Fetal Cardiac Interventions

AbstractThe present article aims to highlight fetal cardiac interventions (FCIs) in terms of indications, strategies, and fetal prognoses. FCIs of the early years were predominantly pharmacological therapies for fetal arrhythmia or heart block. A transplacental transmission of therapeutic agents has now become the main route of pharmacological FCIs. There have been various FCI strategies, which can be categorized into three types: pharmacological, open FCIs, and closed FCIs. Rather than as a routine management for materno-fetal cardiac disorders, however, FCIs are only applied in those fetal cardiac disorders that are at an increased risk of mortality and morbidity and warrant an interventional therapy. Pharmacological FCIs have been well applied in fetal arrhythmias but require further investigations for novel therapeutic agents. The development of open FCI in humans is an issue for the long run. Closed FCIs may largely rely on advanced imaging techniques. Hybrid FCIs might be the future goal in the treatment of fetal heart diseases

Postpartum aortic dissection

AbstractPostpartum aortic dissection is a rare but lethal event. Until now, only a limited number of cases have been reported, and a comprehensive literature review from 1988 to 2012 yielded 27 cases. Postpartum aortic dissection occurred between Day 1 and Day 42 after delivery, either vaginally or by cesarean section. Pregnancy alone without underlying contributing risk factors and Marfan syndrome were the two main risk factors for postpartum aortic dissection, accounting for 44.4% and 40.7% of cases, respectively. Late presentation and delayed diagnosis may lead to sudden death. Improving prenatal and peripartum care is, therefore, crucial in preventing the development of aortic dissection. Prompt diagnosis and timely treatment of postpartum aortic dissection may prevent patient death

Te application of ex utero intrapartum treatment (EXIT) procedure for cardiothoracic disorders

Te ex utero intrapartum treatment (EXIT) procedure was primarily developed to reverse temporary tracheal occlusion in patients with fetal surgery for congenital diaphragmatic hernia. Nowadays, it is widely used to resect fetal neck masses and to maintain an unobstructed airway. It is indicated for the management of several cardiothoracic diseases, including mediastinal or lung mass resection, drainage of pleural efusions, palliative treatment of critical congenital heart disease and establishment of EXIT-to-extracorporeal membrane oxygenation (ECMO). EXIT has been attempted successfully in many centers, and it has been proven that mothers and babies tolerate the procedure well. Maternal and fetal surveillance during anesthesia is important to maintain maternal blood pressure and placental blood fow and fetal oxygenation. Te aim of this article is to discuss the application of the EXIT procedure for the management of fetal cardiothoracic diseases

Lung replacement therapies for acute respiratory failure

Acute respiratory failure is one of the critical conditions with an increased mortality. In order to reverse lung injury and reduce the mortality rate, several lung replacement therapies have been developed, including the extracorporeal membrane oxygenation, the intravascular oxygenator and carbon dioxide removal device, the intravenous membrane oxygenator and the thoracic artificial lung. This article aims to present the properties, indications and advantages of these devices

Clinical significance of mitral leaflet flail

Background: There has been scant academic consideration paid to investigations of mitral leaflet flail in terms of clinical profile, surgical strategy, and surgical outcome. Methods: One hundred consecutive patients with mitral leaflet flail referred for surgical treatment in the past 42/3 years were included in this study. Results: The most common reasons leading to mitral leaflet flail were chord rupture (38%), myxomatous degeneration (23%), and combined chord rupture and myxomatous degeneration (12%). Mitral leaflet flail was predominantly characterized by independent P2 flail, followed by P2,3 flail and independent A2 flail. Chord rupture occurred in 54 patients, and the most commonly involved segments were P2, P2,3, and P3. The most common risk factors for mitral valve replacement were papillary muscle rupture, extensive myxomatous degeneration, extensive chord rupture, and severely dilated mitral valve annulus. Multivariate regression analyses demonstrated that the development of mitral leaflet flail was significantly associated with the pertinent variables tested, especially correlated with insertion of the prosthetic ring, number of artificial chord, and presence of carotid stenosis. Conclusions: Mitral leaflet flail may affect patients of any age, but is more prevalent among males and younger patients. Mitral chord rupture was the leading cause for mitral leaflet flail. Myxomatous degeneration, infective endocarditis, mitral annulus calcification, and papillary muscle rupture were the next most common causes. An increased incidence of mitral leaflet flail was closely related to the chords of the posterior leaflet and the middle scallop. Due to the progressive disappointing prognosis of mitral leaflet flail, surgery should be performed at an early stage

Congenital heart defects in Kabuki syndrome

Background: Kabuki syndrome (KS) is an entity of multiple congenital malformations withmental retardation with undetermined etiology. Congenital heart defects are one of the clinicalmanifestations of KS with insuffi cient elucidations.Methods: Literature of congenital heart defects associated with KS was comprehensivelyretrieved, collected and reviewed. The clinical features of the congenital heart defects in thepatients with KS were summarized.Results: Congenital heart defects were one of the clinical manifestations of KS with 90.6%of the patients being diagnosed prenatally or at an early age. Left-sided obstructions/aorticdilation and septal defects were the fi rst two types of anomalies, accounting up to 46.1% and32.9%, respectively. The most common congenital heart defects were coarctation of the aorta,and atrial and ventricular septal defects. Fifteen (19.7%) patients received surgical repair ofcongenital heart defects at a mean age of 0.8 ± 1.3 years.Conclusions: Congenital heart defects are one of the clinical manifestations of KS with 90.6%of the patients being diagnosed prenatally or at an early age. About 20% of the patients warrantedsurgical repair of the heart defects. Patients with KS require close follow-up in terms oftheir etiology, clinical presentations and long-term prognosis

Hoarseness subsequent to cardiovascular surgery, intervention, maneuver and endotracheal intubation: The so-called iatrogenic Ortner’s (cardiovocal) syndrome

Background: The clinical characteristics and outcomes of hoarseness subsequent to cardiovascular surgery, intervention, maneuver and endotracheal intubation have not been systematically elucidated. Methods: The literature of hoarseness following cardiovascular surgery, intervention, and maneuver and intubation published between 1980 and 2011 was comprehensively retrieved in the MEDLINE database and the Google and Highwire Press search engines. Results: The so-called “iatrogenic Ortner’s (cardiovocal) syndrome” developed 0–7 (2.33 ± ± 2.66) days following cardiovascular surgery, intervention, maneuver and endotracheal intubation with an incidence of 10.15%. The most common symptoms associated with hoarseness were stridor (49.45%) and aspiration (15.38%). Patent ductus arteriosus ligation and otherwise congenital heart disease repair were the two main causes leading to such a complication. Patients’ hoarse voice spontaneously resolved in 70.52%, and persisted in 33.61% of the patients. Treatment of the hoarseness included gelfoam/teflon injection, intravenous steroid therapy, type 1 thyroplasty and arytenoid adduction. Hoarseness recovered in 46.67%, improved in 13.33%, and persisted in 40%. Conclusions: The recurrent laryngeal nerve was often injured following cardiovascular surgery, intervention, maneuver and endotracheal intubation. Care must be taken during the manipulations in order to avoid the nerve injury. The so-called “iatrogenic Ortner’s (cardiovocal) syndrome” was a wrong concept as it did not meet the satisfaction of a main element cardiovascular disease as an underlying cause of hoarseness of the definition of Ortner’s (cardiovocal) syndrome defined by Ortner in 1897. It was actually an immediate vocal cord complication following cardiovascular manipulation

Sudden cardiac death in the young: cytokines and pathways

Objectives: The purpose of this paper is to clarify the cytokines and signaling pathways involved in the mechanisms of sudden cardiac death (SCD) in the young. Methods: The representing literature concerning the cytokines and signaling pathways of SCD in the young were retrieved and analyzed. Results: Extrinsic and intrinsic apoptotic pathways, influenced by growth factor pathways, may render arrythmogenic cardiac disorders and ultimately lead to SCD. Other cytokines probably involved in the mechanisms of SCDs in the young may include heme oxygenase-1 and the gaseous molecules (carbon monoxide and nitric oxide), insulin-like growth factor-1, gap junctional proteins and homeobox transcription factor NKX2-5, etc., which may be responsible for atrioventricular conduction impairments. Active therapeutics options for the pertinent arrhythmias have significantly reduced the incidence of SCD in the young. Conclusions: The apoptotic and growth factor signaling pathways are the two major ways leading to conduction system impairment and eventual SCDs. The prophylactic antiarrhythmic agent, device therapies, or surgical operation could dramatically reduce SCD incidence. Good understanding of the mechanisms of the cytokine-related pathways is crucial for the treatment of the causative cardiac disorders responsible for SCDs in the young. New agents including apoptotic blockers, heme metabolite homologues, and c-Src, PIK3 and NKX2-5 inhibitors, etc., are anticipated for the prevention of SCDs in the near future.</p

Mitral valve myxoma: Clinical features, current diagnostic approaches, and surgical management

Background: The purpose of this article is to document the clinical features of the unusual mitral valve myxoma based on the literature of recent years. Methods: A literature retrieval of the mitral valve myxoma reported in recent years was made using the MEDLINE and EMBASE databases. The clinical information about this unusual disorder was collected and analyzed. Results: Mitral valve myxoma showed female predilection. Their major symptoms were cardiovascular or cerebrovascular, in addition to constitutional or embolic. The diagnosis was usually made based on two- and three-dimensional transthoracic and/or transesophageal echocardiography, as well as magnetic resonance imaging in the current era. Surgical resection with mitral valve defect repair was the commonest remedy for mitral valve myxoma when mitral valve function could be preserved, and the mitral valve should be replaced when necessary. Patients showed good response to surgical treatment during the follow-up of 17.0 &#177; 28.4 months after the operation. Conclusions: Two- and three-dimensional echocardiography and magnetic resonance imaging are the major diagnostic tools for the diagnosis of a cardiac myxoma. After diagnosis, surgery should be performed urgently, in order to prevent complications such as embolic events or obstruction of the mitral orifice. Due to the fact that myxomas can recur, regular, postoperative cardiological control is mandatory. (Cardiol J 2012; 19, 1: 105&#8211;109