Left atrium veno-arterial extra corporeal membrane oxygenation as temporary mechanical support for cardiogenic shock:A case report

BACKGROUND Veno-arterial extra corporeal membrane oxygenation(VA-ECMO)support is commonly complicated with left ventricle(LV)distension in patients with cardiogenic shock.We resolved this problem by transeptally converting VAECMO to left atrium veno-arterial(LAVA)-ECMO that functioned as a temporary paracorporeal left ventricular assist device to resolve LV distension.In our case LAVA-ECMO was also functioning as a bridge-to-transplant device,a technique that has been scarcely reported in the literature.CASE SUMMARY A 65 year-old man suffered from acute myocardial injury that required percutaneous stents.Less than two weeks later,noncompliance to antiplatelet therapy led to stent thrombosis,cardiogenic shock,and cardiac arrest.Femorofemoral VA-ECMO support was started,and the patient underwent a second coronary angiography with re-stenting and intra-aortic balloon pump placement.The VA-ECMO support was complicated by left ventricular distension which we resolved via LAVA-ECMO.Unfortunately,episodes of bleeding and sepsis complicated the clinical picture and the patient passed away 27 d after initiating VA-ECMO.CONCLUSION This clinical case demonstrates that LAVA-ECMO is a viable strategy to unload the LV without another invasive percutaneous or surgical procedure.We also demonstrate that LAVA-ECMO can also be weaned to a left ventricular assist device system.A benefit of this technique is that the procedure is potentially reversible,should the patient require VA-ECMO support again.A transeptal LV venting approach like LAVA-ECMO may be indicated over ImpellaTM in cases where less LV unloading is required and where a restrictive myocardium could cause LV suctioning.Left ventricular over-distention is a well-known complication of peripheral VA-ECMO in cardiogenic shock and LAVA ECMO through transeptal cannulation offers a novel and safe approach for treating LV overloading,without the need of an additional percutaneous access.

商业综合体建筑防火设计浅析——以西安大悦城项目为例

文章在对商业综合体建筑特点进行分析之后,结合项目实例——西安大悦城,从商业建筑的功能使用需求出发,对该商业项目内部防火分区划分、中庭商业空间防火设计、下沉广场疏散使用及特殊部位防火措施做法等方面进行了研究,总结了商业综合体建筑中消防设计的一些方法和注意事项。

大体量办公建筑消防设计要点

以京东集团西南总部大厦为例,从建筑师的角度解析大体量办公建筑的消防设计,从总平面图设计、中庭设计、大体量单层平面设计以及与之相关的防火分隔和疏散等多个方面,提出建筑专业在消防设计中必要的理念与技巧,总结出大体量办公建筑中典型的消防总体设计思路与具体设计手法,期望能为同类型建筑的消防设计提供实践经验与参考。

Fieldwork Test Research of the Impact on Building Physical Environment on Six Types of Atrium Space in Cold Climates

Since the research on verification to passive design strategies in sustainable building is at the initial stage,and its test method and verification conclusion are not scientific enough to validate,this paper proposes the necessity of building physical environmental monitoring to quantitative optimization of passive strategies efficiency from the perspective of architecture design and building environment. Adopting comparative research method,this research chooses six types of atrium space in cold climate in China as a prototype,focusing on building physical environmental performance difference in and between atrium and building main space. Spatial parameters of the atrium space will be divided into four factors: spatial geometry,interfacial properties,internal and external related categories. With subdividing these four factors into sub-factors,this paper makes crosscomparison among the sub-factors to clarify passive strategies effectiveness in atrium. Data comparison analysis shows that Winter atrium passive strategy in cold regions from traditional view is not obvious in practical application,and test data need to be stratified refined in atrium design in case of optimizing passive strategy from building prototype perspective.

Energy consumption of large space atrium under nozzle outlet during winter season

Based on the thermal and velocity layer's theory,the experimental setup was established on large space atrium under nozzle outlet. A series of winter experiments were accomplished and the following conclusions could be drawn. At the sunny day of winter in Shanghai,the thermal and velocity layer are similar. The height of the both layer is 10-30 mm,and the temperature gratitude is 5-10 ℃ /m. Decreasing the angle of the nozzle outlet can increase the layer height dramatically. The maximum temperature difference of the occupant zone has relation with the angle of the nozzle outlet. The less the angle of the nozzle outlet is set,the greater the temperature difference is. The occupant temperature differences at these angles of the nozzle outlet are 5.1-4.4 ℃. The velocity of the wind is 0.02 and 0.17 m/s and they can accord with design demand. So,it can decrease the temperature gratitude by about 30% and it can save 10%-15% energy consumption.

The relationship between serum miR-21 levels and left atrium dilation in elderly patients with essential hypertension

BACKGROUND MicroRNA-21(miR-21)is related to hypertension and cardiac remodelling.Left atrium(LA)dilation is highly sensitive to small haemodynamic changes in the left ventricle(LV)that are induced by hypertension.This study aimed to elucidate the relationship between miR-21 expression and LA dilation in elderly patients with essential hypertension(EH).METHODS In this cross-sectional study,one hundred elderly patients with EH were recruited for the study.According to their left atrium diameters(LADs),the patients were divided into the LA dilation group[42 patients(42%)]and the no-LA dilation group[58 patients(58%)].The serum levels of miR-21 and chemical biomarkers used in the clinic,such as creatinine,blood urea nitrogen,uric acid,fasting blood glucose,total cholesterol(TC),triglyceride(TG),high-density lipoprotein cholesterol(HDLC),low-density lipoprotein cholesterol(LDL-C),very-low-density lipoprotein cholesterol,Lp(a),apolipoprotein A1(apoA1),and apolipoprotein B,were measured.All the patients underwent echocardiographic examination,and the LAD,interventricular septum(IVS),right atrium diameter(RAD),right ventricle diameter(RVD),left ventricular end-systolic diameter(LVESD),left ventricular end-systolic diameter(LVEDD)and left ventricular ejection fraction(LVEF)were measured.RESULTS The levels of miR-21[8.02(5.21,14.39)vs.6.05(3.81,8.95),P=0.011]and LVEF(67.02±3.82 vs.64.14±4.43,P=0.001)were higher in the LA dilation group.The levels of creatinine[70.40(64.45,80.15)vs.63.9(60.1,73.43)],P=0.020]were higher in the no-LA dilation group.The levels of HDLC(r=-0.209,P=0.037),apoA1(r=-0.269,P=0.007)and RAD(r=0.203,P=0.043)were significantly correlated with miR-21 expression.The LAD was significantly correlated with the RAD(r=0.287,P=0.004),RVD(r=0.450,P<0.001),LVEDD(r=0.248,P=0.013)and LVEF(r=0.232,P=0.020).Multivariate logistic regression revealed that miR-21 significantly influenced LA dilation in elderly patients with EH(P<0.05).CONCLUSIONS Circulating serum levels of miR-21 are increased in elderly patients with EH with LA dilation.miR-21 levels are significantly correlated with LA dilation in elderly patients with EH,and miR-21 may be a factor related to the clinical pathophysiological occurrence of and treatment for the progression of hypertension-related early heart damage in EH patients.

Calcific left atrium:A rare consequence of endocarditis

Usually, cardiac calcifications are observed in aortic and mitral valves, atrio-ventricular plane, mitral annulus, coronary arteries, pericaridium(usually causing constrictive pericarditis) and cardiac masses. Calcifications of atrial walls are unusual findings that can be identified only using imaging with high spatial resolution, such as cardiac magnetic resonance and computed tomography. We report a case of a 43-year-old patient with no history of heart disease that underwent cardiac evaluation for mild dyspnoea. The echocardiogram showed a calcific aortic valve and a hyper-echogenic lesion located in atrio-ventricular plane. The patient was submitted to cardiac magnetic resonance and to computed tomography imaging to better characterize the localization of mass. The clinical features and location of calcified lesion suggest an infective aetiology causing an endocarditis involving the aortic valve, atrioventricular plane and left atrium. Although we haven't data to support a definite and clear diagnosis, the clinical features and location of the calcified lesion suggest an infective aetiology causing an endocarditis involving the aortic valve, atrio-ventricular plane and left atrium. The patient was followed for 12 mo both clinically and by electrocardiogram and echocardiography without worsening of clinical, electrocardiographic and echocardiographic data. Cardiac magnetic resonance imaging and computed tomography are ideal methods for identifying and following over time patients with calcific degeneration in the heart.

Research on the Winter Thermal Comfort of Library's Atrium Reading Space in Harbin Universities

As a transition space,atrium not only organizes traffic,makes the flow line flexible,but also modulates the indoor micro-climate. Because of its good sense of space and lighting performance,designers generally set reading space around the atrium. But nowadays,people are more concerned with the external form of the architecture,rather than the thermal comfort conditions of the atrium reading space. This article chooses the universities' library atrium space of Harbin in typical city in cold regions as the carrier of research,testes the thermal environment of atrium reading space, analyzes the user 's subjective feelings of the thermal environment and establishes climate adaptation model applied to library buildings. This paper aims to study on Winter thermal comfort of universities' library atrium reading space in cold area. Bases on thermal comfort adaptive model,it establishes a reasonable heating methods and design temperature index of indoor thermal environment. Optimum comfort is obtained while achieving building energy efficiency and providing viewers a comfortable reading space.

Spatial Atrium软交换的组网及维护

文章主要介绍了上海贝尔阿尔卡特(ASB)Spatial Atrium软交换的构成、容量和组网,以及Spatial交换网络优化,并对Spatial Atrium的个别故障案例进行了分析。

Influence of Horizontal Flow on Atrium in High-Rise Residential Building

In this study a 10-storied residential building model was employed to clarify the ventilation characteristics of the atrium and the rooms,which were effected by the different forms of lateral openings.The experiment was conducted under the combined effect of wind force and thermal buoyancy,and the similarity requirements were satisfied.The results have shown that the different forms of lateral openings cause the different ventilation effect of the building,and also have some certain regularity.The conclusions provide a theoretical foundation for how to use the ventilation of atrium better in high-rise residential building.

Atrium of stone:A case of confined left atrial calcification without hemodynamic compromise

Dystrophic cardiac calcification is often associated with conditions causing systemic inflammation and when present,is usually extensive,often encompassing multiple cardiac chambers and valves.We present an unusual case of dystrophic left atrial calcification in the setting of end stage renal disease on hemodialysis diagnosed by echocardiography and computed tomography.Significant calcium deposition is confined within the walls of the left atrium with no involvement of the mitral valve,and no hemodynamic effects.

Comparison of Intracardiac and Extracardiac Malformations Associated with Single Atrium,Single Ventricle and Single Atrium-Single Ventricle Using Dual-Source Computed Tomography

Background:To evaluate the qualitative and quantitative differences between intracardiac and extracardiac vascular malformations in patients with a single atrium(SA),single ventricle(SV)and single atrium-single ventricle(SA-SV)using dual-source CT(DSCT),and to compare the diagnostic performances of DSCT and transthoracic echocardiography(TTE).Methods:This retrospective study included 24 SA,75 SV and 24 SA-SV patients who underwent both DSCT and TTE before surgery.The diagnostic values of DSCT and TTE for intracardiac and extracardiac malformations were compared according to the surgical results.The diameters of the major artery and vein were measured and calculated based on DSCT and compared among the three groups.Results:The most common malformation was pulmonary artery disease in SA(50.0%)and SA-SV(45.8%)groups and patent ductus arteriosus(33.3%)in SV group.Although there was no statistical difference,arterial development was relatively poor in the SA group.All groups showed the trend of pulmonary artery stenosis(SA vs.SV vs.SA-SV:50.0%vs.30.7%vs.33.3%).There was a significant difference in mean pulmonary vein index among the groups(p=0.017).The diagnostic sensitivity of DSCT was superior to that of TTE for extracardiac malformations.Conclusions:The most common malformation in SA and SA-SV patients is pulmonary artery stenosis.SV patients are most likely to be complicated with patent ductus arteriosus.DSCT is more advantageous than TTE for diagnosing combined extracardiac malformations and can accurately measure the diameter of arteriovenous vessels.

Study of Temperature Field in Natural Ventilated Atrium

Full-scale experimental measurements and modified k-ε two-equation computational fluid dynamics(CFD) model with buoyancy term are used to investigate temperature field of the single-sided natural ventilated atrium with large openings. Compared with the measured values, the modified k-ε turbulent mode can effectively simulate the low Reynold number airflow in the single-side naturally ventilated atrium. Based on the experiment, the optimum period of utilizing natural ventilation for indoor climate control was determined. And the characteristic of the temperature field was analyzed and classified into two zones:lower linear temperature distribution zone and upper thermal accumulation area where temperature is power function distributed. These can be referenced for design and operation of atrium in north China.

NEGATIVE EFFECTS OF ETHANOL ON ISOLATED GUINEA PIG LEFT ATRIUM AND PAPILLARY MUSCLES

Objective To investigate the effects of ethanol on physiological characteristics of the isolated guinea pig left atrium and papillary muscles.Methods The effects of ethanol on contractility, post-rest potentiation and positive staircase phenomenon were observed in isolated left atrium and papillary muscles of guinea pig.Results Ethanol(50.0,100.0,200.0mmol·L -1)prominently inhibited the contraction of papillary muscles. Ethanol(12.5,25.0,50.0,100.0,200.0mmol·L -1) inhibited the contraction of left atrium, and markedly decreased the post-rest potentiation of myocardial contractility in left atrium. High concentration of ethanol(100,200mmol·L -1) depressed the positive staircase phenomenon of isolated guinea pig left atrium.Conclusion These results suggest that ethanol induces inhibitory effects of the contractility, post-rest potentiation, positive staircase phenomenon of left atrium. The mechanism by which ethanol induces the negative inotropic effects may be related to decrease the amount of calcium released from the intracellular stores.

Device closure of fistula from left lower pulmonary artery to left atrium using a vascular plug:A case report

BACKGROUND Pulmonary artery-to-left atrial fistula is a variant of pulmonary arteriovenous fistula and is a developmental anomaly.Delayed presentation,cyanosis and effort intolerance are some of the important features.The diagnosis is confirmed by computed tomography or pulmonary artery angiography.Catheter-based closure is preferred to surgery.CASE SUMMARY Left pulmonary artery-to-left atrial fistula is rare.A 40-year-old male presented with effort intolerance,central cyanosis,and recurrent seizures.He had a large and highly tortuous left pulmonary artery-to-left atrial fistula associated with a large aneurysmal sac in the course.Catheter-based closure was performed using a vascular plug.CONCLUSION Left pulmonary artery-to-left atrial fistula is relatively uncommon compared to right pulmonary artery-to-left atrial fistula.Percutaneous closure by either a transeptal technique or guide wire insertion into the pulmonary vein through the pulmonary artery is preferred.The need for an arteriovenous loop depends on the tortuosity of the course of the fistula and the size of the device to be implanted because a larger device needs a larger sheath,necessitating firm guide wire support to facilitate negotiation of the stiff combination of the delivery sheath and dilator.

Hepatocellular carcinoma with tumor thrombus extends to the right atrium and portal vein:A case report

BACKGROUND Hepatocellular carcinoma(HCC)is the most important primary malignant liver disease.A large proportion of patients with advanced HCC have macrovascular invasion.HCC tends to infiltrate vascular structures,particularly the portal vein and its branches,and more rarely,the hepatic veins.The intravascular tumor thrombus can affect the inferior vena cava(IVC)or even the right atrium(RA),the latter having a poor prognosis.CASE SUMMARY HCC is one of the most aggressive malignant tumors.Tumor thrombus(TT)formation in advanced HCC stages is common and usually involves the hepatic or portal veins.Herein,we report a 69-year-old woman who presented with dyspnea to the emergency department.A ventilation/perfusion lung scan was performed,ruling out pulmonary embolism.Hepatopulmonary syndrome and portopulmonary hypertension were discarded with contrasted echocardiography,but a mass in the RA was detected and confirmed by cardiac magnetic resonance imaging.Abdominal computed tomography showed a liver mass with a dynamic enhancement pattern compatible with HCC and an intraluminal IVC mass extending from the hepatic vein into the RA.HCC with TT expansion to IVC and RA is rare and indicates poor prognosis.CONCLUSION HCC with TT expansion to IVC and RA is rare and indicates poor prognosis.There is no consensus about anticoagulation or other interventions in these patients.

Double Compression of Left Atrium and Pulmonary Artery by a Huge Descending Aortic Aneurysm with Intramural Hematoma Mimicking Pulmonary Embolism: A Case Report

Hemodynamic instability secondary to left atrial (LA) compression by an aortic aneurysm is a rare entity. We report?the case of a 43-year old woman with no previous diagnosis of congestive heart failure who was admitted for an initial diagnosis of pulmonary embolism (PE) based on shortness of breath, hypotension and D-Dimers?elevation. The electrocardiogram and blood counts were within normal limits. The chest X-ray revealed widening of the mediastinum. Transthoracic echocardiography demonstrated LA compression by a large descending thoracic aortic aneurysm. Left and right ventricle systolic functions were preserved. Chest angiography showed LA and left pulmonary artery (LPA) compression by a descending aortic aneurysm and an intramural hematoma with no evidence of PE evidence. Emergency surgery could not be done because of her financial status. She was treated medically and was discharged 1?week later with significant improvement. However she remained hypotensive.

Right Atrium Myxoma in an 11-Year-Old Girl in Guinea

The objective of this study was to describe the myxoma of the right atrium occurring in an 11-year-old girl. It was an 11-year-old girl weighing 22 kg, admitted for exertional dyspnea, dry cough, palpitations, hepatitis, abdominal bloating, fever evolving for more than 9 months without a history of known cardiovascular disease;referral from a pulmonology department for cardiomegaly and right pleurisy. At cardiac auscultation, the rhythm was irregularly fast at 130 beats without added noise with a blood pressure of 110/65 mmhg. In the lungs, there was silence and a decrease in vocal vibrations at the right base, SaO2 at 70%. Elsewhere a thoracic collateral venous circulation was visible. Electrocardiogram recorded rapid atrial fibrillation at 134 cycles. The cardiac ultrasound concluded that there was a mobile mass in the right atrium prolapsing in the right ventricle measuring 25 mm × 18.9 mm suggesting a myxoma. The myxoma of the right atrium is of a rare localization with a polymorphic clinical manifestation. It should be diagnosed as early as possible to avoid the occurrence of dreaded complications. Its management is surgical.

Rheumatic Giant Left Atrium—An Overview

Aim: To present the aneurysmal dilatation of left atrium due to rheumatic mitral valve disease and its clinical consequences such as arrhythmic, thromboembolic and compressive manifestations. Introduction: Extreme enlargement of left atrium, usually referred to as giant, gigantic or aneurysmal dilatation is an uncommon finding with a reported incidence of 0.3% in rheumatic heart disease. It is an important clinical risk identifier to predict the outcome of cardiovascular disease. Case reports: Aneurysmal left atrium correlating with the length of pure mitral regurgitation jet in a 18-year-old girl, posterior mitral leaflet prolapse with regurgitation jet swirling around the entire interatrial septum in a 37-year-old male, Giant left atrium in mixed mitral valve disease in a 37-year-old female and a thrombosed giant left atrium resembling as “coconut” in a 50-year-old female were reported. Conclusion: Giant left atrium may be misinterpreted as right-sided pleural effusion, pericardial effusion and mediastinal tumor on X-ray chest and so echocardiographic evaluation is mandatory to exclude the aneurysmal left atrium in such conditions.

Resection of Lung Cancer with Left Atrium Extension via the Pulmonary Vein: Case Report

A 49-year-old man had an abnormal shadow on chest X-ray. Enhanced chest computed tomography (CT) revealed an 8-cm diameter right lung mass invading the right chest wall, with a tumor thrombus extending from the superior pulmonary vein into the left atrium. Transesophageal echocardiography confirmed that the tumor adjoined the side wall of the atrium. Endobronchial and CT-guided needle biopsy demonstrated a low-grade carcinoma or small cell carcinoma. Operative findings through left atriotomy under cardiopulmonary bypass showed no tumor invasion of the atrium wall, but protrusion through the pulmonary vein. Frozen sections revealed a non-small cell carcinoma. We performed right upper lobectomy with parietal pleura and mediastinal lymph node dissection after detachment of cardiopulmonary bypass. Pathological examination demonstrated a large-cell neuroendocrine carcinoma p-T4N0M0, stage IIIA. The patient recovered without postoperative complications and tolerated two cycles of adjuvant chemotherapy. He was doing well without symptoms of recurrence 42 months after surgery.