Combined Modality Therapy; Diagnosis, Differential; Disease-Free Survival; Heart Atria; Heart Neoplasms; Humans; Male; Mitotane; Vena Cava, Inferior
PubMed: 28471969
DOI: 10.1097/MD.0000000000006751 -
Polski Przeglad Chirurgiczny May 2020<b>Introduction:</b> Tumors which most frequently metastasize to the heart include: malignant melanoma, lung cancer, breast cancer, ovarian cancer, kidney...
<b>Introduction:</b> Tumors which most frequently metastasize to the heart include: malignant melanoma, lung cancer, breast cancer, ovarian cancer, kidney cancer, leukemia, lymphomas and esophageal cancer. <br><b>Purpose:</b> The purpose of this paper was clinical analysis of a group of patients operated in deep hypothermic circulatory arrest due to tumors of the right atrium and the inferior vena cava. <br><b>Material and method:</b> The study covered 7 patients operated at the Cardiac Surgery Clinic with a cardiac tumor diagnosed on the basis of an echocardiographic assessment in the years 2012-2019. Before qualifying for surgical treatment, each patient underwent: thorough interview and physical examination, 12-lead ECG, laboratory tests and echocardiography. Patients additionally underwent: computed tomography of the chest or abdomen, magnetic resonance imaging and coronary angiography on the basis of which patients with significant coronary artery changes underwent simultaneous coronary artery bypass graft. After preparation, the tumor was excised from the vena cava and right atrium with simultaneous removal of the primary tumor, most often kidney cancer. Early and distant results of treatment were analyzed in the examined group of patients to determine the following endpoints: hospital mortality and survival after surgery: after 3 months and 12 months. <br><b>Results:</b> Of all operated patients: 2 individuals died in the early postoperative period due to hemorrhagic complications (hospital mortality - 28.6%), and 5 patients (71.4%) were discharged from the Clinic in a good general condition. In total, 3-month survival was 71.4%, and 12-month survival amounted to 28.6%. <br><b>Conclusions:</b> Surgeries are very complex and challenging, and usually take on average 8-10 hours. It can improve the outcomes of palliative oncological treatment, better physical function (cardiovascular fitness) and extend life from several months to several years in more than ²/3 patients.
Topics: Circulatory Arrest, Deep Hypothermia Induced; Coronary Artery Bypass; Heart Atria; Humans; Kidney Neoplasms; Vena Cava, Inferior
PubMed: 32908013
DOI: 10.5604/01.3001.0014.1371 -
Clinical Cardiology Nov 2015The right atrium (RA) plays a pivotal role in electromechanical and endocrine regulation of the heart. Its peculiar anatomical features and phasic mechanical function... (Review)
Review
The right atrium (RA) plays a pivotal role in electromechanical and endocrine regulation of the heart. Its peculiar anatomical features and phasic mechanical function make it distinct from ventricles. Various invasive and noninvasive techniques have been used to elucidate RA structure and function. Of these modalities, echocardiography has distinct advantages over others. Several conventional measures of RA function through echocardiography have been described in the literature, but they are load dependent. A relatively new technique is speckle tracking-derived strain, which is relatively less dependent on loading conditions. Speckle tracking echocardiography tracks acoustic scatters (speckles) of myocardium frame-by-frame to calculate strain or deformation of the myocardium. Speckle tracking echocardiography has been used extensively for strain assessment of the right and left ventricle to detect subtle disease pathology, to gain mechanistic insight, as a marker of ischemic metabolic memory, as an endpoint in clinical trials, and as a functional assessment tool. The RA is a relatively neglected chamber, as it is mostly studied for assessment of atrial mass lesions, for electrophysiological studies, and in animal models for physiological assessment. However, its role in the systolic and diastolic function of the right heart, pulmonary vascular pathology, congenital heart diseases, and combined electromechanical activation phenomena has been less explored or unexplored. Speckle tracking echocardiography is an ideal tool for the assessment of the RA because of its regional and global functional characterization, angle independence, and high temporal resolution.
Topics: Atrial Function, Right; Biomechanical Phenomena; Echocardiography; Heart Atria; Heart Diseases; Humans; Image Processing, Computer-Assisted; Myocardial Contraction; Predictive Value of Tests; Prognosis; Stress, Mechanical
PubMed: 26418622
DOI: 10.1002/clc.22438 -
Scientific Reports Nov 2021Echocardiography is the most common routine cardiac imaging method. Nevertheless, only few data about sex-specific reference limits for right atrium (RA) dimensions are...
Echocardiography is the most common routine cardiac imaging method. Nevertheless, only few data about sex-specific reference limits for right atrium (RA) dimensions are available. Transthoracic echocardiographic RA measurements were studied in 9511 participants of the Gutenberg-Health-Study. A reference sample of 1942 cardiovascular healthy subjects without chronic obstructive pulmonary disease was defined. We assessed RA dimensions and sex-specific reference limits were defined using the 95th percentile of the reference sample. Results showed sex-specific differences with larger RA dimensions in men that were attenuated by standardization for body-height. RA-volume was 20.2 ml/m in women (5th-95th: 12.7-30.4 ml/m) and 26.1 ml/m in men (5th-95th: 16.0-40.5 ml/m). Multivariable regressions identified body-mass-index (BMI), coronary artery disease (CAD), chronic heart failure (CHF) and atrial fibrillation (AF) as independent key correlates of RA-volume in both sexes. All-cause mortality after median follow-up-period of 10.7 (9.81/11.6) years was higher in individuals who had RA volume/height outside the 95% reference limit (HR 1.70 [95%CI 1.29-2.23], P = 0.00014)). Based on a large community-based sample, we present sex-specific reference-values for RA dimensions normalized for height. RA-volume varies with BMI, CHF, CAD and AF in both sexes. Individuals with RA-volume outside the reference limit had a 1.7-fold higher mortality than those within reference limits.
Topics: Adult; Aged; Atrial Fibrillation; Body Mass Index; Coronary Artery Disease; Echocardiography; Female; Germany; Heart Atria; Heart Failure; Humans; Male; Middle Aged; Multivariate Analysis; Reference Values; Risk Factors; Treatment Outcome
PubMed: 34795353
DOI: 10.1038/s41598-021-01968-y -
Texas Heart Institute Journal Dec 2023Idiopathic dilatation of the right atrium is a rare condition with an unknown etiology. It is characterized by a significant enlargement of the right atrium without the...
Idiopathic dilatation of the right atrium is a rare condition with an unknown etiology. It is characterized by a significant enlargement of the right atrium without the presence of other valvopathies, intracardiac shunts, or pulmonary hypertension. This report presents the case of a 50-year-old woman with a significantly enlarged right atrium that was identified at birth; however, a definitive diagnosis was made later in life. The patient did not have any genetic diseases. Through the help of regular follow-up, anticoagulant therapy, previous radio-frequency ablation, and antiarrhythmic medications, she was able to carry a pregnancy to full term and live a regular life.
Topics: Female; Humans; Middle Aged; Anti-Arrhythmia Agents; Dilatation, Pathologic; Heart Atria
PubMed: 38111176
DOI: 10.14503/THIJ-23-8192 -
Chinese Medical Journal Jan 2018
Topics: Heart Atria; Humans; Rupture, Spontaneous; Thrombosis
PubMed: 29336375
DOI: 10.4103/0366-6999.222329