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Journal of Cardiothoracic Surgery Mar 2021"Swiss Cheese" ventricular septal defects (VSDs) is a kind of rare and complex congenital heart defects and the surgical management remains controversial and a...
Biventricular surgical repair of "Swiss Cheese" ventricular septal defects with two-patch and right ventricle apex excluding technique: preliminary experience and clinical results.
BACKGROUND
"Swiss Cheese" ventricular septal defects (VSDs) is a kind of rare and complex congenital heart defects and the surgical management remains controversial and a challenge. We reviewed our preliminary clinical experience on biventricular surgical repair of "Swiss Cheese" VSDs with two-patch and right ventricle apex excluding technique in 10 cases.
METHODS
From May 2014 to December 2019, a series of 10 patients (M/F = 3/7) were admitted in our center. Nine cases underwent one-stage surgical repair with two-patch and right ventricle apex excluding technique and 1 case received two-stage surgical repair with the same technique. Surgical repair was done with cardiopulmonary bypass (CPB) in all cases. Two fresh autologous pericardium patches were used to close defects of the outflow tract area and the apex trabecular area respectively and as a result, the right ventricular apex was excluded from the right ventricular inflow tract.
RESULTS
All operations were successful. Median CPB time and aortic clamping time were 96 min and 68 min respectively. Delayed chest closure was performed in 2 cases within 48-72 h postoperatively. The Median time of mechanical ventilation and ICU stay were 131.3 h and 8 days respectively. Median length of hospital stay after operation was 11 (9-42) days. There was no mortality and major complication except for 2 cases of ventilator associated pneumonia. There was no death and major complication during a median follow-up time of 3.2 years.. The latest echocardiography results showed the left and right heart function was normal in all the cases.
CONCLUSIONS
Biventricular surgical repair of "Swiss Cheese" VSDs with two-patch of fresh autologous pericardium and right ventricle apex excluding technique in infants is safe and feasible with favorable early and mid-term results. Long term results need to be evaluated with more cases.
Topics: Aorta; Cardiac Surgical Procedures; Cardiopulmonary Bypass; Echocardiography, Transesophageal; Female; Heart; Heart Septal Defects, Ventricular; Heart Ventricles; Humans; Infant; Male; Postoperative Complications; Surgical Instruments; Treatment Outcome
PubMed: 33743761
DOI: 10.1186/s13019-021-01399-w -
BMC Cardiovascular Disorders Nov 2022Primary cardiac schwannoma remains extremely rare and difficult to distinguish from other myocardial tumours. We report a case of cardiac schwannoma that occurred in the... (Review)
Review
BACKGROUND
Primary cardiac schwannoma remains extremely rare and difficult to distinguish from other myocardial tumours. We report a case of cardiac schwannoma that occurred in the lateral wall of the right ventricle and grew in the myocardial walls. It is the third case of schwannoma that occurred in the free wall of the right ventricle. Moreover, we reviewed and summarised the literature for cases involving benign cardiac schwannomas.
CASE PRESENTATION
We present a case of a 64-year-old woman who presented to our centre with syncope for 1-2 min. Echocardiogram and contrast-enhanced computed tomography subsequently revealed a 2.9 × 1.9 cm homogeneous mass originating from the anterior wall of the right ventricle. The patient underwent thoracotomy to resect the mass, which was pathologically verified as Schwann cell tumour.
CONCLUSIONS
This is a rare case added to the limited existing literature on cardiac schwannoma. Comprehensive analysis of various imaging examinations is helpful to determine the extent of the tumour. Complete surgical resection is recommended for similar cases involving cardiac schwannomas, especially when the patient has related symptoms. Patients generally have a good prognosis. The pathogenesis of cardiac schwannoma needs further research in order to prevent and manage this rare lesion.
Topics: Female; Humans; Middle Aged; Heart Ventricles; Neurilemmoma; Heart Neoplasms; Tomography, X-Ray Computed; Echocardiography
PubMed: 36418938
DOI: 10.1186/s12872-022-02941-x -
Acta Bio-medica : Atenei Parmensis May 2022Cardiac Magnetic Resonance (CMR) allows an accurate Right Ventricle (RV) assessment that could be of great relevance in diseases causing inflammation or fibrosis. The...
Cardiac Magnetic Resonance with Delayed Enhancement of the Right Ventricle in patients with Left Ventricle primary involvement: diagnosis and evaluation of functional parameters.
Cardiac Magnetic Resonance (CMR) allows an accurate Right Ventricle (RV) assessment that could be of great relevance in diseases causing inflammation or fibrosis. The aim of this study was to evaluate the concomitant involvement of the RV in patients with delayed enhancement (DE) of the Left Ventricle (LV-DE) using CMR. We retrospectively enrolled 95 (male n. 66; age 55±18years; BMI 26±5kg/m2) consecutive patients with LV-DE who underwent a CMR (Achieva 1.5 T, Philips) for different indications: post-ischemic dilated cardiopathy (PDM), hypertrophic cardiomyopathy (HCM), myocardial infarction (MI), myocarditis/pericarditis (MP) and congenital heart disease (CD). We assessed the presence and extension of DE and functional parameters such as ventricular end-diastolic (EDV), end-systolic volumes (ESV) and ejection fraction (EF) of both LV and RV. Prevalence of RV-DE was 30.5% (29/95): 75% (3/4) for CD, 44% (4/9) for PDM, 36% (17/47) for MI, 27.8% (5/18) for MP and 0% (0/17) for HCM. LV-EF and RV-EF were 53±15mL and 51±13mL, respectively, for patients without RV-DE (RV-DE-), and 40±19 mL and 42±15 mL, respectively, for patients with RV-DE (RV-DE+) (p<0.05), while LV-EDV and LV-ESV were 80±28 mL and 40±26 mL, respectively, for RV-DE- and 100±45 mL and 65±49 mL, respectively, for RV-DE+ (p<0.05). The prevalence of RV-DE in patients with LV primary involvement is not negligible and it is found mainly in patients with CD and PDM and then in patients with MI and MP. It is more often associated with LV-EF and RV-EF reduction and increase in LV volumes.
Topics: Adult; Aged; Heart Defects, Congenital; Heart Ventricles; Humans; Magnetic Resonance Imaging; Magnetic Resonance Spectroscopy; Male; Middle Aged; Retrospective Studies; Stroke Volume
PubMed: 35546038
DOI: 10.23750/abm.v93i2.10765 -
Acta Clinica Croatica Mar 2018Histologic and radiologic studies describe intramyocardial fat tissue as a normal finding or as part of cardiac pathology. The role of fat cells within the myocardium is...
Histologic and radiologic studies describe intramyocardial fat tissue as a normal finding or as part of cardiac pathology. The role of fat cells within the myocardium is not fully understood. The aim of this study was to assess fat tissue distribution in the myocardium of right atrium (RA) and right ventricle (RV) and age differences in subjects free from cardiac disease. The study included 10 males without cardiac disease divided into two groups according to age (below/above 50 years). Three cross sections were performed (RV free wall and apex and RA free wall) with histomorphological analysis on digital photographs. The shares of total myocardial fat (TMF), peri-vascular fat (PVF) and non-perivascular (nPVF) fat were calculated. Samples from the older group had larger amounts of fat in the epicardium and myocardium, without statistically significant differ-ence (TMF p=0.847, PVF p=0.4 and nPVF p=0.4). The largest quantities of fat tissue were found in the RV apex samples (14.9%), followed by RV free wall (7.5%) and RA (4.5%), where total apical RV fat share was significantly larger than in RA sample (p=0.044). Intramyocardial fat cells were present within the non-diseased RA and RV in all samples, mostly in the apex. Further investigations on age difference, effect of visceral obesity and sex differences are needed.
Topics: Adipose Tissue; Autopsy; Female; Heart Atria; Heart Ventricles; Humans; Male; Middle Aged
PubMed: 30256020
DOI: 10.20471/acc.2018.57.01.15 -
JACC. Heart Failure Nov 2018In the last decade, there has been renewed interest in the study of the right ventricle. It is now well established that right ventricular function is a strong predictor... (Review)
Review
In the last decade, there has been renewed interest in the study of the right ventricle. It is now well established that right ventricular function is a strong predictor of mortality, not only in heart failure but also in pulmonary hypertension, congenital heart disease, and cardiothoracic surgery. The right ventricle is part of a cardiopulmonary unit with connections to the pulmonary circulation, venous return, atria, and left ventricle. In this context, ventriculoarterial coupling, interventricular interactions, and pericardial constraint become important to understand right ventricular adaptation to injury or abnormal loading conditions. This state-of-the-art review summarizes major advances that occurred in the field of right ventricular research over the last decade. The first section focuses on right ventricular physiology and pulmonary circulation. The second section discusses the emerging data on right ventricular phenotyping, highlighting the importance of myocardial deformation (strain) imaging and assessment of end-systolic dimensions. The third section reviews recent clinical trials involving patients at risk for or with established right ventricular failure, focusing on beta blockade, phosphodiesterase inhibition, and mechanical support of the failing right heart. The final section presents a perspective on active areas of research that are most likely to translate in clinical practice in the next decade.
Topics: Cardiovascular Diseases; Heart Ventricles; Humans; Ventricular Function, Right
PubMed: 30316939
DOI: 10.1016/j.jchf.2018.05.022 -
Medical Science Monitor : International... Mar 2020BACKGROUND Left ventricle diastolic malfunction (LVDMf) is a valvular cardiovascular disease. Here, we assessed the correlation between right ventricle (RV) load and...
Echocardiographic Analysis of Correlation Between Right Ventricle Load and Function and Left Ventricle Diastolic Malfunction in Symptomless Valvular Cardiovascular Disease Patients.
BACKGROUND Left ventricle diastolic malfunction (LVDMf) is a valvular cardiovascular disease. Here, we assessed the correlation between right ventricle (RV) load and function (L&F) and diastolic malfunction (DMf) in symptomless valvular cardiovascular disease patients. MATERIAL AND METHODS We enrolled 59 subjects who underwent right-heart catheterization, assessing their echocardiographic analysis results while performing exercises in supine position, comparing results at rest and during maximum exercise. Subjects were furthermore stratified according to resting DMf. Using cardiac resonance imaging (CRM), we assessed cardiac morphology and chamber size. RV stroke, pulmonary artery conformation, pulmonary artery elastance, pulmonary artery pulsatility, and right atrial (pRA) pressure were indexed for supine exercises. RESULTS We observed that DMf grade 1 (G-1) and grade 2 (G-2) were present in 28 patients and 16 patients, respectively, while the remaining 15 patients had a normal filling pattern in the left ventricle. In comparison to patients with DMf of G-1, patients with normal diastolic filling pattern had higher volume index for RV end-diastolic (endD) (81±14 mL/m² vs. 68±12 mL/m², P=0.08) and for RV end-systolic (endS) (34±11 mL/m² vs. 27±8 mL/m², P=0.07). We also observed that in G-2 DMf pulmonary artery, pressure and elastance of the pulmonary artery were enhanced and were correlated with optimum oxygen intake and RV volume (r=-0.69, P<0.001). CONCLUSIONS We found that enhancement in RV afterload, which returns to normal at rest, is correlated with mild DMf. Additionally, despite maximum exercise, it is reciprocally associated with maximum oxygen intake and right atrial pressure.
Topics: Aged; Aged, 80 and over; Cardiovascular Diseases; Diastole; Echocardiography; Female; Heart Ventricles; Humans; Male; Middle Aged; Ventricular Dysfunction, Left; Ventricular Dysfunction, Right; Ventricular Function, Right
PubMed: 32127512
DOI: 10.12659/MSM.920982 -
Annals of Cardiac Anaesthesia Oct 2016The left ventricle, with its thickened myocardial walls, unlike the right ventricle has no measurable geometric shape. It has a conical apex and its function... (Review)
Review
The left ventricle, with its thickened myocardial walls, unlike the right ventricle has no measurable geometric shape. It has a conical apex and its function quantification, needs intensive, 2D, 3D and M mode transesophageal echocardiography, which is described in this review.
Topics: Echocardiography, Transesophageal; Heart Ventricles; Humans; Ventricular Dysfunction, Left; Ventricular Function, Left
PubMed: 27762246
DOI: 10.4103/0971-9784.192617 -
The American Journal of Case Reports Nov 2021BACKGROUND The cardiotoxic effects of chemotherapy in cancer treatment can damage cardiomyocytes. A common link in the pathogenesis is the proliferation of fibroblasts...
BACKGROUND The cardiotoxic effects of chemotherapy in cancer treatment can damage cardiomyocytes. A common link in the pathogenesis is the proliferation of fibroblasts and the increase of collagen synthesis, leading to development of common endomyocardial fibrosis. The walls of ventricles become rigid and their inability to relax prevents them from carrying the required amount of blood. The myocardial contractility gradually decreases and leads to ventricular dysfunction and signs of heart failure. CASE REPORT A 29-year-old woman with reduced exercise tolerance, dyspnea, and heart rhythm disorders was admitted to our hospital. Lymphoblastic leukemia had been diagnosed at the age of 8 years, and she underwent 8 courses of polychemotherapy. She had normal heart anatomy. At the current admission, the diagnostic protocol included echocardiography, computed tomography, cardiac catheterization, and angiocardiography. She was diagnosed with restrictive cardiomyopathy with isolated endomyocardial fibrosis of the right ventricle, and moderate tricuspid valve insufficiency NYHA class III. The patient underwent a right-sided bidirectional cavopulmonary connection with tricuspid valve repair. The early postoperative period was uneventful, and SVCp decreased to 14 mmHg. At discharge, the patient's clinical condition had improved and tricuspid regurgitation was minimal. CONCLUSIONS The one-and-a-half ventricular correction, commonly used in patients with Ebstein's anomaly and RV dysfunction or in patients with congenital heart defects associated with RV hypoplasia, is proposed as the method of choice for cardiomyopathy type RV dysfunction.
Topics: Adult; Cardiomyopathies; Cardiomyopathy, Restrictive; Child; Ebstein Anomaly; Female; Heart Ventricles; Humans; Precursor Cell Lymphoblastic Leukemia-Lymphoma; Treatment Outcome
PubMed: 34815376
DOI: 10.12659/AJCR.933677 -
Multimedia Manual of Cardiothoracic... Jan 2023A 9-month-old girl born with an interrupted aortic arch type B, an arteria lusoria (aberrant right subclavian artery) and a multilevel left ventricular outflow tract...
A 9-month-old girl born with an interrupted aortic arch type B, an arteria lusoria (aberrant right subclavian artery) and a multilevel left ventricular outflow tract obstruction underwent a Yasui completion after an initial interim palliation. After the Damus-Kaye-Stansel procedure was carried out and the Sano shunt had been established as a source of pulmonary flow, the reported procedure comprised closure of the ventricular septal defect and the intraventricular baffling of left ventricular outflow through a malaligned ventricular septal defect, incision and partial resection of a conal septum and establishment of a right ventricle-to-pulmonary artery connection using an autologous left atrial appendage as a free graft. This technique consisted of dissecting and harvesting the left atrial appendage, which was then used as autologous material for an interposition plasty connecting the central pulmonary artery bifurcation segment with the upper rim of the infundibulotomy. Native, autologous tissue thus comprised the backwall of the newly created right ventricle-to-pulmonary artery continuity. Porcine pericardial patch plasty was then used to complete the remaining circumference of the right ventricle-to-pulmonary artery continuity.
Topics: Humans; Animals; Swine; Pulmonary Artery; Heart Ventricles; Atrial Appendage; Ventricular Outflow Obstruction; Heart Septal Defects, Ventricular
PubMed: 36629786
DOI: 10.1510/mmcts.2022.051 -
Circulation Journal : Official Journal... Jan 2020Right ventricular (RV) volumetric and functional assessments are both crucial for the management of patients with hypoplastic left heart syndrome (HLHS). 3-dimensional...
Simultaneous Volumetric and Functional Assessment of the Right Ventricle in Hypoplastic Left Heart Syndrome After Fontan Palliation, Utilizing 3-Dimensional Speckle-Tracking Echocardiography.
BACKGROUND
Right ventricular (RV) volumetric and functional assessments are both crucial for the management of patients with hypoplastic left heart syndrome (HLHS). 3-dimensional echocardiography (3DE) for volume measurements and 2D speckle-tracking echocardiography (2D-STE) for strain analysis are performed separately. 3D-STE is capable of evaluating those parameters simultaneously and providing principal strain (PS), unifying the concepts of myofiber orientation and contraction into a single, maximal contractile direction. However, the application of 3D-STE to HLHS has not been studied and so became the aim of our study.Methods and Results:64 HLHS patients after Fontan palliation underwent 3D-STE analysis measuring RV end-diastolic volume index (EDVi), ejection fraction (EF), global PS (GPS), global circumferential strain (GCS), and global longitudinal strain (GLS). Volume measurements were compared between 3D-STE and 3DE, and strains were compared between 3D- and 2D-STE. EDVi and EF showed strong correlations between 3D-STE and 3DE (r=0.93 and 0.87, respectively). GCS and GLS showed moderate correlations between 3D- and 2D-STE (r=0.65 and 0.61, respectively). GPS showed highest magnitude and excellent correlation with EF (r=-0.95).
CONCLUSIONS
Simultaneous volumetric and functional assessment by 3D-STE was a useful method in this HLHS cohort. PS is a promising parameter for evaluating the RV function of HLHS, which could be useful during longitudinal follow-up.
Topics: Adolescent; Child; Child, Preschool; Echocardiography, Three-Dimensional; Feasibility Studies; Female; Fontan Procedure; Heart Ventricles; Humans; Hypoplastic Left Heart Syndrome; Male; Observer Variation; Palliative Care; Predictive Value of Tests; Recovery of Function; Reproducibility of Results; Time Factors; Treatment Outcome; Ventricular Function, Right
PubMed: 31932561
DOI: 10.1253/circj.CJ-19-0926