Pulmonary Hypertension Related to Left-Sided Cardiac Pathology

Pulmonary hypertension (PH) is the end result of a variety of diverse pathologic processes. The chronic elevation in pulmonary artery pressure often leads to right ventricular pressure overload and subsequent right ventricular failure. In patients with left-sided cardiac disease, PH is quite common and associated with increased morbidity and mortality. This article will review the literature as it pertains to the epidemiology, pathogenesis, and diagnosis of PH related to aortic valve disease, mitral valve disease, left ventricular systolic and diastolic dysfunction, and pulmonary veno-occlusive disease. Moreover, therapeutic strategies, which focus on treating the underlying cardiac pathology will be discussed

952-30 Left Ventricular Ejection Performance Improves Late After Aortic Valve Replacement in Patients with Aortic Stenosis and Reduced Ejection Fraction

To assess the time course and magnitude of change in left ventricular (LV) wall stress and ejection performance indices, 24 patients undergoing aortic valve replacement (AVR) for aortic stenosis were prospectively evaluated. Each patient underwent resting radionuclide angiography (RNA), echocardiography, and cardiac catheterization (high fidelity pressure) before AVR, then RNA and echocardiogram at one week and six months after AVR. Patients were stratified by preoperative ejection fraction (EF) into reduced EF (<50%) and normal EF (≥50%) groups.Pre-operatively, peak positive dp/dt was lower in the reduced EF group (1300 vs 1700mmHg/sec, p=0.035), and wall stress was elevated similarly in both groups (p=NS).Temporal Relationships of EF and Wall StressPre-op1 Week6 MosNormal EF (n=14)Mean Ejection Fraction (%)666468Mean Wall Stress (dyne/cm2×103)623444Reduced EF (n=10)Mean Ejection Fraction (%)383757Mean Wall Stress (dyne/cm2×103)785261Wall stress was reduced at one week post-operatively (p<0.005) in both groups. Ejection fraction remained depressed in the reduced EF group. By six months, however, EF had dramatically improved in the reduced EF group (p=0.002).ConclusionIn patients with LV dysfunction, EF remains low one week after AVR despite rectification of afterload mismatch. At six months, however, ejection performance improves. Therefore, when measured by ejection phase indices, the surgical benefit from AVR is not evident until late post-operatively

Sevilla, Spain. The chalcolithic mega-site of Valencina de la Concepción (Sevilla), Spain. Results of the fieldwork from 2018 to 2020

The chalcolithic site of Valencina de la Concepción is located in Andalusia, in southern Spain, on the western edge of the Lower Guadalquivir river basin. The settlement area and a contemporaneous necropolis extend over more than 460 ha, constituting the largest site among a series of chalcolithic mega-­sites located throughout the southwest of the Iberian Peninsula. The project focuses on the history of the chalcolithic settlement of Valencina de la Concepción. The investigations include excavations and field surveys on the agricultural land in the northern area of the archaeological site. Through geomagnetic surveys ten different lines of ditches, forming a total of five different enclosures and a sixth, smaller one could be detected. Besides ditches and pits, six dwelling structures and workshops, partially dug into the geological base, are being excavated. The available information and radiocarbon dates from the ditches and excavated structures indicate a continuous occupation of the settlement of Valencina from 3300/3200 to 2200 cal. BC and allow a hypothetical reconstruction of the different enclosures. Between 2300 and 2200 cal. BC settlement activity in Valencina came almost to an end. There are only a few remains indicating occupation of the site during a final stage of the Early Bronze Age, between 1900 and 1700 cal. BC

EL POBLADO DE LA EDAD DEL COBRE DE VALENCINA DE LA CONCEPCIÓN (SEVILLA): NUEVOS DATOS SOBRE SUS RECINTOS Y ESPACIOS DOMÉSTICOS. CAMPAÑA DE 2018

The second excavation campaign during 2018 in the northern sector of the site of Valencina de la Concepción has documented four Chalcolithic huts with an oval floor plan, semi-excavated in the subsoil, which should have adobe walls, of which the biggest one, UC 447/448, is 6 m long by 3 m wide. Moreover, the largest identified ditch, No. 10, was drilled, which has a V-section, 11 m wide in grid 4 and a maximum depth of 8,50 m according to the drillings made. The main occupation of the sector corresponds to the Middle Chalcolithic, although there are structures assignable to the Early Chalcolithic and more specific occupation of the early Bell-Beakers, Early- Middle Bronze Age and transition from the Late Bronze Age to the Early Iron Age. Otherwise, the geomagnetic surveys of 2018 have covered 14 ha and made it possible to identify a fifth possible enclosure with two parallel ditches, which at least are surrounding the North, Northwest and West sides of the settlement. La segunda campaña de excavación durante 2018 en el sector norte del yacimiento de Valencina de la Concepción ha documentado cuatro cabañas calcolíticas de planta oval, semi-excavadas en el subsuelo, que debían tener paredes de adobes, de las cuales, la de mayores dimensiones, UC 447/448, tiene 6 m de longitud por 3 m de ancho. Por otra parte, se sondeó el foso más grande identificado, el n.º 10, que presenta sección en V, 11 m de ancho en el corte 4 y 8,50 m de profundidad máxima según las perforaciones realizadas. La ocupación principal del sector corresponde al Calcolítico Medio, aunque hay estructuras asignables al Calcolítico Inicial y ocupación más puntual de inicios del Campaniforme, Bronce Antiguo-Medio y transición del Bronce Final al Hierro Inicial. Por otra parte, las prospecciones geomagnéticas de 2018 han abarcado 14 ha y permitido identificar un quinto posible recinto con dos fosos paralelos, los cuales al menos están rodeando el norte, noroeste y oeste del yacimiento.&nbsp

MANAGEMENT OF METASTATIC LESIONS OF THE HUMERUS

The management of patients with metastatic disease of the humerus is a complex and challenging problem. Patients present with varying degrees of bone destruction and medical debilitation. The pattern of metastatic disease spread, with frequent involvement of the lower extremity, especially the proximal femur, often places increased functional demands on the upper extremity for mobility. Optimal treatment requires coordination between the orthopedic surgeon, pathologist, medical oncologist, and radiation oncologist along with close communication with the patient and patient's family to develop a course of treatment that results in pain relief and improved function

Postural exercise abnormalities in symptomatic patients with mitral valve prolapse

AbstractThe hemodynamics of the supine and upright exercise response in 16 symptomatic women with mitral valve prolapse (Group I) was compared with that in 8 asymptomatic normal control women (Group II). All subjects had supine and upright echocardiography and phonocardiography at rest and none demonstrated mitral regurgitation. All participants then underwent same day graded bicycle exercise, with simultaneous radionuclide angiography in both the upright and the supine posture. Catecholamines were measured, and a variety of volumetric and hemodynamic data were obtained.Group I (patients with mitral valve prolapse) demonstrated a reduced exercise tolerance, especially during upright exercise, as measured by both total exercise duration and maximal work load achieved. Mean total catecholamine measurements were similar between the two study groups at comparable mean heart rate, mean blood pressure and mean rate-pressure (double) product. No difference was observed in the ratio of right to left ventricular stroke counts at rest or during exercise regardless of posture, suggesting that exercise-induced mitral regurgitation did not occur.A difference was noted, however, in left ventricular end-diastolic volume index. At rest, Group I patients exhibited a 42% decrease in this index when sitting upright, and this difference from supine values persisted at submaximal (300 kpm/min) and peak work loads (34 and 29% difference, respectively). This contrasted with the control subjects whose upright end-diastolic volumes at rest, at 300 kpm/min and at peak exercise were reduced 21, 10 and 3%, respectively, compared with supine values. Cardiac index measurements reflected the reduced left ventricular end-diastolic volume observed. Other measurements, including ejection fraction, left ventricular end-systolic volume index and peak systolic pressure/end-systolic volume ratio, were similar between the two groups at each posture and level of exercise. The percent stroke volume ejected during each third of systolic ejection was also not remarkably different between the groups.In summary, as compared with control subjects, patients with mitral valve prolapse exhibit an exaggerated reduction in left ventricular end-diastolic volume throughout upright exercise. The associated redaction in cardiac output at each level of exercise may contribute to the reduction in exercise tolerance observed in this symptomatic patient subset