58 research outputs found
Transcatheter Closure of Atrial Septal Defect: Does Age Matter?
Atrial septal defect (ASD) is the most common type of common congenital heart disease (CHD) in adults. During the last decade, there has been a remarkable change in the treatment strategy of ASD, shifting the therapeutic gold standard from surgery to transcatheter closure, along with refinements and the evolution of device technology. Reports on the outcome of transcatheter ASD closure have shown an excellent efficacy as well as a low complication rate. However, the procedural details and/or outcomes of this procedure may be influenced by several factors including morphologic characteristics of the defect, co-morbid diseases, as well as individual factors including age and weight of the patient. Because the risk-benefit relationship in both the very young and the elderly subsets of the patients has not been clearly defined yet, closure of an ASD with device may be potentially subtracted from the treatment option in these patient groups. In this article, we will review the basis for device closure in small children and elderly patients with ASD and provide an overview of the frequently encountered problems
Atrioventricular block of intraoperative device closure perimembranous ventricular septal defects; a serious complication
<p>Abstract</p> <p>Background</p> <p>Atrioventricular block (AVB) is a well-reported complication after closure of perimembranous ventricular septal defects (VSDs). To report the occurrence of AVB either during or following closure of perimembranous VSDs using a novel "hybrid" method involving a minimal inferior median incision and of intraoperative device closure of the perimembranous VSDs.</p> <p>Methods</p> <p>Between January 2009 and January 2011, patients diagnosed with perimembranous VSDs eligible for intraoperative device closure with a domestic occluder were identified. All patients were assessed by real-time transesophageal echocardiography (TEE) and electrocardiography.</p> <p>Results</p> <p>Of the 97 included patients, 94 were successfully occluded using this approach. Complete AVB occurred in only one case and one case of Mobitz type II AVB was diagnosed intraoperatively. In both patients, the procedure was aborted and the AVBs quickly resolved. Glucocorticosteroids were administered to another two patients who developed Mobitz type II AVB intraoperatively. Those two patients converted to Mobitz type I AVB 3 days and 5 days postsurgically. During the follow-up period (range, 6-24 months), one patient developed complete AVB 1 week following device insertion. Surgical device removal was followed by a rapid and complete recovery of atrioventricular conduction.</p> <p>Conclusions</p> <p>Intraoperative device closure of perimembranous VSDs with a domestic occluder resulted in excellent closure rates; however, AVB is a serious complication that can occur either during or any time after device closure of perimembranous VSDs. The technique described herein may reduce the incidence of perioperative AVB complications. Surgeons are encouraged to closely monitor all patients postsurgically to ensure AVB does not occur in their patients. Additional long-term data to better identify the prevalence and risk factors for AVB in treated patients are needed.</p
Superior vena cavaâright atrium junction flowâpattern postâtranscatheter closure of patent foramen ovale
Diastolic function in young patients with cryptogenic stroke: A caseâcontrol pilot study
Supplementary Material for: Biventricular Rupture with Extracardiac Left-to-Right Shunt Complicating Acute Myocardial Infarction
<b><i>Background:</i></b> Simultaneous rupture of the left and right ventricles is an extremely rare mechanical complication of acute myocardial infarction (MI). When associated with the formation of a false aneurysm, an extracardiac left-to-right shunt may occur. <b><i>Methods:</i></b> We summarized all published data describing this unique condition. We searched the PubMed and Google Scholar databases for case reports in peer-reviewed journals from 1 January 1980 to 1 May 2015. We identified 16 articles describing 17 cases. <b><i>Results:</i></b> In all but 1 case, biventricular wall rupture (BVWR) resulted from an inferior MI. The clinical presentations of BVWR were variable and included cardiogenic shock, congestive heart failure and an absence of any cardiac symptoms. In most cases, there was a hemodynamically significant left-to-right shunt, with pulmonary to systemic blood flow (Qp/Qs) >2. Diagnostic difficulties were reported in most cases, and some patients were initially misdiagnosed as having ventricular septal rupture (VSR). Surgical closure of the defect was successful in most cases, and some asymptomatic patients were managed conservatively. <b><i>Conclusion:</i></b> BVWR with an intact interventricular septum and extracardiac left-to-right shunt is a rare mechanical complication of acute MI, often misdiagnosed as VSR. It has a variable clinical course, probably related to the magnitude of the shunt
Acute Effects of Insulin on Cardiac Function in Patients with Diabetes Mellitus: Clinical Applicability and Feasibility
Background. Insulin promotes glucose consumption as the main cardiac energy source, while increasing myocardial efficiency. The short-term effects of insulin on cardiac function and its potential curative role in an acute diabetological cardiology setting remain unknown. Our study evaluated the role of acute insulin administration in the diabetic heart, its corresponding effective blood insulin level, and the time-course applicability of insulin treatment in a routine clinical setting. Methods. We evaluated a case series of six male (48.1â±â4.9ây/o) patients with controlled diabetes (HbA1c of 6.6â±â0.3%) and disease duration of 14.4â±â6.7âyr. Each subject was evaluated for glucose homeostasis, as well as hemodynamic and echocardiographic (systolic and diastolic) parameters at three points: baseline followed by two successive insulin loads in euglycemic hyperinsulinemic clamp study. Results were analysed using Studentâs t-test. Results. The first insulin load led to a physiologic blood insulin level of 145â±â36âÎŒU/ml, and both systolic (7âmmHg) blood pressure and diastolic (4âmmHg) blood pressure decreased significantly. Left ventricular fractional shortening (LVFS) increased significantly by 11.8%. Diastolic function parameters of mitral annulus movement of the AâČ wave increased relative to baseline by 20.0% (27.8% under the second insulin load), AâČ medial increased relative to baseline by 30%, and AâČ lateral increased relative to baseline by 17%, displayed by tissue Doppler imaging. Conclusions. Insulin acutely affected the diabetic heart at a physiologic level within a 2âh time course. Insulin mainly increased left ventricular systolic function and, to a second degree, improved left ventricular diastolic functions and atrial systole in diabetic subjects. These results may facilitate the development of insulin-based acute treatment in diabetic patients with cardiac morbidity. This trial is registered with NCT02962921
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Accuracy of the long-axis area-length method for the measurement of left ventricular volumes and ejection fraction using multidetector computed tomography
Multidetector computed tomography (MDCT) is useful for assessing left ventricular (LV) volumes and function. Validation has mainly been carried out using Simpson's method of summing up consecutive short-axis areas. Because the latter method is time-consuming, many users prefer using a quicker method, based on a single view or a pair of views.
To evaluate the accuracy of the long-axis area-length method (AL), which has not been validated for MDCT, using Simpson's method as the gold standard, as well as right anterior oblique LV angiography as a clinical standard.
Twenty-three patients admitted with acute chest pain were clinically evaluated with electrocardiogram-gated MDCT and invasive LV angiography. MDCT-based end-diastolic, end-systolic and stroke volumes, and ejection fraction (EF) were calculated using Simpson's method, biplane AL and single-plane AL. For LV angiography, EF was calculated using single-plane AL.
A Bland-Altman analysis showed a close agreement between biplane AL and Simpson's method for EF, with 1% underestimation, 95% CI of ±11% and a correlation of 0.89. For end-diastolic, end-systolic and stroke volumes, overestimations of 7
mL, 4
mL and 2 mL, and 95% CI of ±27 mL, ±15 mL and ±26 mL, respectively were found. Correlation coefficients were 0.95, 0.97 and 0.82, respectively. Comparisons with LV angiography were considerably weaker. The vertical long-axis AL method by MDCT correlated better with both LV angiography and Simpson's method than the horizontal long-axis AL method.
The biplane AL method gives results for EF, which correspond closely with the more cumbersome Simpson's method, although volumes are slightly overestimated.
La tomographie Ă multidĂ©tecteurs (TGMD) est utile pour Ă©valuer les volumes et la fonction ventriculaires gauches (VG). La validation a Ă©tĂ© pour une bonne part rĂ©alisĂ©e Ă lâaide de la mĂ©thode de Simpson Ă©tablissant la somme des aires axe court consĂ©cutives. Parce que cette derniĂšre mĂ©thode est fastidieuse, de nombreux utilisateurs prĂ©fĂšrent une mĂ©thode plus rapide basĂ©e sur une ou deux perspectives.
Ăvaluer la prĂ©cision de la mĂ©thode aire-longueur (AL) long axe, qui nâa pas Ă©tĂ© validĂ©e pour la TGMD, Ă lâaide de la mĂ©thode de Simpson comme Ă©talon-or et Ă lâaide de lâangiographie VG droite antĂ©rieure oblique comme norme clinique.
Vingt-trois patients admis pour DRS aiguĂ« ont Ă©tĂ© Ă©valuĂ©s sur le plan clinique au moyen dâune TGMD synchronisĂ©e avec lâĂ©lectrocardiogramme et dâune angiographie VG effractive. Les volumes tĂ©lĂ©diastoliques, tĂ©lĂ©systoliques, le volume dâĂ©jection systolique et la fraction dâĂ©jection (FĂ) ont Ă©tĂ© calculĂ©s Ă lâaide de la mĂ©thode de Simpson AL bidimensionnelle et AL unidimensionnelle. Pour lâangiographie VG, la FĂ a Ă©tĂ© calculĂ©e Ă lâaide de la mĂ©thode AL unidimensionnelle.
Une analyse de Bland-Altman a montrĂ© une concordance Ă©troite entre la mĂ©thode AL bidimensionnelle et la mĂ©thode de Simpson pour la FĂ, avec une sous-estimation de 1% et un IC Ă 95% de ± 11% et un coefficient de 0,89. Pour les volumes tĂ©lĂ©diastoliques, tĂ©lĂ©systoliques et dâĂ©jection systolique, on a observĂ© des surestimations de 7 mL, 4 mL, 2 mL, et des IC Ă 95% de ± 27 mL, ± 15 mL et ± 26 mL. Les coefficients de corrĂ©lation Ă©taient de 0.95, 0.97 et 0.82, respectivement. Les comparaisons avec lâangiographie VG ont Ă©tĂ© considĂ©rablement plus faibles. La mĂ©thode AL long axe par TGMD a Ă©tĂ© en meilleure corrĂ©lation avec lâangiographie VG et avec la mĂ©thode de Simpson, comparativement Ă la mĂ©thode AL long axe horizontale.
La mĂ©thode AL bidimensionnelle donne des rĂ©sultats de FĂ qui correspondent Ă©troitement avec la mĂ©thode de Simpson, plus fastidieuse, mĂȘme si les volumes sont lĂ©gĂšrement surestimĂ©s
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