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PubMed2005

Migration of two venous stents into the right ventricle in a patient with May-Thurner syndrome.

May-Thurner syndrome is an uncommon process in which the right common iliac artery compresses the left common iliac vein, possibly resulting in pain, severe edema of the left leg or in left iliofemoral deep vein thrombosis [May R, Thurner J. The cause of the predominately sinistral occurrence of thrombosis of the pelvic veins. Angiology 1957; 8: 419-427 .]. Corrective surgical treatment requires extensive dissection. Therefore, endovascular venous stenting is currently used in these patients [Lamont JP, Pearl GJ, Patetsios P, Warner MT, Gable DR, Garrett W, et al. Prospective evaluation of endoluminal venous stents in the treatment of the May-Thurner syndrome. Ann Vasc Surg. 2002 Jan; 16(1): 61-4. Epub 2002 Jan 17 .]. We present a case of migration of two iliacal vein stents into the right ventricle in a patient with May-Thurner syndrome.

Constriction, Pathologic↗
PubMed1999

Heart transplantation after successful donor postpartum pulmonary embolectomy.

A fulminant pulmonary embolism can be treated surgically if thrombolytic therapy is contraindicated. A 31-year-old woman developed a fulminant pulmonary embolism after right-sided deep venous thrombosis 1 day after undergoing a cesarean section. A pulmonary embolectomy with cardiopulmonary bypass was performed, but the patient was brain-dead. After 2 days of echocardiographic observation, her heart was explanted for a 61-year-old man with ischemic cardiomyopathy. His right heart data were unremarkable, and he remains well 16 months after transplantation. Despite the sudden strain on the right ventricle that occurs with a pulmonary embolism, such a heart may be transplanted successfully after a pulmonary embolectomy.

Adult↗
PubMed2000

The abdominojugular reflux sign.

PURPOSE: The abdominojugular reflux sign is useful in diagnosing right ventricular failure, but is often performed and interpreted incorrectly. Our objective was to review the history, epidemiology, and pathophysiology of the abdominojugular reflux sign. METHODS: We conducted a MEDLINE search of the English language reports published between 1966 and 1999 and a manual search of bibliographies of relevant papers. RESULTS: A positive abdominojugular reflux sign is defined by an increase in the jugular venous pressure of greater than 3 cm, sustained for greater than 15 seconds. In the absence of left heart failure, a positive abdominojugular reflux sign should prompt consideration of impaired right ventricular preload, a decrease in right ventricular compliance, a decrease in right ventricular systolic function or an elevation in right ventricular afterload. In patients presenting with dyspnea, the abdominojugular reflux is useful in predicting congestive heart failure (LR+ 6.0 (95% CI; 0.8-51); LR- 0.78; (95% CI: 0.62 to 0.98)) and suggests pulmonary capillary wedge pressures of greater than 15 mm Hg (LR+ 6. 7 (95% CI: 3.3 to 13.4); LR- 0.08 (95% CI: 0.01 to 0.52)). CONCLUSION: The abdominojugular reflux is not specific to any one disorder, but rather is a reflection of a right ventricle that cannot accommodate augmented venous return. Constrictive pericarditis, right ventricular infarction, and restrictive cardiomyopathy are common causes of a positive finding. Left ventricular failure may also induce the sign, but only when the pulmonary capillary wedge pressure is greater than 15. The one diagnosis not seen with abdominojugular reflux is cardiac tamponade.

Abdomen↗
PubMed1996

Left and right ventricular dysplasia and Uhl's anomaly. A case report.

Myocardial dysplasia involves a quasi-complete or localized absence of myocardial fibers in the right or left ventricle, with corresponding partial or complete filling by fibroadipose tissue. This disorder, in its full form called "Uhl's anomaly", was first described in 1952 as an anomaly of the heart conferring a parchment-like appearance to its walls. Incomplete forms of the disorder fall into the category of right or left arrhythmogenic ventricular dysplasia. Although approximately 50 cases of right ventricular dysplasia have been documented, only two reports concern left ventricular dysplasia. Having encountered the latter anomaly, we first present the case and our observations, and then review the etiology, pathogenesis, clinical aspects, and evolution of this disorder.

Adult↗
PubMed2001

Inhaled nitric oxide effectively decreases right heart afterload following right heart infarct in pigs.

OBJECTIVE: To test the hypothesis that nitric oxide is beneficial in acute right heart failure after right ventricle infarct. Right ventricle infarct results in a decrease in right heart function with a subsequent reduction in ejection fraction and cardiac index. The pulmonary circulation is compromised as the right ventricle weakens, and the resulting stasis and further weakening of the ventricle present clinically as an increase in right heart afterload. Pulmonary vasodilation should ease these hemodynamic symptoms of right heart infarct. DESIGN: Ten 3-4-month-old pigs were chosen as experimental animals. All animals were cannulated, a sternotomy was performed and branches of the right main coronary were ligated to cause infarct of the right ventricle. After a 4-h stabilization period, all animals received fluid preload with a dextrose-based solution after which control hemodynamic measurements were recorded. Treatment with inhaled nitric oxide was begun at progressive concentrations and hemodynamic measurements recorded at 30-min intervals. RESULTS: Nitric oxide treatment significantly reduced right heart afterload, which was also apparent as a reduction in left heart preload. A significant deterioration was observed in cardiac output as well as in left and right ventricle stroke work indices. CONCLUSION: The use of nitric oxide in this model of right heart infarct in previously healthy young swine effected a decrease in both right heart afterload and left heart preload, with an overall deterioration in global hemodynamics.

Administration, Inhalation↗
PubMed1995

Acquired cor triatriatum after orthotopic cardiac transplantation.

Orthotopic cardiac transplantation was performed in a 42-year-old woman with idiopathic cardiomyopathy. Postoperative right ventricular failure developed and a transesophageal echocardiogram demonstrated acquired cor triatriatum with marked obstruction to mitral valve inflow and severe right ventricular dilatation. At reexploration, redundant donor atrial tissue was excised correcting the cor triatriatum. She was alive and well with normal hemodynamic parameters 12 months after transplantation.

Adult↗
PubMed2004

Induction of heat shock protein 72 in the failing heart is attenuated after an exposure to heat shock.

Induction of heat shock protein (Hsp) 72 in the right ventricular muscle of the rat with heart failure following acute myocardial infarction (AMI) was examined. AMI was induced by the left coronary artery ligation (CAL). The animals at the 8th, but not 2nd, week after CAL revealed a decrease in cardiac output index (COI), suggesting that heart failure had developed by 8 weeks after CAL. Increases in the right ventricular developed pressure and the ratios of right ventricle/body weight and lung/body weight at the 2nd and 8th weeks showed the development of the right ventricular hypertrophy. After measurement of hemodynamic parameters, the hearts isolated from animals at the 2nd and 8th weeks after CAL (2w- and 8w-CAL hearts, respectively) were perfused and subjected to heat shock (at 42 degrees C, for 15 min) followed by 6-h perfusion. At the end of perfusion, Hsp72 content in the left ventricle without infarct area (viable LV) and the right ventricle (RV) was determined by the Western immunoblotting method. The production of myocardial Hsp72 in the viable LV and RV of the 2w-CAL heart increased after an exposure to heat shock. In contrast, induction of Hsp72 in the viable LV and RV of the 8w-CAL heart was blunted. The results suggest that the development of heart failure following AMI may result in a decrease in the ability for Hsp72 induction not only in the viable LV but also in the RV, leading to contractile dysfunction of the heart.

Animals↗
PubMed2001

Contralateral pulmonary artery stenosis after left pneumonectomy.

Contralateral pulmonary artery stenosis is a rare complication following pneumonectomy. When extensive intrapericardial dissection is warranted, one must be wary of this potential complication and take measures to avoid it. Postoperatively, a high index of suspicion must be maintained in a patient with a new onset of right-sided heart failure after intrapericardial pneumonectomy. We discuss intraoperative risk factors, postoperative clinical findings, and our strategy for repair.

Arterial Occlusive Diseases↗
PubMed2005

Agreement between four available algorithms to evaluate global systolic left and right ventricular function from tomographic radionuclide ventriculography and comparison with planar imaging.

BACKGROUND AND AIM: Left and right ventricular ejection fractions (LVEF and RVEF) and end-diastolic and end-systolic volumes (LVEDV, RVEDV, LVESV and RVESV) can be calculated from tomographic radionuclide ventriculography (TRV). The aim of this study was to validate and compare these parameters obtained using four different TRV software programs (QBS, QUBE, 4D-MSPECT and BP-SPECT). METHODS: LVEF obtained from planar radionuclide ventriculography (PRV) was compared with LVEF obtained from TRV using the four different software programs in 166 patients. Furthermore, ventricular volumes obtained using TRV (QBS, QUBE and 4D-MSPECT) were compared with those obtained using BP-SPECT, the latter being the only method with the validation of ventricular volumes in the literature. RESULTS: The correlation of LVEF between PRV and TRV was good for all methods: 0.81 for QBS, 0.79 for QUBE, 0.71 for 4D-MSPECT and 0.79 for BP-SPECT. The mean differences+/-standard deviation (SD) were 3.16+/-9.88, 10.72+/-10.92, 3.43+/-11.79 and 2.91+/-10.39, respectively. The correlation of RVEF between BP-SPECT and QUBE and QBS was poor: 0.33 and 0.38, respectively. LV volumes calculated using QBS, QUBE and 4D-MSPECT correlated well with those obtained using BP-SPECT (0.98, 0.90 and 0.98, respectively), with mean differences+/-SD of 7.31+/-42.94, -22.09+/-36.07 and -40.55+/-39.36, respectively. RV volumes showed poorer correlation between QBS and BP-SPECT and between QUBE and BP-SPECT (0.82 and 0.57, respectively). CONCLUSION: LVEF calculated using TRV correlates well with that calculated using PRV, but is not interchangeable with the value obtained using PRV. Volume calculations (for left and right ventricle) and RVEF require further validation before they can be used in clinical practice.

Algorithms↗
PubMed2005

[Acute inferior and right ventricular myocardial infarction in a patient with congenital secundum atrial septal defect].

We are presenting the case of a forty-six-year old patient, with a previously undiagnosed congenital secundum atrial septal defect, admitted to the intensive care ward because of an acute inferior and right ventricular myocardial infarction. He was randomised to Gusto V Trial and intravenous therapy of reteplase and abciximab was administered, which resulted in electrocardiographic reperfusion. After several hours of right ventricular failure his condition improved. No complications were observed throughout the convalescence. During the routine TTE examination a secundum ASD was diagnosed and confirmed afterwards in the TEE examination. Patient was qualified for coronarography which revealed a critical lesion in the right coronary artery; successful PCI was conducted. He is now waiting for surgical correction of a secundum atrial septal defect.

Acute Disease↗
PubMed1997

[Apical hypertrophic cardiomyopathy with right ventricular involvement].

We report right ventricular involvement in apical hypertrophic cardiomyopathy (HCMP) in two women and one man, aged from 19 to 44 years-old, who presented different signs from those with left ventricular disease (who have good clinical evolution), with signs and symptoms of severe diastolic restriction, showing great atrial enlargement and two with atrial fibrillation and death due to thromboembolism. The right ventricular involvement in apical HCMP leads to a worst prognosis than isolated left ventricular disease, does not have the typical electrocardiographic changes and presents with ventricular restriction and tricuspid regurgitation.

Adult↗
PubMedDate not supplied

Value of the echocardiographic findings of arrhythmogenic right ventricular dysplasia with left ventricular involvement in a child.

A 9-year-old girl was admitted because she had had palpitations for 2 years. Her electrocardiogram revealed multifocal ectopic beats with left bundle branch morphology, sinoatrial block, and first- and second-degree atrioventricular blocks. Cross-sectional echocardiography demonstrated an enlarged left ventricle and filling defects and sacculations of the posterior left ventricular wall, apex, and septum. The diagnosis of arrhythmogenic right ventricular dysplasia (ARVD) was confirmed by endomyocardial biopsy and thallium 201 scintigraphy. We present this case because of the rarity of left ventricular involvement associated with ARVD. We also emphasize the value of echocardiography in the early diagnosis of ARVD.

Child↗
PubMed2006

Impact of mechanical reperfusion on clinical outcome in elderly patients with right ventricular infarction.

BACKGROUND: Previous reports suggest that elderly patients with acute right ventricular infarction suffer in-hospital mortality of 50% and that hemodynamic compromise is irreversible. We hypothesized that mechanical reperfusion would improve such outcomes. METHODS: We retrospectively analyzed in-hospital morbidity and mortality in 54 patients >70 years of age with acute inferior myocardial infarction undergoing primary angioplasty. The presence of right ventricular infarction was determined by a two dimensional echocardiogram. RESULTS: Overall, 18 (33%) patients had inferior myocardial infarction and right ventricular infarction, whereas 36 (67%) patients had inferior myocardial infarction alone. All patients with inferior myocardial infarction alone were successfully reperfused, whereas one patient with right ventricular infarction suffered reperfusion failure. Right ventricular infarction patients more commonly suffered hemodynamic and arrhythmic complications (hypotension in 33 vs. 2.8%, P<0.01; ventricular arrhythmias in 61 vs. 25%, P<0.01; and bradyarrhythmias in 78 vs. 25%, P<0.01). Overall, 72% of right ventricular infarction patients survived, including many with hemodynamic compromise. In-hospital mortality, however, was greater in those with right ventricular infarction than in those without (28 vs. 8.3%, P=0.19). CONCLUSION: Elderly patients with inferior myocardial infarction complicated by right ventricular infarction suffer greater morbidity and mortality than those without. With successful mechanical reperfusion, however, the majority survives, including those with hemodynamic compromise.

Aged↗
PubMed2001

Changes in extracellular matrix and in transforming growth factor beta isoforms after coronary artery ligation in rats.

Extensive myocardial remodeling occurs after transmural myocardial infarction (MI). The infarcted myocardium is being replaced by scar tissue after gradual resorption of the necrotic tissue. The remodeling process involves both synthesis and degradation of collagens as major components of the extracellular matrix (ECM). In the present study we have analyzed the time-dependent changes of the processes related to this fibrosis in the infarct area and in the non-infarcted left ventricle (LV) six hours to 82 days after occlusion of the left anterior descending coronary artery (LAD) in rats. We also examined whether changes occurred in the expression pattern of the transforming growth factor (TGF) beta isoforms, since this cytokine is known as powerful inductor of fibrosis. Elevation in colligin expression preceded the pronounced increase in mRNA expression of both type I and type III collagen after MI from day three onwards. The maximal increase in colligin protein in the infarct area coincided with the most pronounced expression of collagen I and collagen III mRNA expression. Also, the expression and activity of matrix metalloproteinases (MMPs) and of tissue inhibitor of matrix metalloproteinase (TIMP)-2 mRNA were increased predominantly in the infarct area. TGF beta(1)and TGF-beta(2)expression increased within the first days after MI, whereas TGF-beta(3)expression was elevated predominantly in the infarct area. This pronounced increase in TGF-beta(3)persisted up to 82 days and correlated positively with the parameters of ECM metabolism. Thus, the scar formation is an ongoing dynamic process in which TGF-beta(3)seems to play an active role in the complex ventricular remodeling.

Animals↗
PubMed2007

Advanced quantitative echocardiography in arrhythmogenic right ventricular cardiomyopathy.

BACKGROUND: Arrhythmogenic right ventricular (RV) cardiomyopathy (ARVC) is a regional disease of the RV myocardium with variable degrees of left ventricular involvement. Three-dimensional echocardiography and Doppler tissue imaging (DTI) are new echocardiographic modalities for the evaluation of global and regional function, but the diagnostic potential remains to be assessed. METHODS: Twenty patients with previously established ARVC were evaluated by 3-dimensional echocardiography and DTI, and compared with 32 age- and sex-matched control subjects. RESULTS: Using 3-dimensional echocardiography, patients with ARVC had a decreased RV ejection fraction (0.47 +/- 0.08 vs 0.53 +/- 0.05, P < .01), and a decreased peak lateral systolic annular velocity by pulsed wave imaging of both the RV (11.9 +/- 2.6 vs 15.1 +/- 3.7 cm/s, P < .01) and the left ventricle (7.0 +/- 2.6 vs 9.5 +/- 1.9 cm/s, P < .01). DTI showed decreased regional systolic strain, but with wide variation in the measurements. CONCLUSION: Three-dimensional echocardiography identifies decreased RV ejection fraction in ARVC. Assessment of regional contractility by DTI is limited by wide variation. Echocardiographic evaluation of the longitudinal motility appears to be a sensitive marker of preclinical left ventricular involvement.

Adult↗
PubMed1995

Assessment of right ventricular diastolic function by pulsed Doppler echocardiography in chronic pulmonary disease and pulmonary thromboembolism.

We evaluated right ventricular (RV) diastolic performance in 12 healthy subjects (control), 25 patients with chronic pulmonary diseases (CPD) and 6 patients with chronic pulmonary thromboembolism (PTE). Flow velocity patterns were determined by the pulsed Doppler technique. The values determined included acceleration time (AT), deceleration time (DT), and the ratio of the atrial contraction wave (A) to the rapid filling wave (R) (A/R ratio) from flow velocity patterns in the RV inflow tract. DT was significantly prolonged in the CPD and PTE groups compared with the control group, indicating dysfunction during the early (middle) filling period. The prolongation was marked in those patients with pulmonary hypertension. The A/R ratio was significantly higher in the CPD and PTE groups than in the control group, indicating a decrease in RV compliance. The A/R ratio increased slightly with the increase in the end-diastolic volume index. These results suggested that the pressure overload plays an important role in RV diastolic dysfunction in patients with pulmonary disease, and that preload contributes to the dysfunction.

Aged↗
PubMed1995

QRST isointegral map reflects the sudden reduction of right ventricular pressure after balloon pulmonary valvuloplasty.

To elucidate the mechanism of electrocardiographic changes due to right ventricular pressure overload, serial changes on body surface maps recorded in two children with valvular pulmonary stenosis before and after successful reduction of right ventricular pressure by balloon valvuloplasty (BVP) were studied. Body surface maps and 12-lead electrocardiograms were simultaneously recorded before and 1-1.5 hours, 8 hours, and 5 days after BVP. Before BVP, QRST isointegral maps showed either two maxima or an expanded single maximum on the right anterior chest. These abnormal characteristics become normal or near normal 1-1.5 hours after BVP. Electrocardiographic waveforms and QRS and ST-T isointegral maps showed minimal changes. Changes in QRST isointegral maps were observed near the center of the midanterior chest. These results suggest that increased right ventricular pressure caused a primary repolarization abnormality in the mid-anterior chest that was easily detected by body surface QRST isointegral maps.

Body Surface Potential Mapping↗