Background: Right ventricular (RV) dysfunction could develop during exercise in</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">pati...Background: Right ventricular (RV) dysfunction could develop during exercise in</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">patients with both hypertension and left ventricular diastolic dysfunction and may contribute to the patient symptoms. The objective is to assess RV function, both at rest and during exercise in patients with hypertension and left ventricular diastolic dysfunction. Methods: We included 30 patients with hypertension and resting LV diastolic dysfunction. The systolic function of the right ventricle was assessed by TAPSE (Tricuspid Annular Plane Systolic Excursion) and S</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> while E/A ratio, annular lateral E’, E/E’ and E’/A’ were used to measure diastolic function. The global function of the right ventricle was assessed by measuring the right indexed myocardial performance. The dimensions and pulmonary pressures were also measured. Results: The following parameters of RV systolic function were increased significantly with exercise: TAPSE (P = 0.0054), S’ (P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">= 0.0045). Moreover, the following diastolic parameters of the RV increased significantly with exercise: E/E’ (P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.05), A’</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.04). The global RV function showed also a significant increase (P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.0011). The three RV dimensions as well as the pulmonary artery pressures also increased during exercise (P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">= 0.000004, 0.001, and 0.00000064 respectively). In addition, the presence of resting LV grade II DD predicted significantly higher pulmonary pressures during exercise (</span><span style="font-family:Verdana;">P</span><span style="font-family:Verdana;"> =</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.006). The advanced resting grade of LVDD predicted significantly the presence of advanced grade of RVDD with exercise (</span><span style="font-family:Verdana;">P</span><span style="font-family:Verdana;"> =</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.037). Conclusions: Some patients who have both hypertension and LV diastolic dysfunction showed structural and functional changes of the right ventricle at rest. However, all patients had RV functional changes during exercise.展开更多
Mechanical circulatory and/or respiratory assistance with extracorporeal membrane oxygenation (ECMO) has become a standard of care for patients with circulatory (venoarterial) and/or respiratory (venovenous) failure r...Mechanical circulatory and/or respiratory assistance with extracorporeal membrane oxygenation (ECMO) has become a standard of care for patients with circulatory (venoarterial) and/or respiratory (venovenous) failure refractory to standard therapies. Adult patients with congenital heart disease are an increasingly recognized and growing population and include various groups, such as undiagnosed cases in childhood and palliated and/or corrected cases, which require subsequent care because of residual lesions, cardiac arrest/insufficiency, and arrhythmias, among other conditions. In addition, these patients are prone to developing pathologies that are typical of adulthood with a generally increased risk of morbidity and mortality because of their low reserves and organic damage associated with the underlying heart disease, which makes them candidates for ECMO. These patients represent an additional challenge in this therapy because malformations and the presence of a shunt can generally affect the usual cannulation methods and hemodynamic and oximetry monitoring. Thus, the configuration decision must be made on a case-by-case basis. Here, we present a cannulation method, venopulmonary artery ECMO, which provides hemodynamic and respiratory support, and may be ideal for patients with shunts and/or right ventricular dysfunction. To our knowledge, this is the first report of this configuration in patients with congenital heart diseases.展开更多
Objective: The aim of the study was to determine usefulness of isovolumic acceleration to assess right ventricular function in patients with pulmonary hypertension. Background: Right ventricular dysfunction is...Objective: The aim of the study was to determine usefulness of isovolumic acceleration to assess right ventricular function in patients with pulmonary hypertension. Background: Right ventricular dysfunction is a powerful predictor of adverse outcomes in patients with pulmonary hypertension. Although isovolumic acceleration is a sensitive and relatively load-independent parameter for ventricular contractile function, it has not been widely used. So, the aim of the study was to determine the usefulness of isovolumic acceleration in assessing right ventricular function in patients with pulmonary hypertension. Methods: A single center, prospective observational case-control study has been carried out for the period of one year at Osmania general hospital (Hyderabad). A total of 32 consecutive patients with pulmonary hypertension and 32 age matched healthy controls were recruited in the study as per the inclusion and exclusion criteria of the study. Receiver operator characteristic curves were used to study sensitivity, specificity, positive predictive value, negative predictive values as well as pearson’s correlation coefficients. Results: The results of the study showed that isovolumic acceleration has good significant correlation with right ventricular fractional area change (r = 0.554, p = 0.001) and tissue Doppler myocardial performance index (r = -0.599, p = 0.001) whereas a lesser but significant correlation was observed with tricuspid annular plane systolic excursion (r = 0.327, p = 0.034). Isovolumic acceleration showed higher specificity (81%) and positive predictive value (88%) in diagnosing right ventricular dysfunction in pulmonary hypertension compared to tricuspid annular systolic excursion velocity and tissue Doppler myocardial performance index parameters. Therefore isovolumic acceleration may be a better variable for diagnosing right ventricular dysfunction. Conclusions: Isovolumic acceleration is a sensitive and specific marker of right ventricular function in pulmonary hypertension.展开更多
Background: In patients undergoing pneumonectomy, intraoperative pulmonary and cardiac complications are the major cause of morbidity and mortality. Protective lung ventilation strategies may decrease the overall lung...Background: In patients undergoing pneumonectomy, intraoperative pulmonary and cardiac complications are the major cause of morbidity and mortality. Protective lung ventilation strategies may decrease the overall lung injury. Right, ventricular dysfunction may occur during the surgery and after the pneumonectomy, in the early postoperative period, with reduced RV ejection fraction and increased RV end-diastolic volume index, caused by increased RV afterload. Case report: We describe the case of a 28-year-old non-smoker female who underwent to a right pneumonectomy. The patient presented intraoperative hemodynamic instability and signs of RV dysfunction, requiring vasoactive amines and nitric oxide. Discussion: This article is intended to provide an overview of the anesthetic management for pneumonectomy including the hemodynamic management and considerations of the causes and management of right ventricular dysfunction.展开更多
目的回顾性分析心房颤动(AF)患者右心结构及压力的变化,并分析右心功能不全的危险因素。方法序贯收集2011年5月至2013年5月在北京协和医院心内科确诊AF的患者291例。所有入选对象左心收缩功能正常,并除外冠心病、心肌病、先天性心脏病...目的回顾性分析心房颤动(AF)患者右心结构及压力的变化,并分析右心功能不全的危险因素。方法序贯收集2011年5月至2013年5月在北京协和医院心内科确诊AF的患者291例。所有入选对象左心收缩功能正常,并除外冠心病、心肌病、先天性心脏病、瓣膜性心脏病、原发性肺动脉高压及慢性肺病患者。记录患者基本资料、基础疾病、AF症状(EHRA评级)、体质指数、血生化指标、超声心动图参数。分析AF伴或不伴右心室收缩压升高、伴或不伴右心增大患者的临床资料。结果与右心室收缩压<30 mm Hg的AF患者比较,右心室收缩压≥30 mm Hg的AF患者合并糖尿病、高血压、EHRA>I级的比例较高(22.9%比13.2%,67.1%比49.0%,37.1%比19.2%,均为P<0.05),左心房内径相对较大[(44.0±6.8)mm比(40.5±5.4)mm,P<0.01];右心房增大与右心房正常的AF患者在右心室收缩压[(33.8±10.1)mm Hg比(27.6±9.2)mm Hg]、下腔静脉内径[(16.2±2.8)mm比(14.6±2.3)mm]、左心房内径[(45.4±5.6)mm比(39.1±5.3)mm]、右心室内径[(25.7±5.4)mm比(22.1±4.5)mm]、静息心率[(82.2±17.4)次/min比(77.2±15.7)次/min],以及CHADS2评分[(1.5±1.2)分比(1.1±1.1)分]、CHADS2-VASc评分[(2.6±1.5)分比(2.0±1.6)分]上差异均有统计学意义(均为P<0.05),且右心房增大的AF患者EHRA>Ⅰ级比例较高(34.5%比20.7%,P<0.05);右心室增大与右心室内径正常的AF患者下腔静脉内径[(16.8±3.7)mm比(15.2±2.3)mm]、左心房内径[(47.7±8.1)mm比(40.9±5.1)mm]、左心室射血分数(65.0%±8.5%比62.9%±7.1%)以及高血压比例(74.1%比54.0%)差异有统计学意义(均为P<0.05);左心房内径与右心室收缩压(RR=0.481)、右心室内径(RR=0.34)、右心房内径(RR=0.544)均呈显著正相关(均为P<0.01)。结论存在糖尿病、高血压,EHRA评分>Ⅰ级,已出现左心房增大及体循环容量负荷高(下腔静脉相对较宽)的AF患者更易出现右心功能不全征象。左心房内径增加可能是AF合并右心功能不全的有力证据。CHADS2/CHADS2-VASC评分较高、心室率偏快的AF患者应积极进行右心功能及结构评估,以早期发现右心功能不全。展开更多
文摘Background: Right ventricular (RV) dysfunction could develop during exercise in</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">patients with both hypertension and left ventricular diastolic dysfunction and may contribute to the patient symptoms. The objective is to assess RV function, both at rest and during exercise in patients with hypertension and left ventricular diastolic dysfunction. Methods: We included 30 patients with hypertension and resting LV diastolic dysfunction. The systolic function of the right ventricle was assessed by TAPSE (Tricuspid Annular Plane Systolic Excursion) and S</span><span style="font-family:Verdana;">,</span><span style="font-family:Verdana;"> while E/A ratio, annular lateral E’, E/E’ and E’/A’ were used to measure diastolic function. The global function of the right ventricle was assessed by measuring the right indexed myocardial performance. The dimensions and pulmonary pressures were also measured. Results: The following parameters of RV systolic function were increased significantly with exercise: TAPSE (P = 0.0054), S’ (P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">= 0.0045). Moreover, the following diastolic parameters of the RV increased significantly with exercise: E/E’ (P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.05), A’</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">(P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.04). The global RV function showed also a significant increase (P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">=</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.0011). The three RV dimensions as well as the pulmonary artery pressures also increased during exercise (P</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">= 0.000004, 0.001, and 0.00000064 respectively). In addition, the presence of resting LV grade II DD predicted significantly higher pulmonary pressures during exercise (</span><span style="font-family:Verdana;">P</span><span style="font-family:Verdana;"> =</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.006). The advanced resting grade of LVDD predicted significantly the presence of advanced grade of RVDD with exercise (</span><span style="font-family:Verdana;">P</span><span style="font-family:Verdana;"> =</span><span style="font-family:Verdana;"> </span><span style="font-family:Verdana;">0.037). Conclusions: Some patients who have both hypertension and LV diastolic dysfunction showed structural and functional changes of the right ventricle at rest. However, all patients had RV functional changes during exercise.
文摘Mechanical circulatory and/or respiratory assistance with extracorporeal membrane oxygenation (ECMO) has become a standard of care for patients with circulatory (venoarterial) and/or respiratory (venovenous) failure refractory to standard therapies. Adult patients with congenital heart disease are an increasingly recognized and growing population and include various groups, such as undiagnosed cases in childhood and palliated and/or corrected cases, which require subsequent care because of residual lesions, cardiac arrest/insufficiency, and arrhythmias, among other conditions. In addition, these patients are prone to developing pathologies that are typical of adulthood with a generally increased risk of morbidity and mortality because of their low reserves and organic damage associated with the underlying heart disease, which makes them candidates for ECMO. These patients represent an additional challenge in this therapy because malformations and the presence of a shunt can generally affect the usual cannulation methods and hemodynamic and oximetry monitoring. Thus, the configuration decision must be made on a case-by-case basis. Here, we present a cannulation method, venopulmonary artery ECMO, which provides hemodynamic and respiratory support, and may be ideal for patients with shunts and/or right ventricular dysfunction. To our knowledge, this is the first report of this configuration in patients with congenital heart diseases.
文摘Objective: The aim of the study was to determine usefulness of isovolumic acceleration to assess right ventricular function in patients with pulmonary hypertension. Background: Right ventricular dysfunction is a powerful predictor of adverse outcomes in patients with pulmonary hypertension. Although isovolumic acceleration is a sensitive and relatively load-independent parameter for ventricular contractile function, it has not been widely used. So, the aim of the study was to determine the usefulness of isovolumic acceleration in assessing right ventricular function in patients with pulmonary hypertension. Methods: A single center, prospective observational case-control study has been carried out for the period of one year at Osmania general hospital (Hyderabad). A total of 32 consecutive patients with pulmonary hypertension and 32 age matched healthy controls were recruited in the study as per the inclusion and exclusion criteria of the study. Receiver operator characteristic curves were used to study sensitivity, specificity, positive predictive value, negative predictive values as well as pearson’s correlation coefficients. Results: The results of the study showed that isovolumic acceleration has good significant correlation with right ventricular fractional area change (r = 0.554, p = 0.001) and tissue Doppler myocardial performance index (r = -0.599, p = 0.001) whereas a lesser but significant correlation was observed with tricuspid annular plane systolic excursion (r = 0.327, p = 0.034). Isovolumic acceleration showed higher specificity (81%) and positive predictive value (88%) in diagnosing right ventricular dysfunction in pulmonary hypertension compared to tricuspid annular systolic excursion velocity and tissue Doppler myocardial performance index parameters. Therefore isovolumic acceleration may be a better variable for diagnosing right ventricular dysfunction. Conclusions: Isovolumic acceleration is a sensitive and specific marker of right ventricular function in pulmonary hypertension.
文摘Background: In patients undergoing pneumonectomy, intraoperative pulmonary and cardiac complications are the major cause of morbidity and mortality. Protective lung ventilation strategies may decrease the overall lung injury. Right, ventricular dysfunction may occur during the surgery and after the pneumonectomy, in the early postoperative period, with reduced RV ejection fraction and increased RV end-diastolic volume index, caused by increased RV afterload. Case report: We describe the case of a 28-year-old non-smoker female who underwent to a right pneumonectomy. The patient presented intraoperative hemodynamic instability and signs of RV dysfunction, requiring vasoactive amines and nitric oxide. Discussion: This article is intended to provide an overview of the anesthetic management for pneumonectomy including the hemodynamic management and considerations of the causes and management of right ventricular dysfunction.
文摘目的回顾性分析心房颤动(AF)患者右心结构及压力的变化,并分析右心功能不全的危险因素。方法序贯收集2011年5月至2013年5月在北京协和医院心内科确诊AF的患者291例。所有入选对象左心收缩功能正常,并除外冠心病、心肌病、先天性心脏病、瓣膜性心脏病、原发性肺动脉高压及慢性肺病患者。记录患者基本资料、基础疾病、AF症状(EHRA评级)、体质指数、血生化指标、超声心动图参数。分析AF伴或不伴右心室收缩压升高、伴或不伴右心增大患者的临床资料。结果与右心室收缩压<30 mm Hg的AF患者比较,右心室收缩压≥30 mm Hg的AF患者合并糖尿病、高血压、EHRA>I级的比例较高(22.9%比13.2%,67.1%比49.0%,37.1%比19.2%,均为P<0.05),左心房内径相对较大[(44.0±6.8)mm比(40.5±5.4)mm,P<0.01];右心房增大与右心房正常的AF患者在右心室收缩压[(33.8±10.1)mm Hg比(27.6±9.2)mm Hg]、下腔静脉内径[(16.2±2.8)mm比(14.6±2.3)mm]、左心房内径[(45.4±5.6)mm比(39.1±5.3)mm]、右心室内径[(25.7±5.4)mm比(22.1±4.5)mm]、静息心率[(82.2±17.4)次/min比(77.2±15.7)次/min],以及CHADS2评分[(1.5±1.2)分比(1.1±1.1)分]、CHADS2-VASc评分[(2.6±1.5)分比(2.0±1.6)分]上差异均有统计学意义(均为P<0.05),且右心房增大的AF患者EHRA>Ⅰ级比例较高(34.5%比20.7%,P<0.05);右心室增大与右心室内径正常的AF患者下腔静脉内径[(16.8±3.7)mm比(15.2±2.3)mm]、左心房内径[(47.7±8.1)mm比(40.9±5.1)mm]、左心室射血分数(65.0%±8.5%比62.9%±7.1%)以及高血压比例(74.1%比54.0%)差异有统计学意义(均为P<0.05);左心房内径与右心室收缩压(RR=0.481)、右心室内径(RR=0.34)、右心房内径(RR=0.544)均呈显著正相关(均为P<0.01)。结论存在糖尿病、高血压,EHRA评分>Ⅰ级,已出现左心房增大及体循环容量负荷高(下腔静脉相对较宽)的AF患者更易出现右心功能不全征象。左心房内径增加可能是AF合并右心功能不全的有力证据。CHADS2/CHADS2-VASC评分较高、心室率偏快的AF患者应积极进行右心功能及结构评估,以早期发现右心功能不全。
