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Sakamoto T, Asanuma T, Uchida K, Kawahara H, Endo A, Yoshitomi H, Tanabe K. Evaluation of thyroid congestion in patients with heart failure using shear wave elastography: An observational study. Medicine (Baltimore) 2024; 103:e38159. [PMID: 38728476 PMCID: PMC11081585 DOI: 10.1097/md.0000000000038159] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2024] [Accepted: 04/17/2024] [Indexed: 05/12/2024] Open
Abstract
Shear wave elastography (SWE) is a noninvasive method for measuring organ stiffness. Liver stiffness measured using SWE reflects hepatic congestion in patients with heart failure (HF). However, little is known about the use of SWE to assess other organ congestions. This study aimed to evaluate the utility of SWE for assessing not only the liver but also thyroid congestion in patients with HF. This prospective study included 21 patients with HF who have normal thyroid lobes (age: 77.0 ± 11.0, men: 14). Thyroid and liver stiffness were measured by SWE using the ARIETTA 850 ultrasonography system (Fujifilm Ltd., Tokyo, Japan). SWE of the thyroid was performed on B-mode ultrasonography; a target region was identified within a region of interest. SWE was performed in each lobe of the thyroid gland. Five measurements were taken at the same location and the averages were recorded for comparison. We investigated the relationship between SWE for evaluating thyroid stiffness and the clinical characteristics of patients with HF. SWE of the thyroid was significantly correlated with SWE of the liver (R = 0.768, P < .001), thyroid stimulation hormone (R = 0.570, P = .011), free thyroxine (R = 0.493, P = .032), estimated right atrial pressure (RAP; R = 0.468, P = .033), and composite congestion score (R = 0.441, P = .045). SWE may be useful for evaluating thyroid stiffness and assessing the degree of thyroid congestion. Thyroid congestion may reflect the elevation of RAP and cause thyroid dysfunction through organ congestion.
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Affiliation(s)
- Takahiro Sakamoto
- Division of Cardiology, Shimane University Faculty of Medicine, Shimane, Japan
- Division of Cardiology, Masuda Red Cross Hospital, Shimane, Japan
- Department of Heart Failure and Transplant, National Cerebral and Cardiovascular Center, Osaka, Japan
| | - Toshihiko Asanuma
- Division of Cardiology, Shimane University Faculty of Medicine, Shimane, Japan
| | - Kazuhiko Uchida
- Division of Cardiology, Masuda Red Cross Hospital, Shimane, Japan
| | - Hiroshi Kawahara
- Division of Cardiology, Shimane University Faculty of Medicine, Shimane, Japan
| | - Akihiro Endo
- Division of Cardiology, Shimane University Faculty of Medicine, Shimane, Japan
| | - Hiroyuki Yoshitomi
- Department of Clinical Laboratory, Shimane University Hospital, Shimane, Japan
| | - Kazuaki Tanabe
- Division of Cardiology, Shimane University Faculty of Medicine, Shimane, Japan
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Abozied O, Miranda WR, Connolly HM, Younis A, Ahmed M, Kamath PS, Egbe AC. Temporal Change in Hepatic and Renal Function After Pulmonary Valve Replacement in Adults With Tetralogy of Fallot. Am J Cardiol 2023; 206:40-41. [PMID: 37677883 PMCID: PMC10827362 DOI: 10.1016/j.amjcard.2023.08.074] [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] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2023] [Revised: 08/05/2023] [Accepted: 08/12/2023] [Indexed: 09/09/2023]
Affiliation(s)
| | | | | | | | | | - Patrick S Kamath
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
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Oka H, Nakau K, Nakagawa S, Imanishi R, Shimada S, Mikami Y, Fukao K, Iwata K, Takahashi S. Liver T1/T2 values with cardiac MRI during respiration. Cardiol Young 2023; 33:1859-1865. [PMID: 36281881 DOI: 10.1017/s1047951122003274] [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] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND Assessing the hepatic status of children with CHD is very important in the post-operative period. This study aimed to assess the usefulness of paediatric liver T1/T2 values and to evaluate the impact of respiration on liver T1/T2 values. METHODS Liver T1/T2 values were evaluated in 69 individuals who underwent cardiac MRI. The mean age of the participants was 16.2 ± 9.8 years. Two types of imaging with different breathing methods were possible in 34 participants for liver T1 values and 10 participants for liver T2 values. RESULTS The normal range was set at 620-830 msec for liver T1 and 25-40 ms for liver T2 based on the data obtained from 17 healthy individuals. The liver T1/T2 values were not significantly different between breath-hold and free-breath imaging (T1: 769.4 ± 102.8 ms versus 763.2 ± 93.9 ms; p = 0.148, T2: 34.9 ± 4.0 ms versus 33.6 ± 2.4 ms; p = 0.169). Higher liver T1 values were observed in patients who had undergone Fontan operation, tetralogy of Fallot operation, or those with chronic viral hepatitis. There was a trend toward correlation between liver T1 values and liver stiffness (R = 0.65, p = 0.0004); and the liver T1 values showed a positive correlation with the shear wave velocity (R = 0.62, p = 0.0006). CONCLUSIONS Liver T1/T2 values were not affected by breathing patterns. Because liver T1 values tend to increase with right heart overload, evaluation of liver T1 values during routine cardiac MRI may enable early detection of future complications.
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Affiliation(s)
- Hideharu Oka
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
| | - Kouichi Nakau
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
| | - Sadahiro Nakagawa
- Section of Radiological Technology, Department of Medical Technology, Asahikawa Medical University Hospital, Hokkaido, Japan
| | - Rina Imanishi
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
| | - Sorachi Shimada
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
| | - Yuki Mikami
- Section of Radiological Technology, Department of Medical Technology, Asahikawa Medical University Hospital, Hokkaido, Japan
| | - Kazunori Fukao
- Section of Radiological Technology, Department of Medical Technology, Asahikawa Medical University Hospital, Hokkaido, Japan
| | - Kunihiro Iwata
- Section of Radiological Technology, Department of Medical Technology, Asahikawa Medical University Hospital, Hokkaido, Japan
| | - Satoru Takahashi
- Department of Pediatrics, Asahikawa Medical University, Hokkaido, Japan
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Malick H, Itani S, Gunn DC, Gupta A, Testa G, Ramamoorthy S. An Approach to Anesthetic Management of Venous Anomalies and Outflow Reconstruction in Liver Transplants. Cureus 2023; 15:e44059. [PMID: 37746456 PMCID: PMC10517724 DOI: 10.7759/cureus.44059] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2023] [Indexed: 09/26/2023] Open
Abstract
Hepatic venous outflow is a pivotal factor in liver transplant. However, venous anomalies and the potential for hepatic venous congestion continue to remain major points of concern to ensure the viability of transplanted livers and maximize regenerative capacity. We present a 66-year-old patient undergoing liver transplantation who was found to have anomalous venous drainage requiring venous anastomoses. To ensure adequate venous flow and minimize the possibility of graft congestion and liver dysfunction, the anesthetic management of the patient's hemodynamic status was of utmost importance. The use of osmotic diuretics and intraoperative sonography was used to ensure adequate perfusion.
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Affiliation(s)
- Hamza Malick
- College of Medicine, Texas A&M College of Medicine, Dallas, USA
| | - Sabine Itani
- College of Medicine, Texas A&M College of Medicine, Bryan, USA
| | - Daniel C Gunn
- Department of Anesthesiology, Baylor University Medical Center, Dallas, USA
| | - Amar Gupta
- Department of Transplant Surgery, Baylor University Medical Center, Dallas, USA
| | - Giuliano Testa
- Department of Transplant Surgery, Baylor University Medical Center, Dallas, USA
| | - Saravanan Ramamoorthy
- Anesthesiology and Perioperative Medicine, US Anesthesia Partners, Dallas, USA
- Department of Anesthesiology, Baylor University Medical Center, Dallas, USA
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Oka H, Nakau K, Shibagaki Y, Ito K, Sasaki Y, Imanishi R, Shimada S, Takahashi S. Liver Fibrosis Markers Represent Central Venous Pressure in Post-pubertal Patients With Congenital Heart Disease. Cureus 2023; 15:e39845. [PMID: 37397670 PMCID: PMC10314810 DOI: 10.7759/cureus.39845] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/01/2023] [Indexed: 07/04/2023] Open
Abstract
Background Central venous pressure (CVP) is one of the most important hemodynamic parameters in patients with congenital heart disease (CHD). In adults, it is well-known that liver fibrosis markers reflect CVP, but this is not well-understood in children. We investigated the liver fibrosis markers in pediatric CHD patients and their ability to predict CVP. Methods We studied 160 patients who underwent cardiac catheterization in our hospital between January 2017 and December 2020. The levels of the fibrotic markers, including type IV collagen 7s, procollagen type III peptide, and hyaluronic acid, were measured. Results Procollagen type III peptide was markedly elevated in infants younger than one year of age. From one to 15 years of age, it was slightly lower than in the infant group, with a peak at around 10 years of age. In the age group of 16 years and older, most of its values were generally high. Type IV collagen 7s and hyaluronic acid levels were high in infants, with no significant differences at later ages. Procollagen type III peptide and hyaluronic acid showed no significant correlation with CVP in any of the age groups, whereas type IV collagen 7s significantly correlated with CVP in the age group above one year old. Conclusions We found that elevated liver fibrosis markers, particularly type IV collagen 7s, correlated with central venous pressure in CHD patients older than one year. Measurement of liver fibrosis markers may allow the early detection of changes in CVP and liver function in patients with CHD.
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Affiliation(s)
- Hideharu Oka
- Pediatrics, Asahikawa Medical University, Asahikawa, JPN
| | - Kouichi Nakau
- Pediatrics, Asahikawa Medical University, Asahikawa, JPN
| | - Yuki Shibagaki
- Pediatrics, Asahikawa Medical University, Asahikawa, JPN
| | - Keita Ito
- Pediatrics, Asahikawa Medical University, Asahikawa, JPN
| | - Yuki Sasaki
- Pediatrics, Asahikawa Medical University, Asahikawa, JPN
| | - Rina Imanishi
- Pediatrics, Asahikawa Medical University, Asahikawa, JPN
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Muacevic A, Adler JR, Ishak C, Soliman M. Spontaneous Hepatic Hemorrhage: An Unexpected Complication From Enoxaparin. Cureus 2023; 15:e33371. [PMID: 36751217 PMCID: PMC9897719 DOI: 10.7759/cureus.33371] [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] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/04/2023] [Indexed: 01/06/2023] Open
Abstract
Spontaneous hepatic hemorrhage (SHH) is a rare condition that occurs due to a breach in the liver parenchyma in the absence of an external cause, most commonly from hepatocellular cancer. If a solid liver lesion is absent, then it has been linked with diffuse hepatic diseases or systemic diseases. Although SHH has been linked with the use of warfarin, it has not been thus far linked with enoxaparin. SHH can present with non-specific symptoms, and lab parameters can reveal substantial drops in hemoglobin. It is diagnosed most commonly with computed tomography (CT) imaging and conservative treatment is effective in the majority of cases. We present one such rare case of SHH.
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Abdelaal AM, Raouf MAE, Aref MA, Moselhy AA. Clinical and ultrasonographic investigations of 30 water buffaloes ( Bubalus bubalis) with hepatomegaly. Vet World 2019; 12:789-795. [PMID: 31439995 PMCID: PMC6661495 DOI: 10.14202/vetworld.2019.789-795] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [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: 02/11/2019] [Accepted: 04/22/2019] [Indexed: 11/16/2022] Open
Abstract
Background and Aim: Knowledge of normal ultrasonographic dimensions of the liver and associated vascular structures is an important indicator for the diagnosis of hepatic diseases. Enlargement of the liver beyond its normal dimensions is the term of hepatomegaly and ultrasonography is the primary and the suitable diagnostic technique for this condition. Therefore, this study aimed to describe the clinical and ultrasonographic findings of liver diseases causing hepatomegaly in 30 buffaloes as well as to provide a range of liver dimensions and its blood vessel measurements in normal and diseased buffaloes. Materials and Methods: The study population included 30 buffaloes that were admitted to the clinic of the Faculty of Veterinary Medicine – Zagazig University for investigation of clinical signs associated with gastrointestinal diseases such as anorexia, chronic weight loss, and variable degrees of diarrhea or constipation. The animals were subjected to thorough clinical and ultrasonographic investigations. In addition, 10 healthy buffaloes were investigated ultrasonographically and post-slaughtering for comparison of liver dimensions and physical appearance. Results: Three conditions causing hepatomegaly were identified in this study as multiple focal hepatic lesions, diffuse fatty liver, and hepatic congestion. Clinically, it was difficult to differentiate between each condition while ultrasonography was the ideal tool for diagnosis after comparing with necropsy as a gold standard tool. Hepatomegaly was recorded in all affected animals with a significant decrease in the size of the portal vein (PV) and caudal vena cava (CVC) in animals affected with multiple focal hepatic lesions and fatty liver disease while the size of the PV and CVC was significantly increased in buffaloes with hepatic congestion. Conclusion: Ultrasonography can aid to accurately identify buffaloes with hepatomegaly and differentiate between different lesions involved.
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Affiliation(s)
- A M Abdelaal
- Department of Animal Medicine, Faculty of Veterinary Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - M Abd El Raouf
- Department of Surgery, Anesthesiology and Radiology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - M A Aref
- Department of Anatomy and Embryology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, 44519, Egypt
| | - A A Moselhy
- Department of Anatomy and Embryology, Faculty of Veterinary Medicine, Zagazig University, Zagazig, 44519, Egypt
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Yastrebov K, Kapalli T. Malposition of Double Lumen Bicaval Venovenous Extracorporeal Membrane Oxygenation (VV ECMO) cannula resulting in hepatic venous congestion. Australas J Ultrasound Med 2015; 16:193-197. [PMID: 28191197 PMCID: PMC5030055 DOI: 10.1002/j.2205-0140.2013.tb00247.x] [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] [Indexed: 11/29/2022] Open
Abstract
Introduction: Optimal positioning of double lumen bicaval canula for extracorporeal membrane oxygenation (ECMO) support used as a rescue measure in refractory hypoxaemia is essential to facilitate adequate oxygenation, prevent recirculation and avoid complications. Method: Echocardiography via transoesophageal or transthoracic windows can be used as guidance and as a surveillance technique to prevent cannula malposition. We describe a case of Double‐Lumen Bicaval VV ECMO cannula malposition leading to a massive retrograde hepatic venous flow. Conclusion: Rapid echocardiographic diagnosis was pivotal in preventing potentially fatal complications.
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Affiliation(s)
- Konstantin Yastrebov
- Department of Intensive Care Medicine St George Hospital Kogarah New South Wales Australia
| | - Tejo Kapalli
- Department of Intensive Care Medicine St George Hospital Kogarah New South Wales Australia
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Abstract
Renal dysfunction (RD) in heart failure portends adverse outcomes and often limits aggressive medical and decongestive therapies. Despite the high prevalence in this population, not all forms of RD are prognostically or mechanistically equivalent: RD can result from irreversible nephron loss secondary to diabetic or hypertensive kidney disease or it can develop secondary to heart failure (HF) itself, i.e., the cardiorenal syndrome. Furthermore, filtration is only one aspect of renal performance such that significant renal impairment secondary to cardiorenal syndrome can exist despite a normal glomerular filtration rate. Renal biomarkers have the potential to inform some of the intricacies involved in accurately assessing cardiorenal interactions. This article discusses novel biomarkers for cardiorenal syndrome and their utility in the prognosis, diagnosis, and targeted treatment of heart failure-induced RD.
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Affiliation(s)
- Meredith A Brisco
- Division of Cardiology, Advanced Heart Failure and Cardiac Transplantation, Medical University of South Carolina, 25 Courtenay Drive, ART 7061, MSC 592, Charleston, SC, 29425-5920, USA,
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Abstract
Heart failure (HF) is characterized by the inability of systemic perfusion to meet the body's metabolic demands and is usually caused by cardiac pump dysfunction and may occasionally present with symptoms of a noncardiac disorder such as hepatic dysfunction. The primary pathophysiology involved in hepatic dysfunction from HF is either passive congestion from increased filling pressures or low cardiac output and the consequences of impaired perfusion. Passive hepatic congestion due to increased central venous pressure may cause elevations of liver enzymes and both direct and indirect serum bilirubin. Impaired perfusion from decreased cardiac output may be associated with acute hepatocellular necrosis with marked elevations in serum aminotransferases. Cardiogenic ischemic hepatitis ("shock liver") may ensue following an episode of profound hypotension in patients with acute HF. We discuss pathophysiology and identification of liver abnormalities that are commonly seen in patients with HF.
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Affiliation(s)
- Alicia M Alvarez
- Department of Internal Medicine, Texas Tech University Health Sciences Center, El Paso, TX
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