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Heo J, Lee H, Lee IH, Nam HS, Kim YD. Impact of Left Atrial or Left Atrial Appendage Thrombus on Stroke Outcome: A Matched Control Analysis. J Stroke 2023; 25:111-118. [PMID: 36592972 PMCID: PMC9911853 DOI: 10.5853/jos.2022.02068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/30/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND AND PURPOSE Left atrial or left atrial appendage (LA/LAA) thrombi are frequently observed during cardioembolic evaluation in patients with ischemic stroke. This study aimed to investigate stroke outcomes in patients with LA/LAA thrombus. METHODS This retrospective study included patients admitted to a single tertiary center in Korea between January 2012 and December 2020. Patients with nonvalvular atrial fibrillation who underwent transesophageal echocardiography or multi-detector coronary computed tomography were included in the study. Poor outcome was defined as modified Rankin Scale score >3 at 90 days. The inverse probability of treatment weighting analysis was performed. RESULTS Of the 631 patients included in this study, 68 (10.7%) had LA/LAA thrombi. Patients were likely to have a poor outcome when an LA/LAA thrombus was detected (42.6% vs. 17.4%, P<0.001). Inverse probability of treatment weighting analysis yielded a higher probability of poor outcomes in patients with LA/LAA thrombus than in those without LA/LAA thrombus (P<0.001). Patients with LA/LAA thrombus were more likely to have relevant arterial occlusion on angiography (36.3% vs. 22.4%, P=0.047) and a longer hospital stay (8 vs. 7 days, P<0.001) than those without LA/LAA thrombus. However, there was no difference in early neurological deterioration during hospitalization or major adverse cardiovascular events within 3 months between the two groups. CONCLUSIONS Patients with ischemic stroke who had an LA/LAA thrombus were at risk of a worse functional outcome after 3 months, which was associated with relevant arterial occlusion and prolonged hospital stay.
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Affiliation(s)
- JoonNyung Heo
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyungwoo Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Il Hyung Lee
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Hyo Suk Nam
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea
| | - Young Dae Kim
- Department of Neurology, Yonsei University College of Medicine, Seoul, Korea,Correspondence: Young Dae Kim Department of Neurology, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea Tel: +82-2-2228-1619 Fax: +82-2-393-0705 E-mail:
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Maddali MM, Raju S, Al Aamri I, Al Maskari SN, Al Kindi HN. A New-Onset Mass in the Right-Sided Atrium in a Child After Cardiac Surgery: Unravelling the Diagnosis. J Cardiothorac Vasc Anesth 2022; 36:4217-4219. [PMID: 35965230 DOI: 10.1053/j.jvca.2022.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Madan Mohan Maddali
- Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Oman.
| | - Sowmiya Raju
- Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Oman
| | - Is'haq Al Aamri
- Department of Cardiac Anesthesia, National Heart Center, Royal Hospital, Muscat, Oman
| | | | - Hamood Nasar Al Kindi
- Department of Cardiothoracic surgery, National Heart Center, Royal Hospital, Muscat, Oman
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Aquino GJ, Chamberlin J, Yacoub B, Kocher MR, Kabakus I, Akkaya S, Mercer M, Waltz J, Fiegel M, Leaphart N, Jacob A, Gulsun MA, Gilkes J, Stephenson J, Sharma P, Sahbaee P, Schoepf J, Zimmerman S, Field ME, Agha AM, Burt JR. Diagnostic accuracy and performance of artificial intelligence in measuring left atrial volumes and function on multiphasic CT in patients with atrial fibrillation. Eur Radiol 2022. [PMID: 35275258 DOI: 10.1007/s00330-022-08657-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2021] [Revised: 11/16/2021] [Accepted: 12/04/2021] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To evaluate the effectiveness of a novel artificial intelligence (AI) algorithm for fully automated measurement of left atrial (LA) volumes and function using cardiac CT in patients with atrial fibrillation. METHODS We included 79 patients (mean age 63 ± 12 years; 35 with atrial fibrillation (AF) and 44 controls) between 2017 and 2020 in this retrospective study. Images were analyzed by a trained AI algorithm and an expert radiologist. Left atrial volumes were obtained at cardiac end-systole, end-diastole, and pre-atrial contraction, which were then used to obtain LA function indices. Intraclass correlation coefficient (ICC) analysis of the LA volumes and function parameters was performed and receiver operating characteristic (ROC) curve analysis was used to compare the ability to detect AF patients. RESULTS The AI was significantly faster than manual measurement of LA volumes (4 s vs 10.8 min, respectively). Agreement between the manual and automated methods was good to excellent overall, and there was stronger agreement in AF patients (all ICCs ≥ 0.877; p < 0.001) than controls (all ICCs ≥ 0.799; p < 0.001). The AI comparably estimated LA volumes in AF patients (all within 1.3 mL of the manual measurement), but overestimated volumes by clinically negligible amounts in controls (all by ≤ 4.2 mL). The AI's ability to distinguish AF patients from controls using the LA volume index was similar to the expert's (AUC 0.81 vs 0.82, respectively; p = 0.62). CONCLUSION The novel AI algorithm efficiently performed fully automated multiphasic CT-based quantification of left atrial volume and function with similar accuracy as compared to manual quantification. Novel CT-based AI algorithm efficiently quantifies left atrial volumes and function with similar accuracy as manual quantification in controls and atrial fibrillation patients. KEY POINTS • There was good-to-excellent agreement between manual and automated methods for left atrial volume quantification. • The AI comparably estimated LA volumes in AF patients, but overestimated volumes by clinically negligible amounts in controls. • The AI's ability to distinguish AF patients from controls was similar to the manual methods.
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Samiei N, Abbasi F, Shojaeifard M, Parsaee M, Hosseini S, Rezaei Y, Naderi N. The Role of Left Atrial Strain in Detecting Left Ventricular Diastolic Dysfunction: Comparison between the 2009 and 2016 Recommendations. J Tehran Heart Cent 2022; 16:58-67. [PMID: 35082873 PMCID: PMC8742863 DOI: 10.18502/jthc.v16i2.7386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 02/04/2021] [Indexed: 12/02/2022] Open
Abstract
Background: The frequency of left ventricular diastolic dysfunction (DD) is overestimated by earlier recommendations. We compared the 2009 and 2016 guidelines regarding the detection of DD and explored the potential of adding left atrial (LA) strain to the current guideline. Methods: Consecutive patients with heart failure were enrolled. All the patients were examined using 2-dimensional speckle-tracking echocardiography (2D-STE) and tissue Doppler imaging. DD was evaluated in terms of E/eʹ, eʹ velocity, E, A, tricuspid regurgitation velocity, LA volume, and LA strain. Results: This study evaluated 147 patients (101 males, 68.7%) at a mean age of 54.73±14.42 years. LA strain decreased with increasing grades of DD in both guidelines. The rate of reclassification between the 2 guidelines was 41%. The detection rate of normal diastolic function increased after the implementation of the 2016 guideline. LA strain discriminated individuals with normal diastolic function from those with DD more accurately than did LA volume index (area under the curve [AUC] =0.816 vs AUC=0.759, respectively). When LA strain <23% was incorporated into the 2016 guideline, 2 out of 4 patients with indeterminate diastolic function were reclassified as normal and 2 patients as grade I DD. The rate of reclassification was 4.1% after the addition of LA strain to the current guideline (κ=0.939, P<0.001). Conclusion: This study showed that the current guideline detected lower rates of DD than did the earlier recommendations. Furthermore, the incorporation of LA strain into the current guideline resulted in lower rates of indeterminate diastolic function.
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Affiliation(s)
- Niloufar Samiei
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Abbasi
- Department of Cardiology, Chamran Hospital, Isfahan University of Medical Sciences, Isfahan, Iran
| | - Maryam Shojaeifard
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Mozhgan Parsaee
- Echocardiography Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Saeid Hosseini
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Yousef Rezaei
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Nasim Naderi
- Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Anastasopoulos C, Yang S, Pradella M, Akinci D'Antonoli T, Knecht S, Cyriac J, Reisert M, Kellner E, Achermann R, Haaf P, Stieltjes B, Sauter AW, Bremerich J, Sommer G, Abdulkadir A. Atri-U: assisted image analysis in routine cardiovascular magnetic resonance volumetry of the left atrium. J Cardiovasc Magn Reson 2021; 23:133. [PMID: 34758821 PMCID: PMC8582149 DOI: 10.1186/s12968-021-00791-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Accepted: 07/08/2021] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Artificial intelligence can assist in cardiac image interpretation. Here, we achieved a substantial reduction in time required to read a cardiovascular magnetic resonance (CMR) study to estimate left atrial volume without compromising accuracy or reliability. Rather than deploying a fully automatic black-box, we propose to incorporate the automated LA volumetry into a human-centric interactive image-analysis process. METHODS AND RESULTS Atri-U, an automated data analysis pipeline for long-axis cardiac cine images, computes the atrial volume by: (i) detecting the end-systolic frame, (ii) outlining the endocardial borders of the LA, (iii) localizing the mitral annular hinge points and constructing the longitudinal atrial diameters, equivalent to the usual workup done by clinicians. In every step human interaction is possible, such that the results provided by the algorithm can be accepted, corrected, or re-done from scratch. Atri-U was trained and evaluated retrospectively on a sample of 300 patients and then applied to a consecutive clinical sample of 150 patients with various heart conditions. The agreement of the indexed LA volume between Atri-U and two experts was similar to the inter-rater agreement between clinicians (average overestimation of 0.8 mL/m2 with upper and lower limits of agreement of - 7.5 and 5.8 mL/m2, respectively). An expert cardiologist blinded to the origin of the annotations rated the outputs produced by Atri-U as acceptable in 97% of cases for step (i), 94% for step (ii) and 95% for step (iii), which was slightly lower than the acceptance rate of the outputs produced by a human expert radiologist in the same cases (92%, 100% and 100%, respectively). The assistance of Atri-U lead to an expected reduction in reading time of 66%-from 105 to 34 s, in our in-house clinical setting. CONCLUSIONS Our proposal enables automated calculation of the maximum LA volume approaching human accuracy and precision. The optional user interaction is possible at each processing step. As such, the assisted process sped up the routine CMR workflow by providing accurate, precise, and validated measurement results.
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Affiliation(s)
| | - Shan Yang
- Department of Research and Analysis, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Maurice Pradella
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tugba Akinci D'Antonoli
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Radiology, University Children's Hospital Basel, University of Basel, Basel, Switzerland
| | - Sven Knecht
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Joshy Cyriac
- Department of Research and Analysis, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Marco Reisert
- Medical Physics, Department of Radiology, University Medical Center Freiburg, Freiburg, Germany
| | - Elias Kellner
- Medical Physics, Department of Radiology, University Medical Center Freiburg, Freiburg, Germany
| | - Rita Achermann
- Department of Research and Analysis, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Philip Haaf
- Department of Cardiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Bram Stieltjes
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
- Department of Research and Analysis, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Alexander W Sauter
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Jens Bremerich
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Gregor Sommer
- Department of Radiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Ahmed Abdulkadir
- University Hospital of Old Age Psychiatry and Psychotherapy, University of Bern, Bern, Switzerland
- Center for Biomedical Image Computing and Analytics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, USA
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Altmann S, Halfmann MC, Abidoye I, Yacoub B, Schmidt M, Wenzel P, Forman C, Schoepf UJ, Xiong F, Dueber C, Kreitner KF, Varga-Szemes A, Emrich T. Compressed sensing acceleration of cardiac cine imaging allows reliable and reproducible assessment of volumetric and functional parameters of the left and right atrium. Eur Radiol 2021; 31:7219-7230. [PMID: 33779815 PMCID: PMC8452582 DOI: 10.1007/s00330-021-07830-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 01/26/2021] [Accepted: 02/24/2021] [Indexed: 11/05/2022]
Abstract
Objectives To compare volumetric and functional parameters of the atria derived from highly accelerated compressed sensing (CS)–based cine sequences in comparison to conventional (Conv) cine imaging. Methods CS and Conv cine sequences were acquired in 101 subjects (82 healthy volunteers (HV) and 19 patients with heart failure with reduced ejection fraction (HFrEF)) using a 3T MR scanner in this single-center study. Time-volume analysis of the left (LA) and right atria (RA) were performed in both sequences to evaluate atrial volumes and function (total, passive, and active emptying fraction). Inter-sequence and inter- and intra-reader agreement were analyzed using correlation, intraclass correlation (ICC), and Bland-Altman analysis. Results CS-based cine imaging led to a 69% reduction of acquisition time. There was significant difference in atrial parameters between CS and Conv cine, e.g., LA minimal volume (LAVmin) (Conv 24.0 ml (16.7–32.7), CS 25.7 ml (19.2–35.2), p < 0.0001) or passive emptying fraction (PEF) (Conv 53.9% (46.7–58.4), CS 49.0% (42.0–54.1), p < 0.0001). However, there was high correlation between the techniques, yielding good to excellent ICC (0.76–0.99) and small mean of differences in Bland-Altman analysis (e.g. LAVmin − 2.0 ml, PEF 3.3%). Measurements showed high inter- (ICC > 0.958) and intra-rater (ICC > 0.934) agreement for both techniques. CS-based parameters (PEF AUC = 0.965, LAVmin AUC = 0.864) showed equivalent diagnostic ability compared to Conv cine imaging (PEF AUC = 0.989, LAVmin AUC = 0.859) to differentiate between HV and HFrEF. Conclusion Atrial volumetric and functional evaluation using CS cine imaging is feasible with relevant reduction of acquisition time, therefore strengthening the role of CS in clinical CMR for atrial imaging. Key Points • Reliable assessment of atrial volumes and function based on compressed sensing cine imaging is feasible. • Compressed sensing reduces scan time and has the potential to overcome obstacles of conventional cine imaging. • No significant differences for subjective image quality, inter- and intra-rater agreement, and ability to differentiate healthy volunteers and heart failure patients were detected between conventional and compressed sensing cine imaging. Supplementary Information The online version contains supplementary material available at 10.1007/s00330-021-07830-z.
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Affiliation(s)
- Sebastian Altmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Moritz C Halfmann
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Ibukun Abidoye
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.,Afe Babalola University/Multisystem Hospital, Km 8.5, Afe Babalola way, Ado-Ekiti, Ekiti, Nigeria
| | - Basel Yacoub
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29425, USA
| | - Michaela Schmidt
- Cardiac MR R&D, Siemens Healthcare GmbH, Henkestraße, 127, 91052, Erlangen, Germany
| | - Philip Wenzel
- German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Langenbeckstraße 1, 55131, Mainz, Germany.,Center for Cardiology, Cardiology I, University Medical Center Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Christoph Forman
- Cardiac MR R&D, Siemens Healthcare GmbH, Henkestraße, 127, 91052, Erlangen, Germany
| | - U Joseph Schoepf
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29425, USA
| | - Fei Xiong
- Cardiac MR R&D, Siemens Healthcare GmbH, Henkestraße, 127, 91052, Erlangen, Germany
| | - Christoph Dueber
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Karl-Friedrich Kreitner
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany
| | - Akos Varga-Szemes
- Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29425, USA
| | - Tilman Emrich
- Department of Diagnostic and Interventional Radiology, University Medical Center of the Johannes Gutenberg-University Mainz, Langenbeckstraße 1, 55131, Mainz, Germany. .,German Center for Cardiovascular Research (DZHK), Partner Site Rhine-Main, Mainz, Langenbeckstraße 1, 55131, Mainz, Germany. .,Department of Radiology and Radiological Science, Medical University of South Carolina, 25 Courtenay Drive, Charleston, SC, 29425, USA.
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Abstract
A 63-year-old diabetic and hypertensive lady presented in New York Heart Association class III-IV dyspnea on exertion. Echocardiography showed a large mass attached to the anterior mitral leaflet and the base of the interatrial septum. After removal of the mass and excision of the anterior and posterior mitral leaflets, a bioprosthetic valve was deployed. The postoperative course was uneventful. Histopathology showed that the tumor was a high-grade rhabdomyosarcoma. Although it is a highly lethal tumor, surgical removal was indicated to relieve dyspnea, clarify the diagnosis, and improve short-term survival. Our patient survived for 8 months after surgical excision.
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Affiliation(s)
- Hemant Chaturvedi
- Department of Noninvasive Cardiology, Eternal Hospital, Jaipur, Rajasthan, India
| | - Ravindra Singh Rao
- Department of Intervention Cardiology Eternal Hospital, Jaipur, Rajasthan, India
| | - Navneet Mehta
- Department of Cardiac Anesthesia, Eternal Hospital, Jaipur, Rajasthan, India
| | - Ajeet Bana
- Department of Cardiothoracic and Vascular Surgery, Eternal Hospital, Jaipur, Rajasthan, India
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Vakilian F, Tavallaie A, Alimi H, Poorzand H, Salehi M. Right Atrial Strain in the Assessment of Right Heart Mechanics in Patients with Heart Failure with Reduced Ejection Fraction. J Cardiovasc Imaging 2020; 29:135-143. [PMID: 33605100 PMCID: PMC8099572 DOI: 10.4250/jcvi.2020.0092] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Revised: 10/24/2020] [Accepted: 11/15/2020] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Cardiac catheterization is the gold standard for cardiopulmonary hemodynamic assessment, although its widespread use could be restricted due to its invasive nature. The aim of this study is to compare multiple echocardiography parameters, including right atrial (RA) strain, with right heart catheterization (RHC) data in patients with heart failure reduced ejection fraction (HFrEF) in the assessment of right heart hemodynamics. METHODS Patients with HFrEF (defined by left ventricular ejection fraction [LVEF] ≤ 35%) were enrolled prospectively in this study. All patients underwent echocardiography and RHC. RA pressure (RAP), right ventricular end diastolic pressure (RVEDP), systolic pulmonary artery pressure (sPAP) and pulmonary vascular resistance (PVR) were calculated in RHC. Right ventricular (RV) diastolic and systolic function, RAP, RA size, sPAP and PVR were also measured by echocardiography. RESULTS Fifty patients (36 men) aged 13–51 years with LVEF ≤ 35% were enrolled in this study. There was a significant correlation between echocardiography and catheterization data (r > 0.6, p < 0.001). The RV diastolic grading had significant relation with RA volume (p < 0.001) and RA strain (p < 0.001) in echocardiography, and with RVEDP (p = 0.01) and RAP (p < 0.001) in RHC. There were significant relations between the New York Heart Association classification and RV diastolic function grading (p < 0.001), with RA strain (p = 0.019), and size (p = 0.04). CONCLUSIONS RA function, as assessed by strain imaging, correlates with right heart hemodynamics in patients with HFrEF.
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Affiliation(s)
- Farveh Vakilian
- Cardiovascular Department, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Alireza Tavallaie
- Cardiovascular Department, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hedieh Alimi
- Vascular and Endovascular Surgery Research Center, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Hoorak Poorzand
- Vascular and Endovascular Surgery Research Center, Imam Reza Hospital, Faculty of Medicine, Mashhad University of Medical Sciences, Mashhad, Iran.
| | - Maryam Salehi
- Clinical Research Unit, Ghaem Hospital, Mashhad University of Medical Sciences, Mashhad, Iran
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9
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Kallifatidis A, Mouratoglou SA, Giannakoulas G, Finitsis S, Karvounis H, Sianos G. Myocardial deformation assessment in patients with precapillary pulmonary hypertension: A cardiac magnetic resonance study. Diagn Interv Imaging 2021; 102:153-61. [PMID: 32917553 DOI: 10.1016/j.diii.2020.08.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 07/01/2020] [Accepted: 08/03/2020] [Indexed: 11/22/2022]
Abstract
PURPOSE The purpose of this study was to investigate right atrial and ventricular strain parameters on cardiac magnetic resonance (CMR) in patients with precapillary pulmonary hypertension (PPH) and whether they can aid in the assessment of PPH prognosis. MATERIALS AND METHODS Adult patients with groups 1 and 4 PPH were invited to participate in the study. Age- and sex-matched healthy volunteers were also recruited as controls. At baseline, patients underwent clinical examination, N-terminal pro-B-type natriuretic peptide measurement and CMR with feature tracking post-processing (CMR-FT). Healthy controls underwent only CMR-FT. The study's primary endpoint was clinical failure, defined as death, hospitalization or demonstrable clinical deterioration during follow-up. Patients who were unable to perform 6-minute walking test due to musculoskeletal disorders were excluded from the study. RESULTS Thirty-six patients (8 men, 28 women; mean age, 50.6±13.8 [SD] years [range: 18.6-78.5years]) and 12 healthy control subjects (5 mean, 7 women; mean age, 40.6±13.5 [SD] years [range: 23.1-64.4years]) were recruited. Right ventricular global longitudinal strain (GLS) was significantly impaired in PPH patients (-20.2±5.3 [SD] % [range: -28.8 to -9.1%] vs. -28.4±3.1% [-33.7 to -22.7%] respectively, P<0.001). The right atrial GLS was significantly impaired in PPH compared to healthy controls (-19.9±4.5% [range: -28.6 to -3.6%] vs. -26.5±4.2% [range: -32.8 to -15.8%] respectively) (P<0.001). Clinical failure occurred in 19 (19/36, 53%) of patients. Right ventricular GLS predicted clinical failure most reliably among CMR parameters (-22.6±3.8 [SD] % [range: -27.6 to -12.7%] for patients without clinical failure vs. -18±5.6 [SD] % [range: -28.8 to -9.1%] for patients with clinical failure; hazard ratio [HR]=1.85; P=0.007; area under the AUC curve=0.75). Lower absolute right atrial GLS was significantly associated with clinical failure (-22.7±3.0 [SD] % [range: -28.6 to -17.7%] for patients without clinical failure vs. -16.9±5.8 [SD] % [range: -24.2 to -3.6%] for patients with clinical failure) (HR=1.53; P=0.035). CONCLUSION CMR feature tracking-derived myocardial strain parameters of both the right atrium and ventricle can assist clinicians in the prognosis of PPH.
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Picón-Jaimes YA, Ortega-Uribe LF, Orozco-Chinome JE, Molina-Franky JS, Franky-Rojas MP. Primary undifferentiated sarcoma of left atrium. CIR CIR 2020; 88:98-101. [PMID: 32963403 DOI: 10.24875/ciru.20001718] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
El objetivo es ilustrar al lector sobre un tumor infrecuente en la literatura médica y resumir los conocimientos actuales que se tienen sobre esta patología. Caso clínico: Reportamos el caso de un varón en la quinta década de la vida, a quien se realizó ecocardiograma transtorácico por deterioro de la clase funcional. La ultrasonografía evidenció un tumor que ocupaba el 95% de la aurícula izquierda, con compromiso hemodinámico e hipertensión pulmonar grave. Luego de estudios de extensión, fue llevado a cirugía para extracción de la masa por esternotomía media. La patología reveló sarcoma de alto grado indiferenciado sin compromiso linfovascular. This text aimed to illustrate the reader about one of the most infrequent tumors in the medical literature and discuss based on current literature what is known to date of this pathology. Case report: We report the case of a male in the fifth decade of life, who underwent transthoracic echocardiography due to impairment of the functional class. Ultrasound showed tumor lesion that occupied 95% of the left atrium, with hemodynamic compromise and severe pulmonary hypertension. After extension studies, he was taken to surgery with total mass extraction by middle stereotomy. The pathology revealed undifferentiated high-grade sarcoma without lymphovascular involvement.
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Mohseni-Badalabadi R, Hosseinsabet A, Mohseni-Badalabadi M, Forozannia K. Simultaneous Rupture of an Aortomitral Intervalvular Fibrosa Pseudoaneurysm to the Aorta and the Left Atrium. J Tehran Heart Cent 2019; 14:195-197. [PMID: 32461762 PMCID: PMC7231683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Affiliation(s)
| | - Ali Hosseinsabet
- Corresponding Author: Ali Hosseinsabet, Associate Professor of Cardiology, Tehran Heart Center, North Karegar Street, Tehran, Iran. 1411713138. Tel: +98 21 88029731. Fax: +98 21 88029731. E-mail: .
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12
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Akçay M, Çamlıdağ İ. Huge Hiatal Hernia Mimicking a Mass with Compressive Effects on the Left Atrium Causing Paroxysmal Atrial Fibrillation. J Tehran Heart Cent 2019; 14:90-91. [PMID: 31723352 PMCID: PMC6842017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Affiliation(s)
- Murat Akçay
- Department of Cardiology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey. ,Corresponding Author: Murat Akcay, Assistant Professor of Cardiology, Department of Cardiology, Faculty of Medicine, Ondokuz Mayıs University, Kurupelit Campus/Atakum, 55139, Samsun, Turkey. Tel: +90 5067795760. Fax: +90 3624576041. E-mail: .
| | - İlkay Çamlıdağ
- Department of Radiology, Faculty of Medicine, Ondokuz Mayıs University, Samsun, Turkey.
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13
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Karunasumetta C, Wongbhuddha C, Sangkhamanon S, Mokarat B. Infantile cardiac hemangioma causing right ventricular inflow obstruction. Asian Cardiovasc Thorac Ann 2019; 27:597-599. [PMID: 30862170 DOI: 10.1177/0218492319836899] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiac hemangiomas are extremely rare tumors, especially in infants. We present the case of a 4-month-old girl who developed cyanosis due to a large right atrial tumor causing right ventricular inflow obstruction. The patient underwent emergency surgery for tumor resection and recovered uneventfully. Pathological examination confirmed the diagnosis of a combined capillary and cavernous type hemangioma.
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Affiliation(s)
- Chananya Karunasumetta
- 1 Cardiothoracic Surgery Division, Department of Surgery, Srinagarind Hospital and Queen Sirikit Heart Center of the Northeast, Faculty of Medicine, Khon Kaen University, Thailand
| | - Chawalit Wongbhuddha
- 1 Cardiothoracic Surgery Division, Department of Surgery, Srinagarind Hospital and Queen Sirikit Heart Center of the Northeast, Faculty of Medicine, Khon Kaen University, Thailand
| | - Sakkarn Sangkhamanon
- 2 Department of Pathology, Srinagarind Hospital, Faculty of Medicine, Khon Kaen University, Thailand
| | - Bundit Mokarat
- 1 Cardiothoracic Surgery Division, Department of Surgery, Srinagarind Hospital and Queen Sirikit Heart Center of the Northeast, Faculty of Medicine, Khon Kaen University, Thailand
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14
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Mazurkiewicz Ł, Ziółkowska L, Petryka J, Śpiewak M, Małek Ł, Kubik A, Marczak M, Misko J, Brzezińska-Rajszys G. Biatrial performance in children with hypertrophic cardiomyopathy: CMR study. Eur Radiol 2018; 28:5148-5159. [PMID: 29882072 PMCID: PMC6223845 DOI: 10.1007/s00330-018-5519-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2017] [Revised: 04/19/2018] [Accepted: 04/26/2018] [Indexed: 01/11/2023]
Abstract
OBJECTIVES To investigate biatrial mechanics and their relation with left ventricular outflow tract (LVOT) obstruction (LVOTO), the degree of hypertrophy, indices of ventricular diastolic function and fibrosis in children with hypertrophic cardiomyopathy (HCM). METHODS Fifty-five consecutive, prospectively recruited children with HCM (mean age 12.5 ± 4.6 years, 69.1% male), 19 (34.5%) of whom had LVOTO, underwent cardiac magnetic resonance and echocardiography with quantification of phasic components of biatrial function, biventricular diastolic function and fibrosis. Twenty healthy, sex-matched subjects served as controls. RESULTS We found a significant increase of left atrial (LA) and right atrial (RA) volumes and reduction in the majority of indices of contractile function, strains and strain rates (p < 0.05) in children with HCM compared with controls. Nearly all of the LA dynamics markers attained a significant association with the LVOT gradient (p < 0.05), the RA volumes and contractile functions were affected by LV fibrosis and mass (p < 0.05), and the RA mechanical components were related to the degree of LVOTO (p < 0.05). The minority of biatrial dynamics markers were associated with indices of ventricular diastolic function. CONCLUSIONS The majority of biatrial volumetric and functional indices were severely compromised in children with HCM compared with controls. The degree of LVOTO appears to trigger LA volumetric and LA and RA mechanical malfunction. On the other hand, the deterioration of RA volumetric components was linked to LV fibrosis and mass. KEY POINTS • Biatrial function was severely compromised in children with HCM. • Left atrial malfunction was associated with the degree of LVOTO. • Fibrosis and LV mass were related to RA volumetric and contractile dysfunction. • The degree of LVOTO was linked to right atrial mechanical abnormalities.
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Affiliation(s)
- Łukasz Mazurkiewicz
- Departament of Cardiomyopathies, CMR Unit, Institute of Cardiology, 42nd Alpejska Str, 04-682, Warsaw, Poland.
| | - Lidia Ziółkowska
- Department of Pediatric Cardiology, The Children's Memorial Health Institute, Warsaw, Poland
| | - Joanna Petryka
- Department of Coronary and Structural Heart Diseases, CMR Unit, Institute of Cardiology, Warsaw, Poland
| | | | | | - Agata Kubik
- CMR Unit, Institute of Cardiology, Warsaw, Poland
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15
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Alper AT, Hayıroğlu Mİ, Barutça H, Tekkeşin Aİ, Türkkan C. Multipolar Left Ventricular Lead Implantation in a Unique Coronary Sinus: Direct Drainage of the Posterior Vein into the Right Atrium. J Tehran Heart Cent 2018; 13:80-83. [PMID: 30483318 PMCID: PMC6246437] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
The coronary sinus, whose electrical features play an important role in cardiac arrhythmias, is the integral part of the cardiac venous system. Here we describe a 67-year-old male patient with congestive heart failure who was referred to our hospital after the failure of the first cardiac resynchronization therapy defibrillator (CRT-D) implantation. During the cannulation of the coronary sinus, the separate orifice of the posterior cardiac vein was demonstrated by the retrograde filling of the coronary sinus via contrast injection into the posterior cardiac vein. Due to the serious tortuosity of the coronary venous sinus, a multipolar left ventricular lead was implanted using the separate ostium of the posterior cardiac vein. In our patient, the posterior cardiac vein directly drained into the right atrium. At 3 months' follow-up with the CRT-D, he was asymptomatic (New York Heart Association functional class I).
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Affiliation(s)
- Ahmet Taha Alper
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital,İstanbul, Turkey.
| | - Mert İlker Hayıroğlu
- Department of Cardiology, Haydarpasa Sultan Abdulhamid Han Training and Research Hospital, Istanbul, Turkey.,Corresponding Author: Mert İlker Hayıroğlu, Department of Cardiology, Haydarpasa Sultan Abdulhamid Han Training and Research Hospital, 34668 Kadikoy, Istanbul, Turkey. 34688. Tel: +90 535 7154808. Fax: +90 216 542 2020. E-mail: .
| | - Hakan Barutça
- Department of Radiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital,Kadiköy, Istanbul, Turkey.
| | - Ahmet İlker Tekkeşin
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital,İstanbul, Turkey.
| | - Ceyhan Türkkan
- Department of Cardiology, Dr. Siyami Ersek Thoracic and Cardiovascular Surgery Training and Research Hospital,İstanbul, Turkey.
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16
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Moradian M, Mortezaeian H, Baghaei R, Ghadrdoost B. Left Atrial Drainage of the Right Superior Vena Cava: A Case Report. J Tehran Heart Cent 2018; 13:84-87. [PMID: 30483319 PMCID: PMC6246439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
An isolated right superior vena cava (RSVC) draining into the left atrium represents a very rare congenital malformation, especially in the absence of a partial anomalous pulmonary venous return. This condition leads to hypoxemia, cyanosis, and clubbing without any other signs of heart defects. We describe an 8-year-old girl, who was referred to our hospital due to unexplained cyanosis. Segmental approach in transthoracic echocardiography showed left atrial drainage of the RSVC, which was subsequently confirmed by contrast echocardiography and angiography. Surgical repair via trans-section and anastomosis of the superior vena cava to the right atrium was performed to prevent the complications of right-to-left shunting and cyanosis. During a 4-year follow-up, the patient remained in very good clinical status and her serial echocardiography was normal except for very mild left atrial and left ventricular enlargement.
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Affiliation(s)
- Maryam Moradian
- Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Hojjat Mortezaeian
- Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran.,Corresponding Author: Hojjat Mortezaeian, Associated Professor of Pediatric Cardiology, Rajaie Cardiovascular, Medical and Research Center, Mellat Park, Vali-e-Asr Avenue, Tehran, Iran. 1996911151. Tel: +98 21 23922161. Fax: +98 21 23922782.E-mail: .
| | - Ramin Baghaei
- Modarres Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Behshid Ghadrdoost
- Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, Iran.
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17
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Güner A. Left Atrial Thrombus Presenting with Acute Coronary Syndrome and Cerebrovascular Event. J Tehran Heart Cent 2018; 13:99-100. [PMID: 30483321 PMCID: PMC6246433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Affiliation(s)
- Ahmet Güner
- Corresponding Author: Ahmet Güner, Kartal Kosuyolu Heart & Research Hospital, Department of Cardiology, 34846, Kartal, Istanbul, Turkey. Tel: +90 5056533335. Fax: +90 2165001500.E-mail: .
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18
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Selthofer-Relatić K, Belovari T, Bijelić N, Kibel A, Rajc J. Presence of Intramyocardial Fat Tissue in the Right Atrium and Right Ventricle - Postmortem Human Analysis. Acta Clin Croat 2018; 57:122-129. [PMID: 30256020 PMCID: PMC6400345 DOI: 10.20471/acc.2018.57.01.15] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
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.
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Affiliation(s)
| | - Tatjana Belovari
- Department of Histology and Embryology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Nikola Bijelić
- Department of Histology and Embryology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Aleksandar Kibel
- Department of Cardiovascular Disease, Osijek University Hospital Centre, Osijek, Croatia.,Department of Physiology and Immunology, Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, Osijek, Croatia
| | - Jasmina Rajc
- Department of Pathology and Forensic Medicine, Osijek University Hospital Centre, Osijek, Croatia
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19
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Han L, Dong QB, Wei YC, Zheng AC, Li JX, Hong K, Wu YQ, Cheng XS. [Homocysteine induces calcium overload in neonatal rat atrial cells through activation of sodium current and CaMKⅡδ]. Zhonghua Xin Xue Guan Bing Za Zhi 2018; 46:143-151. [PMID: 29495239 DOI: 10.3760/cma.j.issn.0253-3758.2018.02.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To investigate the effect and related mechanism of homocysteine (Hcy) on calcium overload in neonatal rat atrial cells (NRICs). Methods: NRICs were assigned to 9 groups after culture for 3 days: (1) control group; (2) Hcy group (0, 50, 100, 200, 500 μmol/L for 48 hours); (3) antioxidant group (NAC, 10 μmol/L for 24 hours); (4) Hcy+NAC group (500 μmol/L Hcy for 48 hours, then treated with 10 μmol/L NAC for 24 hours); (5) calcium/calmodulin dependent protein kinase Ⅱδ (CaMKⅡδ) inhibitor group (KN-93, 3 μmol/L KN-93 for 5 hours); (6) specific sodium current inhibitor group (ELE, 1 μmol/L ELE for 5 hours); (7) Hcy+KN-93 group (500 μmol/L Hcy for 48 hours, then treated with 3 μmol/L KN-93 for 5 hours); (8) Hcy+ELE group (500 μmol/L Hcy for 48 hours, then treated with 1 μmol/L ELE for 5 hours; (9) Hcy+KN-93+ELE group (500 μmol/L Hcy for 48 hours, then treated with 3 μmol/L KN-93 and 1 μmol/L ELE for 5 hours). Moreover, NRICs were also treated with CaMKⅡδ-siRNA lentivirus, and Nav1.5-siRNA lentivirus, negative lentivirus carrier containing green fluorescent protein (GFP) for 24 hours. The MOI values of the three groups were 10. Infection efficiency of lentivirus was determined by observing the percentage of GFP fluorescence under inverted fluorescence microscope after transfection for 24 hours, and cultured regularly with simultaneous Puro screening, then cells were grouped as Hcy+CaMKⅡδ-siRNA group, Hcy+Nav1.5-siRNA group and Hcy+negative group. The concentration of Ca(2+) in NRICs ([Ca(2+)]i) of various groups was detected through Fluo-4/AM fluorescence probe, then 2', 7'- two chlorofluorescein diacetate (DCFH-DA) was used as a probe to detect reactive oxygen species (ROS) in NRICs by flow cytometry. The malondialdehyde (MDA) was detected by the activity of superoxide dismutase (SOD) and xanthine oxidase was detected by thiobarbituric acid colorimetry. The protein and mRNA expression level of CaMKⅡδ and Nav1.5 in NRICs were detected by Western blot and quantitative real-time PCR. Results: (1) ROS, MDA and SOD were similar between NAC group and control group, ROS and MDA were significantly increased, while SOD was significantly reduced in Hcy group in a concentration-dependent manner. (2) [Ca(2+)]i: The level of [Ca(2+)]i was (155.57+7.25), (187.43+13.07), (248.98+27.22) and (307.36+15.09) nmol/L in 50, 100, 200 and 500 μmol/L Hcy groups, which was significantly higher than that in the control group ((123.18+7.24) nmol/L, P<0.01). In addition, the level of [Ca(2+)]i in Hcy+NAC group ((222.87+23.71)nmol/L) was significantly lower than that in Hcy 500 μmol/L group ((305.15+39.45) nmol/L, P<0.05), while [Ca(2+)]i level was similar between NAC group and the control group. (3) The protein expression of CaMKⅡδ and Nav1.5 was significantly upregulated in Hcy groups than in the control group. The protein expression level of CaMKⅡδ-Thr287 was significantly lower in NAC group than in Hcy 500 μmol/L group (P<0.01), however, there was no significant difference on the protein expression levels of CaMKⅡδ-Thr287 and Nav1.5 between NAC group and control group (all P>0.05). (4) The protein expression levels of CaMKⅡδ-Thr287 and the concentration of [Ca(2+)]i were significantly lower in Hcy+KN-93 group and Hcy+KN-93+ELE group than in Hcy 500 μmol/L group (P<0.05). [Ca(2+)]i concentration was significantly lower in Hcy+KN-93 group, Hcy+ELE group and KN-93+ELE+Hcy group than in Hcy 500 μmol/L group (P<0.05). (5) The mRNA and protein expression levels of CaMKⅡδ and Nav1.5 in each group infected with lentivirus: the GFP expression was ideal post lentivirus transfection for 24 hours (up to 90%), which was significantly lower in the CaMKⅡδ-siRNA group and Nav1.5-siRNA group than in the negative infection group (all P<0.05), which was similar between negative infection group and control group (P>0.05). Moreover, the mRNA and protein expression levels of CaMKⅡδ and CaMKⅡδ-Thr287 was significantly lower in Hcy+Nav1.5-siRNA group than in Hcy+negative infection group (P<0.05). The protein and mRNA levels of Nav1.5 were similar between Hcy+CaMKⅡδ-siRNA group and Hcy+negative infection group (P>0.05). Conclusions: Hcy can induce calcium overload in NRICs by increasing oxidative stress, upregulating the sodium channel protein, and activating the late sodium current and phosphorylating CaMKⅡδ.
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Affiliation(s)
- L Han
- Department of Cardiology, Second Affiliated Hospital of Nanchang University, Nanchang 330006, China
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20
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Eto K, Kotani Y, Kobayashi Y, Edaki D, Kasahara S, Masuda Z. Surgery for tricuspid regurgitation in a case of anomalous systemic venous return. Asian Cardiovasc Thorac Ann 2018; 26:227-230. [PMID: 29411635 DOI: 10.1177/0218492318759153] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A 75-year-old woman presented with severe tricuspid regurgitation requiring surgical repair. She had extremely rare anomalies in systemic venous return in spite of situs solitus: persistent left superior vena cava with absent right superior vena cava, infrahepatic inferior vena cava interruption, and hemiazygos continuation to a persistent left superior vena cava. These unusual systemic venous anomalies had significantly enlarged the coronary sinus, and the stretched coronary sinus orifice changed the geometry of the tricuspid annulus and triggered tricuspid regurgitation. There were technical difficulties in establishing cardiopulmonary bypass and achieving successful tricuspid valve repair.
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Affiliation(s)
- Koki Eto
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yasuhiro Kotani
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Yasuyuki Kobayashi
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Daichi Edaki
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Shingo Kasahara
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
| | - Zenichi Masuda
- Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, Okayama, Japan
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21
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Sahratov H, Guler A, Kurkluoglu M, Calişkan B, Gurkan Yesil F, Tavlasoglu M, Sahin MA. Inflammatory Myofibroblastic Tumor Invading the Left Atrium: Report of a Rare Case. J Tehran Heart Cent 2018; 13:24-26. [PMID: 29997667 PMCID: PMC6037625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022] Open
Abstract
Inflammatory myofibroblastic tumors (IMTs) of the lung are rare solid tumors and usually affect children and young adults. We describe an unusual form of an IMT of the left lower lobe invading the left atrium. A 9-year-old male patient with recurrent cough was referred for an evaluation of left-lung pneumonia. Transthoracic needle biopsy was performed, and the histopathological examination showed mixed inflammatory cells. Accordingly, an IMT was considered. Left lower lobectomy was performed. A portion of the tumor invading the left atrium was resected together with the intact atrial wall. The postoperative period was uneventful, and the patient was discharged on the sixth postoperative day.
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Affiliation(s)
- Hikmet Sahratov
- Department of Cardiovascular Surgery, Gulhane Military Medical School, Ankara, Turkey.,Corresponding Author: Hikmet Sahratov, Gulhane School of Medicine, Etlik, Emrah, Apart oteli, No: 220, 06010 Ankara, Turkey. Tel: +90 5345488890. Fax: +90 3123045225.E-mail: .
| | - Adem Guler
- Department of Cardiovascular Surgery, Gulhane Military Medical School, Ankara, Turkey.
| | - Mustafa Kurkluoglu
- Department of Cardiovascular Surgery, Gulhane Military Medical School, Ankara, Turkey.
| | - Bahadır Calişkan
- Department of Cardiovascular Surgery, Gulhane Military Medical School, Ankara, Turkey.
| | - Fahri Gurkan Yesil
- Department of Cardiovascular Surgery, Etimesgut Military Medical Hospital, Ankara, Turkey.
| | - Murat Tavlasoglu
- Department of Cardiovascular Surgery, Gulhane Military Medical School, Ankara, Turkey.
| | - Mehmet Ali Sahin
- Department of Cardiovascular Surgery, Gulhane Military Medical School, Ankara, Turkey.
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22
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Zapata Laguado MI, Palacios Rojas JO, Gómez Lopez EA, Velasco Morales ML, Orozco de la Hoz CE. High-Grade Left Atrial Pleomorphic Sarcoma: Case Report and Review. Case Rep Oncol 2017; 10:1138-1143. [PMID: 29430240 PMCID: PMC5803735 DOI: 10.1159/000485561] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 11/21/2017] [Indexed: 11/22/2022] Open
Abstract
Primary pleomorphic sarcoma of the left atrium is a rare tumor. There is no actual evidence of the management of this pathological entity, so the main treatment is individualized, surgical management being the cornerstone of the treatment. We present a 78-year-old female who had a clinical picture of heart failure, documenting an atrial mass of the left atrium, with high-grade pleomorphic sarcoma revealed in histopathology. The tumor was surgical removed, with no clinical evidence of residual mass. The tumor recurred again within 3 years, to which the patient succumbed.
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23
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Avdagić H, Sijerčić Avdagić S, Pirić Avdagić M, Antonič M. Effect of the Size of the Left Atrium on Sustained Sinus Rhythm in Patients Undergoing Mitral Valve Surgery and Concomitant Bipolar Radiofrequency Ablation for Atrial Fibrillation. Acta Clin Croat 2017; 56:795-802. [PMID: 29590738 DOI: 10.20471/acc.2017.56.04.30] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Atrial fibrillation is associated with systemic embolization and complications due to anticoagulant therapy. Radiofrequency ablation has been established as an effective and safe method for the treatment of atrial fibrillation. The aim of this study was to evaluate the effect of the size of the left atrium on the outcome of surgical radiofrequency ablation. Forty patients scheduled for elective mitral valve surgery and radiofrequency ablation were enrolled in the study. Group 1 consisted of patients with a left atrium diameter ≤5 cm and group 2 of patients with left atrium diameter >5 cm. The primary endpoint of the study was stable sinus rhythm 6 months postoperatively. At 6 months postoperatively, sinus rhythm was present in significantly more group 1 patients as compared with group 2 patients, i.e. 15 (75%) vs. 8 (40%), p=0.025. Multivariate analysis proved the size of the left atrium to be an independent predictor of the radiofrequency ablation outcome. Accordingly, the size of the left atrium was demonstrated to be an important predictor of the outcome of radiofrequency ablation for atrial fibrillation. A lower cut-off value of surgical reduction of the atria than previously reported should be considered in order to improve the radiofrequency ablation outcome.
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Affiliation(s)
| | - Selma Sijerčić Avdagić
- Department of Anesthesiology and Resuscitation, Tuzla University Clinical Centre, Tuzla, Bosnia and Herzegovina
| | - Melika Pirić Avdagić
- Department of Internal Medicine, Tuzla University Clinical Centre, Tuzla, Bosnia and Herzegovina
| | - Miha Antonič
- Department of Cardiac Surgery, Maribor University Medical Centre, Maribor, Slovenia
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24
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Abstract
The left atrial appendage (LAA) has received increasing attention in recent years because of thrombi formation in patients with atrial fibrillation, which increases the risk of stroke. In patients who have contraindications for long-term oral anticoagulation therapy, percutaneous procedures are used to occlude the LAA and there are now several devices available for implantation, both endocardially and epicardially. Despite the high-resolution imaging techniques on hand today, limitations remain in providing information about wall thickness and neighboring structures; therefore, in-depth knowledge of the normal atrial anatomy is mandatory when considering such interventions. Here, the anatomy of the right and left atria is reviewed with relevance to interventional procedures required for LAA occlusion. The components of the atria, particularly the LAA as well as the atrial septum, are described with emphasis on their spatial relationships to neighboring cardiac and extracardiac structures. Sound knowledge of the atrial anatomy including endocardial and epicardial aspects is necessary. This will help interventionists take full advantage of imaging techniques when assessing the suitability of the LAA anatomy for closure, selecting the optimal device types and sizes, and guiding the LAA closure procedure, thereby reducing potential complications and increasing procedural success.
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Affiliation(s)
- Umberto Barbero
- Cardiology Unit, Città della Salute e della Scienza Hospital, University of Turin, Turin, Italy
| | - Siew Yen Ho
- Cardiac Morphology Unit, Royal Brompton and Harefield NHS Foundation Trust and Imperial College London, SW3 6NP, London, UK.
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25
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Abstract
We describe an unusual case of partial atrioventricular septal defect with malalignment of the septum primum to the left atrium with respect to the ventricular septum, committing the tricuspid valve to both ventricles (double-outlet right atrium). Abnormal attachment of the septum primum to the lateral aspect of mitral annulus resulted in left atrial outflow obstruction. The patient underwent successful surgical correction.
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Affiliation(s)
- Arun Gopalakrishnan
- Department of Cardiology, 29354 Sree Chitra Tirunal Institute for Medical Sciences and Technology , Thiruvananthapuram, Kerala, India
| | - Bijulal Sasidharan
- Department of Cardiology, 29354 Sree Chitra Tirunal Institute for Medical Sciences and Technology , Thiruvananthapuram, Kerala, India
| | - Jaganmohan Tharakan
- Department of Cardiology, 29354 Sree Chitra Tirunal Institute for Medical Sciences and Technology , Thiruvananthapuram, Kerala, India
| | - Ajitkumar Valaparambil
- Department of Cardiology, 29354 Sree Chitra Tirunal Institute for Medical Sciences and Technology , Thiruvananthapuram, Kerala, India
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Abstract
Although hematological malignancies are a known complication of Down syndrome, few reports have described cases involving solid tumors. We describe the case of a 3-year-old Down syndrome girl with a primary solid cardiac tumor. Outpatient echocardiography after intracardiac repair of a ventricular septal defect at 6 months of age revealed a highly mobile pedunculated mass (8 × 9 mm) on the free wall of the right atrium. Due to potential incarceration of the mass in the tricuspid orifice, it was excised under extracorporeal circulation and cardiac arrest. Macroscopically, the tumor closely resembled a papillary fibroelastoma, although histopathological tests were inconclusive.
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Affiliation(s)
- Kimiaki Okada
- Department of Pediatric Cardiac Surgery, Saitama Medical University, International Medical Center, Hidaka City, Saitama, Japan
| | - Ayumu Masuoka
- Department of Pediatric Cardiac Surgery, Saitama Medical University, International Medical Center, Hidaka City, Saitama, Japan
| | - Kentaro Hotoda
- Department of Pediatric Cardiac Surgery, Saitama Medical University, International Medical Center, Hidaka City, Saitama, Japan
| | - Yoshimasa Uno
- Department of Pediatric Cardiac Surgery, Saitama Medical University, International Medical Center, Hidaka City, Saitama, Japan
| | - Takaaki Suzuki
- Department of Pediatric Cardiac Surgery, Saitama Medical University, International Medical Center, Hidaka City, Saitama, Japan
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Kuh JH, Song JY, Kim TY, Kim JH, Choi JB. Treatment of Atrial Fibrillation in Elderly Patients with the Cox Maze Procedure Concurrently with Other Cardiac Operations. Korean J Thorac Cardiovasc Surg 2017; 50:171-176. [PMID: 28593152 PMCID: PMC5460963 DOI: 10.5090/kjtcs.2017.50.3.171] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/22/2016] [Revised: 09/29/2016] [Accepted: 09/29/2016] [Indexed: 11/16/2022]
Abstract
BACKGROUND In elderly patients who have atrial fibrillation (AF), surgical ablation of the arrhythmia during cardiac surgery may be challenging. Despite the reported advantages of ablating AF with the Cox maze procedure (CMP), the addition of the CMP may complicate other cardiac operations. We evaluated the effect of the CMP in elderly patients concurrent with other cardiac operations. METHODS From October 2007 to December 2015, we enrolled 27 patients aged >70 years who had AF and who underwent the CMP concurrently with other cardiac operations. The mean preoperative additive European System for Cardiac Operative Risk Evaluation score was 8±11 (high risk). RESULTS Only 1 hospital death occurred (4%). The Kaplan-Meier method showed a high 5-year cumulative survival rate (92%). At mean follow-up of 51 months, 23 patients (89%) had sinus rhythm conversion. The postoperative left atrial dimensions did not significantly differ between the 8 patients who had reduction plasty for giant left atrium (53.4±7.5 cm) and the 19 patients who did not have reduction plasty (48.7±5.7 cm). CONCLUSION In patients aged >70 years, concurrent CMP may be associated with a high rate of sinus rhythm conversion without increased surgical risk, despite the added complexity of the main cardiac procedure.
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Affiliation(s)
- Ja Hong Kuh
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School.,Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital
| | - Joon Young Song
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School
| | - Tae Youn Kim
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School
| | - Jong Hun Kim
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School.,Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital
| | - Jong Bum Choi
- Department of Thoracic and Cardiovascular Surgery, Chonbuk National University Medical School.,Research Institute of Clinical Medicine of Chonbuk National University and Biomedical Research Institute of Chonbuk National University Hospital
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Raja DC, Palanisamy V, Chidambaram K, Pandurangi U, Mullasari AS, Sethuratnam R. Repair of a Submitral Aneurysm with associated left atrial wall dissection. Asian Cardiovasc Thorac Ann 2017; 26:392-395. [PMID: 28537419 DOI: 10.1177/0218492317713425] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We describe a case of submitral aneurysm in a 40-year-old man, which was distinctive in its anatomy and pathophysiology. The patient had a congenital submitral aneurysm located in the anterolateral part of the mitral annulus, complicated by dissection of the left atrial wall, severe mitral regurgitation, and compression of the left circumflex artery. He was managed successfully with aid of a comprehensive preoperative evaluation with all available imaging guidance and methodical surgical techniques, resulting in exclusion of the aneurysm, mitral valve replacement, and a graft to the left circumflex artery.
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Affiliation(s)
- Deep Chandh Raja
- Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, India
| | | | - Kumar Chidambaram
- Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, India
| | - Ulhas Pandurangi
- Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, India
| | | | - Rajan Sethuratnam
- Institute of Cardio-Vascular Diseases, Madras Medical Mission, Chennai, India
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29
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Kim JS, Yeom SY, Kim SH, Choi JW, Kim KH. Delayed Left Atrial Perforation Associated with Erosion After Device Closure of an Atrial Septal Defect. Korean J Thorac Cardiovasc Surg 2017; 50:110-113. [PMID: 28382270 PMCID: PMC5380204 DOI: 10.5090/kjtcs.2017.50.2.110] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Revised: 08/29/2016] [Accepted: 08/30/2016] [Indexed: 11/16/2022]
Abstract
A 43-year-old man who had had a history of atrial septal defect (ASD) device closure 31 months previously presented with abrupt chest and back pain along with progressive cardiogenic shock and cardiac arrest. After resuscitation, he was diagnosed with cardiac tamponade. Diagnostic and therapeutic surgical exploration revealed left atrium (LA) perforation due to LA roof erosion from a deficient aortic rim. Device removal, primary repair of the LA perforation site, and ASD patch closure were performed successfully. The postoperative course was uneventful. The patient was discharged after 6 weeks of empirical antibiotic therapy without any other significant complications.
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Affiliation(s)
- Ji Seong Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
| | - Sang Yoon Yeom
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
| | - Sue Hyun Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
| | - Jae Woong Choi
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
| | - Kyung Hwan Kim
- Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital
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Kim K, Choi J, Doo Y, Yun YS, Kim J, Lee JB. Well-Tolerated and Undiscovered Common Atrium until Late Adulthood. J Cardiovasc Ultrasound 2016; 24:243-246. [PMID: 27721956 PMCID: PMC5050314 DOI: 10.4250/jcu.2016.24.3.243] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2016] [Revised: 06/08/2016] [Accepted: 07/26/2016] [Indexed: 11/22/2022] Open
Abstract
Common atrium is a rare congenital heart disease characterized by complete absence of the interatrial septum, and is commonly accompanied by malformation of the atrioventricular valve. Most patients with common atrium experience symptoms during childhood. Here, we describe a patient with common atrium who experienced his first obvious symptom at 48 years of age.
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Affiliation(s)
- Kyungjoong Kim
- Division of Cardiology, Department of Internal Medicine, Anyang SAM Hospital, Anyang, Korea
| | - Jiwook Choi
- Division of Cardiology, Department of Internal Medicine, Anyang SAM Hospital, Anyang, Korea
| | - Youngjae Doo
- Division of Cardiology, Department of Internal Medicine, Anyang SAM Hospital, Anyang, Korea
| | - Yeong Seop Yun
- Division of Cardiology, Department of Internal Medicine, Anyang SAM Hospital, Anyang, Korea
| | - Jongwook Kim
- Division of Cardiology, Department of Internal Medicine, Anyang SAM Hospital, Anyang, Korea
| | - Jae Beom Lee
- Division of Cardiology, Department of Internal Medicine, Anyang SAM Hospital, Anyang, Korea
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31
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Moradi B, Oraii S, Roshanali F, Ghorbanisharif A, Mikaeili J, Tahraei M. Conservative Management of Left Atrial Intramural Hematoma after Catheter Ablation. Korean Circ J 2016; 46:580-3. [PMID: 27482270 PMCID: PMC4965440 DOI: 10.4070/kcj.2016.46.4.580] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2015] [Revised: 09/25/2015] [Accepted: 10/01/2015] [Indexed: 11/11/2022] Open
Abstract
Left atrial intramural hematoma is a very rare complication of radiofrequency ablation procedures. A patient with tachyarrhythmia underwent radiofrequency catheter ablation. Echocardiography performed the following morning showed a large mass in the left atrium, suggestive of intramural hematoma formation. The patient was in a stable condition; therefore, it was decided that follow-up should be conservative and her anticoagulation therapy was continued. The size of the hematoma decreased significantly over the following 50 days. This case highlights a rare complication of a complex catheter ablation procedure in the left atrium that was managed via a noninvasive approach, with which all interventionists should be familiar.
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Affiliation(s)
- Bahieh Moradi
- Department of Echocardiography, Day General Hospital, Tehran, Iran
| | - Saeed Oraii
- Department of Electrophysiology, Day General Hospital, Tehran, Iran
| | | | | | - Javad Mikaeili
- Department of Electrophysiology, Day General Hospital, Tehran, Iran
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32
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Ananthanarayanan C, Bishnoi AK, Ramani J, Gandhi H. Dumb-bell in the heart: rare case of biatrial myxoma with mitral regurgitation. Asian Cardiovasc Thorac Ann 2016; 24:796-797. [PMID: 27357111 DOI: 10.1177/0218492316655640] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Cardiac myxomas are rare intracardiac tumors, and the majority are benign myxomas involving the left atrium. We report a case of the very rare occurrence of biatrial myxoma associated with mitral regurgitation, which was successfully treated.
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Affiliation(s)
| | | | - Jayadip Ramani
- UN Mehta Institute of Cardiology and Research Center, Asarwa, Ahmedabad, India
| | - Hemang Gandhi
- UN Mehta Institute of Cardiology and Research Center, Asarwa, Ahmedabad, India
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33
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Bockeria LA, Bockeria OL, Sanakoev MK, Shvartz VA, Le TG. Additional superior vena cava combined with abnormal inflow of the hepatic vein. Asian Cardiovasc Thorac Ann 2016; 26:566-569. [PMID: 27206782 DOI: 10.1177/0218492316650345] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We represent a case of successful surgical treatment of a rare congenital heart disease: abnormal inflow of an additional superior vena cava into the left atrium, combined with atrial septal defect, mitral and tricuspid valve regurgitation, and abnormal inflow of the left hepatic vein into a roofless coronary sinus.
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34
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Sabzi F. Iatrogenic Diversion of Inferior Vena Cava into Left Atrium after Surgery for a Rare Combination of Congenital Heart Diseases. J Tehran Heart Cent 2016; 11:88-91. [PMID: 27928261 PMCID: PMC5027167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
Atrial septal defect (ASD) is a common congenital anomaly that has low surgical mortality and morbidity. We report a very rare case of a low-lying ASD, combined with the drainage of the inferior vena cava and the left superior vena cava into the left atrium. This combination was associated with an unroofed coronary sinus. We also describe an iatrogenic surgical diversion of the inferior vena cava into the left atrium with its complication. The patient presented with moderate cyanosis and was referred for elective ASD repair. He underwent surgical repair of the ASD after transthoracic echocardiography. Early postoperative right-to-left shunting with cyanosis and hypoxia was associated with abdominal complications. Surgical re-exploration revealed the diversion of the inferior vena cava into the left atrium, which was repaired with a pericardial patch. Peptic ulcer perforation was repaired after abdominal laparotomy. The patient had an uneventful recovery and was discharged home on the 17th postoperative day. One-year follow-up revealed no recurrence of cyanosis or residual ASD on echocardiography.
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Affiliation(s)
- Feridoun Sabzi
- Corresponding Author: Feridoun Sabzi, Professor of Cardiac Surgery, Kermanshah University of Medical Sciences, Imam Ali Hospital, Shaheed Beheshti Ave, Kermanshah, Iran. 6715847134. Tel: +98 918 1311896. Fax: +98 833 8360043..
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35
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Saxena P, Nerlekar N, Zimmet AD. Late presentation of right atrial thrombus following bilateral lung transplant. Asian Cardiovasc Thorac Ann 2015; 25:65-66. [PMID: 26691582 DOI: 10.1177/0218492315623433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A right atrial mass was incidentally detected in an immunosuppressed 49-year-old woman 5 years after successful bilateral lung transplantation. The mass was surgically excised and found to be an organized thrombus. There was no clear mechanism for the de-novo thrombus formation. The potential mechanisms include immunosuppression-related thrombogenicity, transient pericarditis, and stasis of blood from persisting pulmonary hypertension.
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Affiliation(s)
- Pankaj Saxena
- 1 Department of Cardiothoracic Surgery, The Alfred Hospital, Prahran, Melbourne, Australia
| | - Nitesh Nerlekar
- 2 Department of Cardiology, The Alfred Hospital, Prahran, Melbourne, Australia
| | - Adam D Zimmet
- 1 Department of Cardiothoracic Surgery, The Alfred Hospital, Prahran, Melbourne, Australia
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36
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Garcia-Villarreal OA. Superior septal approach for mitral valve surgery. Interact Cardiovasc Thorac Surg 2015; 22:249-51. [PMID: 26534911 DOI: 10.1093/icvts/ivv298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2015] [Accepted: 09/21/2015] [Indexed: 11/12/2022] Open
Abstract
Superior septal approach is a very useful technique to address the mitral valve surgery. Since this approach virtually divides the left atrium in two parts between the ascending aorta and the superior vena cava, mitral valve exposure becomes quite easy. We present a case of mitral valve repair by means of this approach.
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37
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Lim HE, Na JO, Im SI, Choi CU, Kim SH, Kim JW, Kim EJ, Han SW, Rha SW, Park CG, Seo HS, Oh DJ, Hwang C. Interatrial septal thickness as a marker of structural and functional remodeling of the left atrium in patients with atrial fibrillation. Korean J Intern Med 2015; 30:808-20. [PMID: 26552456 PMCID: PMC4642010 DOI: 10.3904/kjim.2015.30.6.808] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/12/2014] [Revised: 08/26/2014] [Accepted: 09/23/2014] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND/AIMS There have been reports that interatrial septal (IAS) thickness is increased in patients with atrial fibrillation (AF). This study was performed to investigate whether IAS thickness determined by transthoracic echocardiography (TTE) represents the amount of left atrium (LA) structural and functional remodeling. METHODS The study population consisted of 104 consecutive patients who underwent catheter ablation (CA) for AF (paroxysmal atrial fibrillation [PAF], 82; persistent atrial fibrillation [PeAF], 22). IAS thickness and left atrium volume (LAV) using TTE, and LA voltage (LA(VOL)) using 3-dimensional electroanatomical mapping system were assessed during sinus rhythm. RESULTS IAS thickness was significantly correlated with maximal LAV (LAV(max)) (r = 0.288, p = 0.003), mean LA(VOL) (r = -0.537, p < 0.001), total left atrium emptying fraction (LAEF(total); r = -0.213, p = 0.030), and active LAEF (LAEF(active); r = -0.249, p = 0.014). IAS thickness was greater in the high-risk group (≥ 2) compared to other groups according to CHA2DS2-VASc score (p = 0.019). During a follow-up of 19.6 months, 23 subjects (22.1%; PAF, 17; PeAF, 6) had recurrence of arrhythmia. Univariate analysis showed that LAV(max), minimal LAV, mean LA(VOL), LVEF(total), LVEF(active), and IAS thickness were associated with recurrence of arrhythmia. However, on multivariate analysis, only mean LA(VOL) and LAEF(active) were independent risk factors for recurrence. CONCLUSIONS Although IAS thickness showed significant correlations with parameters for LA structural and functional remodeling, this parameter alone could not independently predict recurrence of arrhythmia after CA for AF.
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Affiliation(s)
- Hong Euy Lim
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Jin Oh Na
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
- Correspondence to Jin Oh Na, M.D. Cardiovascular Center, Korea University Guro Hospital, 148 Gurodong- ro, Guro-gu, Seoul 08308, Korea Tel: +82-2-2626-3025 Fax: +82-2-863-1109 E-mail:
| | - Sung Il Im
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Cheol Ung Choi
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Seong Hwan Kim
- Division of Cardiology, Department of Internal Medicine, Korea University Ansan Hospital, Ansan, Korea
| | - Jin Won Kim
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Eung Ju Kim
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Seong Woo Han
- Division of Cardiology, Department of Internal Medicine, Hallym University Hangang Sacred Heart Hospital, Seoul, Korea
| | - Seung-Woon Rha
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Chang Gyu Park
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Hong Seog Seo
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Dong Joo Oh
- Cardiovascular Center, Korea University Guro Hospital, Seoul, Korea
| | - Chun Hwang
- Division of Cardiology, Utah Valley Regional Medical Center, Provo, UT, USA
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Rezahosseini O, Rezaei M, Ahmadi Tafti SH, Jalali A, Bina P, Ghiasi A, Karimi A, Abbasi K, Shirzad M, Davoodi S, Salehi Omran A. Transseptal Approach versus Left Atrial Approach to Mitral Valve: A Propensity Score Matching Study. J Tehran Heart Cent 2015; 10:188-93. [PMID: 26985207 PMCID: PMC4791647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/29/2022] Open
Abstract
BACKGROUND Many patients with mitral valve diseases need surgical procedures for the repair or replacement of their mitral valve. There is a great deal of controversy over the outcomes of the transseptal (TS) and left atrial (LA) approaches to the mitral valve. We sought to evaluate the outcomes of each approach more accurately by eliminating the possible biases in case selection and matching. METHODS This retrospective study included patients who had surgery for mitral valve diseases via either the TS approach or the LA approach between 2004 and 2011 in Tehran Heart Center. Patients with surgical approaches other than the TS and LA were excluded. To control for the confounding effects, a propensity score matching technique was applied and the patients were matched for 14 demographic and preoperative variables. After the selection of controls, the effect of the TS approach (163 patients) versus the LA approach (652 patients) on the outcomes was presented through odds ratio (OR) with 95% confidence intervals (CI). RESULTS The mean age of the patients was 53.15 ± 12.02 years in the TS group and 52.93 ± 13.56 years in the LA group. Females comprised 119 (73.0%) patients in the TS group and 462 (70.9%) in the LA group. There was a significant association in the prevalence of new postoperative atrial fibrillation in the two groups (OR = 1.539, 95%CI: 1.072-2.210; p value = 0.019). Temporary pacemaker placement had no statistically significant difference between the two groups (p value = 0.418). The TS patients had significantly longer pump (p value < 0.001) and cross-clamp (p value < 0.001) times. The mortality rate was 4.1% (27 patients) in the LA group and 6.1% (10 patients) in the TS group (p value = 0.274). CONCLUSION In our study population, the TS approach was associated with higher pump and cross-clamp times as well as risk of postoperative atrial fibrillation, but it did not increase the rates of permanent pacemaker placement, re-operations, and mortality.
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Affiliation(s)
| | - Mohamadreza Rezaei
- Corresponding Author: Mohammadreza Rezaee, Assistant Professor of Cardiac Surgery, North Kargar Street, Tehran Heart Center, Tehran, Iran.1411713138. Tel: +98 21 88029256. Fax: +98 21 88029256..
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Tamenishi A, Nishi T, Okamoto H. Intrapericardial lipoma compressing the right atrium. Asian Cardiovasc Thorac Ann 2015; 24:881-883. [PMID: 26187459 DOI: 10.1177/0218492315594070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
We report a case of intrapericardial lipoma compressing the right atrium. Cardiac lipomas are very rare benign tumors that may cause life-threatening complications by rapid growth. A 67-year-old woman presented with dyspnea and palpitations on effort due to compression of the right atrium. The tumor was surgically resected. There was no local recurrence after surgery.
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Affiliation(s)
- Akinori Tamenishi
- Department of Cardiovascular Surgery, Yokkaichi Municipal Hospital, Yokkaichi, Japan
| | - Toshihiko Nishi
- Department of Cardiovascular Surgery, Yokkaichi Municipal Hospital, Yokkaichi, Japan
| | - Hiroshi Okamoto
- Department of Cardiovascular Surgery, Yokkaichi Municipal Hospital, Yokkaichi, Japan
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40
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García-Villarreal OA. Mini-partial heart autotransplantation: a different way to perform the Cox-maze III. Interact Cardiovasc Thorac Surg 2015; 21:147-50. [PMID: 25956756 DOI: 10.1093/icvts/ivv121] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 04/17/2015] [Indexed: 11/13/2022] Open
Abstract
The Cox-maze III procedure is the gold standard for the surgical treatment of atrial fibrillation. Because of its complexity, this procedure has not been widely accepted by cardiac surgeons. We describe a technique that allows one to work on the mitral valve while more safely performing the standard 'cut-and-sew' Cox-maze III procedure at the same time.
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Abstract
BACKGROUND Pulmonary vein isolation has been employed to eliminate paroxysmal atrial fibrillation. However, the long-term outcome in terms of long-standing persistent atrial fibrillation is unclear. METHODS One hundred patients with rheumatic mitral valve disease and long-standing (>1 year) persistent atrial fibrillation were operated on between July 1998 and June 2007. Mitral valve surgery and surgical isolation (cut-and-sew) of the pulmonary veins were performed in all cases. Transthoracic echocardiography and 24-h Holter monitoring were obtained after 3 and 6 months and yearly thereafter. RESULTS Early and late follow-up was 99% and 92% complete, respectively. The endpoint was freedom from atrial fibrillation. There was one (1%) hospital death. Atrial fibrillation was present in 39%, 47%, 63% and 68% of patients at 3 months, 1 year, 3 years, and 5 years after surgery, respectively. The odds ratios for recurrence of atrial fibrillation postoperatively were 1.41 (95% confidence interval 1.14-1.74), 2.17 (95% confidence interval 1.63-2.90), and 3.62 (95% confidence interval 2.44-5.38) at 1 week, 3 years, and 5 years, respectively. Actuarial freedom from atrial fibrillation was 35% at 3 years, and 30% at 5 years. A direct relationship was observed between preoperative left atrial size >6 cm and atrial fibrillation recurrence at 5 years (p < 0.05 odds ratio = 2.5, 95% confidence interval 1.15 - 5.4). CONCLUSIONS No beneficial effects of simple pulmonary vein isolation for long-standing persistent atrial fibrillation concomitant with rheumatic mitral valve disease were observed. Atrial fibrillation cannot be fully treated using only pulmonary vein isolation.
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Sabzi F. Huge Left Atrium Accompanied by Normally Functioning Prosthetic Valve. J Tehran Heart Cent 2015; 10:53-7. [PMID: 26157465 PMCID: PMC4494521] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Accepted: 04/10/2013] [Indexed: 10/26/2022] Open
Abstract
Giant left atria are defined as those measuring larger than 8 cm and are typically found in patients who have rheumatic mitral valve disease with severe regurgitation. Enlargement of the left atrium may create compression of the surrounding structures such as the esophagus, pulmonary veins, respiratory tract, lung, inferior vena cava, recurrent laryngeal nerve, and thoracic vertebrae and lead to dysphagia, respiratory dysfunction, peripheral edema, hoarse voice, or back pain. However, a huge left atrium is usually associated with rheumatic mitral valve disease but is very rare in a normally functioning prosthetic mitral valve, as was the case in our patient. A 46-year-old woman with a past medical history of mitral valve replacement and chronic atrial fibrillation was admitted to our hospital with a chief complaint of cough and shortness of breath, worsened in the last month. Physical examination showed elevated jugular venous pressure, respiratory distress, cardiac cachexia, heart failure, hepatomegaly, and severe edema in the legs. Chest radiography revealed an inconceivably huge cardiac sell-out. Transthoracic echocardiography demonstrated a huge left atrium, associated with thrombosis, and normal function of the prosthetic mitral valve. Cardiac surgery with left atrial exploration for the extraction of the huge thrombosis and De Vega annuloplasty for tricuspid regurgitation were carried out. The postoperative course was eventful due to right ventricular failure and low cardiac output syndrome; and after two days, the patient expired with multiple organ failure. Thorough literature review showed that our case was the largest left atrium (20 × 22 cm) reported thus far in adults with a normal prosthetic mitral valve function.
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Affiliation(s)
- Feridoun Sabzi
- Corresponding Author: Feridoun Sabzi, Professor of Cardiac Surgery, Kermanshah University of Medical Sciences, Imam Ali Hospital, Shahid Beheshti Ave., Kermanshah, Iran. Tel: +98 9181311896. Fax: +98 831 8360043. E-mail:
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Kang MY, Hsieh SR. Type A dissection and fistula to right atrium after aortic valve replacement. Asian Cardiovasc Thorac Ann 2014; 24:367-9. [PMID: 25406403 DOI: 10.1177/0218492314559983] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A 73-year-old man with a history of severe aortic regurgitation underwent aortic valve replacement with a bioprosthesis. Nine years later, he presented with heart failure and was diagnosed with chronic type A dissection and severe aortic stenosis. During surgery, a fistula from the ascending aortic aneurysm to the right atrium was found incidentally. Replacement of the aortic valve and ascending aorta were performed successfully. The fistula was closed with sutures. The patient was discharged uneventfully on postoperative day 16.
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Affiliation(s)
- Ming-Yuan Kang
- Cardiovascular Center of Taichung Veterans General Hospital, Taichung, Taiwan
| | - Shih-Rong Hsieh
- Cardiovascular Center of Taichung Veterans General Hospital, Taichung, Taiwan
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Albackr HB. A large Right atrial mass in a patient with hepatocellular carcinoma: Case report and literature review. J Saudi Heart Assoc 2014; 26:174-8. [PMID: 24954992 PMCID: PMC4062757 DOI: 10.1016/j.jsha.2014.02.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2014] [Revised: 02/10/2014] [Accepted: 02/11/2014] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) is a common malignancy and the most frequent sites of metastasis include lungs, bone, lymphatic, and brain, however, Intra-cardiac involvement rarely develops in patients with HCC and it has poor prognosis. The clinical course may be complicated by many fatal cardiovascular complications. Absence of cardiac symptoms, however, is an unusual condition. CASE REPORT We reported a rare case of hepatocellular carcinoma with large invasion into the right atrium and no cardiac symptoms. CONCLUSION Cardiac metastases occur in 10% of all cancer patients. Heart involvement should be suspected in all patients.
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Affiliation(s)
- Hanan B. Albackr
- King Fahad Cardiac Center, King Khalid University Hospital College of Medicine, King Saud University
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Sharma D, Dorgan E, Douglas H, Trouton T, McMullan R, Parissis H. Aspergillus infection in pulmonary cavitating lesions with right atrial myxoma. Asian Cardiovasc Thorac Ann 2014; 22:1090-2. [PMID: 24887845 DOI: 10.1177/0218492313492439] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Cardiac myxomas are rare primary tumors with varied clinical presentations that may pose a diagnostic challenge. Here, we describe the case of a 21-year-old man with multiple cavitating lung lesions with aspergillosis and underlying right atrial myxoma, who presented with hemoptysis and weight loss. He was successfully treated with right atrial myxoma resection and antifungal agents, with no recurrence or complications after one year of follow-up.
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Affiliation(s)
- Divyesh Sharma
- The Heart Center, Cardiology and Cardiac Surgery Department, Royal Victoria Hospital, Belfast, UK
| | - Eileen Dorgan
- Department of Microbiology, Belfast Health and Care Trust, Belfast, UK
| | | | - Tom Trouton
- Cardiology Department, Antrim Area Hospital, Antrim, UK
| | - Ronan McMullan
- Department of Microbiology, Belfast Health and Care Trust, Belfast, UK
| | - Haralabos Parissis
- The Heart Center, Cardiology and Cardiac Surgery Department, Royal Victoria Hospital, Belfast, UK
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Nakamura T, Ito H, Sakata K, Kobayashi Y. Rapidly progressing left atrial hemangiopericytoma. Asian Cardiovasc Thorac Ann 2014; 23:1056-9. [PMID: 24696103 DOI: 10.1177/0218492314530979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Cardiac hemangiopericytoma is a rare soft tissue tumor. We describe a case of hemangiopericytoma in the left atrium, which was diagnosed as myxoma preoperatively. A 70-year-old woman was admitted with heart failure. An echocardiogram showed a large myxoma-like mass in the left atrium, herniating into the left ventricle; therefore, an emergency operation was performed. Histological examination revealed a malignant hemangiopericytoma. The patient's postoperative course was uneventful, but she died due to a local recurrence 4 months after the operation.
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Affiliation(s)
- Tamami Nakamura
- Department of Cardiovascular Surgery, Saiseikai Shimonoseki General Hospital, Yamaguchi, Japan
| | - Hiroshi Ito
- Department of Cardiovascular Surgery, Saiseikai Shimonoseki General Hospital, Yamaguchi, Japan
| | - Kensuke Sakata
- Department of Cardiovascular Surgery, Saiseikai Shimonoseki General Hospital, Yamaguchi, Japan
| | - Yurio Kobayashi
- Department of Cardiovascular Surgery, Saiseikai Shimonoseki General Hospital, Yamaguchi, Japan
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Sun HR, Tang H, Song HB. Ball thrombus in the right atrium after patch closure of atrial septal defect. Heart Lung Circ 2014; 23:e152-3. [PMID: 24613187 DOI: 10.1016/j.hlc.2014.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 02/05/2014] [Indexed: 02/05/2023]
Affiliation(s)
- Hao-Rui Sun
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hong Tang
- Department of Echocardiography, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Hai-Bo Song
- Department of Anaesthesiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China.
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Abstract
Surgical excision of the left atrial appendage is an essential key in the Cox maze IV procedure. Management of very thin, friable, and delicate tissue in the base of the left atrial appendage can be difficult. We have designed a simple method to expose adequately without handling the base of the left atrial appendage. With this technique, the risk of bleeding due to excessive traction or manipulation of the heart is dramatically reduced.
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Chong A, Wahi S, Harvey R, Finn C, Shah P, Gould P. An unusual cause of pulmonary edema. Asian Cardiovasc Thorac Ann 2014; 22:338-41. [PMID: 24585913 DOI: 10.1177/0218492312470117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Primary cardiac tumors are rare malignancies. Patients may present with congestive cardiac failure due to intracavitary obstruction to blood flow, valvular dysfunction, embolic phenomena, local invasion resulting in arrhythmias, pericardial involvement, constitutional symptoms, or paraneoplastic syndromes. We describe the case of a previously fit 79-year-old woman who presented with acute pulmonary edema due to a large left atrial pleomorphic sarcoma causing severe functional mitral stenosis. She underwent palliative debulking surgery with good symptomatic relief.
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Affiliation(s)
- Adrian Chong
- Department of Cardiology, Princess Alexandra Hospital, Ipswich Road, Woolloongabba, Queensland, Australia
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Affiliation(s)
- Behnam Dalfardi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran; Research Office for the History of Persian Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
| | - Hassan Yarmohammadi
- Student Research Committee, Shiraz University of Medical Sciences, Shiraz, Iran; Research Office for the History of Persian Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
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