Effect of maintenance hemodialysis on diastolic left ventricular function in end‐stage renal disease

PURPOSE: To analyze the effect of maintenance hemodialysis on left ventricular diastolic function in patients with end-stage renal disease. METHODS: Study population consisted of 42 patients with end-stage renal disease. Before an arteriovenous fistula was surgically created, the patients were evaluated by conventional and Doppler echocardiography and Doppler tissue imaging. Then, the patients undergoing hemodialysis treatment when the arteriovenous fistula was compleated. After the first hemodialysis session (mean 76.14 ± 11.37 days) the second echocardiographic evaluations were performed. RESULTS: Mean age was 58 ± 13 years and 21 (%50) of the patients were female. After maintenance hemodialysis treatment; peak early (E) and peak late (A) diastolic mitral inflow velocities and E/A ratio were not significantly change however the deceleration time of E wave and left atrial diameter were significantly increased. Also there was no change in the early (Em) and late (Am) diastolic myocardial velocities and Em/Am ratios of lateral and septal walls of left ventricular. E/Em ratio was decreased insignificantly. Pulmonary vein velocities and right ventricular functions are remained almost unchanged after hemodialysis treatment. DISCUSSION: The acute and long-term effect of hemodialysis on left ventricular diastolic function is unclearly. Patients with end-stage renal disease treatment with hemodialysis via arteriovenous fistula experience a variety of hemodynamic and metabolic abnormalities that predispose to alterations in left and right ventricular functions. The present study showed that left ventricular diastolic function except left atrial diameter and right ventricular functions were not significantly change, however left ventricular systolic functions were impaired after maintenance hemodialysis treatment in patients with end-stage renal disease. CONCLUSION: It has been suggested that echocardiographic parameters are useful markers for evaluation of left ventricular and right ventricular functions in patients with end-stage renal disease. However, in patients with endstage renal disease treated with hemodialysis, repeated assessment of echocardiographic examinations to observe serial changes in left and right ventricular functions are not yet well established. In this study, we showed that acute changes of volume status and electrolytes and autonomic regulation by hemodialysis session did not affect left ventricular diastolic and right ventricular functions in a relatively long term

Thrombus crossing through a patent foramen ovale

Paradoxical embolism across a patent foramen ovale (PFO) is a rare clinical entity and the thrombus is rarely caught passing through a PFO. A 65-year-old woman presented with dyspnea and pleuritic chest pain. Lower extremity venous Doppler ultrasound showed bilaterally extensive thrombosis at deep veins. Transthoracic echocardiographic examination showed two masses in both left and right atriums. In transesophageal echocardiography (TEE) interatrial septum was thin and aneurysmatic and a thrombus wedged through a patent foramen ovale and lodged in both atriums was demonstrated. We considered this mass as a thrombus crossing through a patent foramen ovale. He refused surgery and during anticoagulation therapy the patient had brachial artery embolism. Embolectomy material was reported as a thrombus. (C) 2007 Elsevier Ireland Ltd. All rights reserved

Fatal Pulmonary Oedema Following Oxytocin Administration in a Pregnant Woman with Acute Myocardial Infarction

Acute myocardial infarction is a rare event in pregnant patients. Mechanical valves are naturally thrombogenic and require careful anticoagulation. Pregnancy produces a hypercoagulable situation and necessitates close follow-up in pregnant patients with mechanical heart valves. We present a 34-year-old pregnant woman who had mitral and aortic valve prosthesis. She developed resistant pulmonary oedema in the post-partum period after myocardial infarction. Oxytocin was used in this patient to induce midterm labour and prevent post-partum bleeding. Issues surrounding management of pulmonary oedema and use of oxytocin therapy during pregnancy are discussed. We emphasize the need for awareness of this condition and call attention to the risk of pulmonary oedema during labour

Severe aortic regurgitation after repair of ruptured sinus of Valsalva aneurysm: The role of Transesophageal Echocardiography

We report a 27-year-old woman who presented with worsening exertional. dyspnea and palpitation. Transthoracic echocardiography showed ventricular septal defect, with left-to-right shunting and mild aortic regurgitation detected. Cardiac catheterization was performed that revealed sinus of Valsalva aneurysm with rupture into the right ventricle. Transesophageal echocardiography (TEE) confirmed a rupture of sinus of Valsalva aneurysm and ventricular septal defect. The patient underwent elective surgical repair of the ruptured sinus and intraoperative TEE demonstrated severe aortic regurgitation after repair and mechanical prosthetic valve was implanted. This case illustrates that TEE frequently establishes the diagnosis and provides more information concerning additional cardiac lesions in a patient with ruptured sinus of Valsalva aneurysm. Aortic regurgitation should be evaluated after repair of rupture of sinus of Valsalva by TEE

Severe aortic regurgitation after repair of ruptured sinus of Valsalva aneurysm: The role of Transesophageal Echocardiography

We report a 27-year-old woman who presented with worsening exertional. dyspnea and palpitation. Transthoracic echocardiography showed ventricular septal defect, with left-to-right shunting and mild aortic regurgitation detected. Cardiac catheterization was performed that revealed sinus of Valsalva aneurysm with rupture into the right ventricle. Transesophageal echocardiography (TEE) confirmed a rupture of sinus of Valsalva aneurysm and ventricular septal defect. The patient underwent elective surgical repair of the ruptured sinus and intraoperative TEE demonstrated severe aortic regurgitation after repair and mechanical prosthetic valve was implanted. This case illustrates that TEE frequently establishes the diagnosis and provides more information concerning additional cardiac lesions in a patient with ruptured sinus of Valsalva aneurysm. Aortic regurgitation should be evaluated after repair of rupture of sinus of Valsalva by TEE