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Cardiac Pathology (cardiac + pathology)
Selected AbstractsExtracorporeal Life Support: A Simple and Effective Weapon for Postcardiotomy Right Ventricular FailureARTIFICIAL ORGANS, Issue 7 2009Kuo-Sheng Liu Abstract Postcardiotomy right ventricular (RV) failure develops during the perioperative period following pulmonary hypertensive crisis or acute myocardial infarction. This study reports our institutional experience in treating these patients with extracorporeal life support (ECLS). Between June 2002 and July 2005, 46 adults were treated with ECLS for postcardiotomy shock. Acute RV failure was the cause of support in 14 (30%). Patient mean age was 55.7 ± 15.4 years. Cardiac pathologies were valvular (n = 7), coronary (n = 1), combined coronary and valvular disease (n = 2), complex congenital heart (n = 2), aortic aneurysm (n = 1), and cardiomyopathy post heart transplant (n = 1). The triggers of RV failure were pulmonary hypertension (n = 6), RV infarction (n = 4), and not defined (n = 4). Patients were supported on ECLS for a mean duration of 71 ± 52 h (range, 10,183 h). Major complications included acute renal failure requiring hemodialysis (n = 4), reexploration for bleeding (n = 2), and acute subdural hematoma (n = 1). Nine (64%) patients were successfully weaned from ECLS, and seven (50%) survived to discharge. Preexisting pulmonary hypertension had a favorable tendency for weaning, and acute renal failure requiring hemodialysis correlated with in-hospital mortality. ECLS is beneficial for treating postcardiotomy RV failure when conventional therapy is exhausted. As it can be deployed rapidly and does not require resternotomy for weaning, ECLS could be regarded as the first choice of mechanical support for postcardiotomy RV failure. [source] Fibrosis in heart disease: understanding the role of transforming growth factor-,1 in cardiomyopathy, valvular disease and arrhythmiaIMMUNOLOGY, Issue 1 2006Razi Khan Summary The importance of fibrosis in organ pathology and dysfunction appears to be increasingly relevant to a variety of distinct diseases. In particular, a number of different cardiac pathologies seem to be caused by a common fibrotic process. Within the heart, this fibrosis is thought to be partially mediated by transforming growth factor-,1 (TGF-,1), a potent stimulator of collagen-producing cardiac fibroblasts. Previously, TGF-,1 had been implicated solely as a modulator of the myocardial remodelling seen after infarction. However, recent studies indicate that dilated, ischaemic and hypertrophic cardiomyopathies are all associated with raised levels of TGF-,1. In fact, the pathogenic effects of TGF-,1 have now been suggested to play a major role in valvular disease and arrhythmia, particularly atrial fibrillation. Thus far, medical therapy targeting TGF-,1 has shown promise in a multitude of heart diseases. These therapies provide great hope, not only for treatment of symptoms but also for prevention of cardiac pathology as well. As is stated in the introduction, most reviews have focused on the effects of cytokines in remodelling after myocardial infarction. This article attempts to underline the significance of TGF-,1 not only in the post-ischaemic setting, but also in dilated and hypertrophic cardiomyopathies, valvular diseases and arrhythmias (focusing on atrial fibrillation). It also aims to show that TGF-,1 is an appropriate target for therapy in a variety of cardiovascular diseases. [source] Surgery for Cardiac Valves and Aortic Root Without Cardioplegic Arrest ("Beating Heart"): Experience with a New Method of Myocardial PerfusionJOURNAL OF CARDIAC SURGERY, Issue 6 2007Tomas A. Salerno M.D. Similarly, beating heart mitral valve surgery via the trans-septal approach with the aorta unclamped, is a novel technique. We, herein, report a series of 346 patients with a variety of cardiac pathologies who were operated upon utilizing a new modality of myocardial perfusion. Among this group of patients, there were 55 patients who were diagnosed with endocarditis of one or more valves. These patients were excluded from this series of patients. Mean age was 59 ± 12, and there were 196 (67.3%) males and 95 (32.7%) females. There were six aortic root procedures, 90 mitral valve replacements (MVR), 46 mitral valve repairs, 20 MVR+ coronary artery bypass grafting (CABG), 28 tricuspid valve repairs, 106 aortic valve replacements (AVR), 17 AVR+CABG, and 8 AVR/MVR. Crude mortality for the group was 20 of 291 (6.8%). Intra-aortic balloon pump utilization at time of weaning from cardiopulmonary bypass was 6/291 (2.06%), and re-operation for bleeding was needed in 12 of 291 (4.1%) patients. Postoperative stroke occurred in 4 of 291 (1.3%) patients. In these patients, the clinical diagnosis of stroke was made prior to surgery. This initial experience with this new method of myocardial perfusion indicates that results are at least comparable, if not superior, to conventional techniques utilizing intermittent cold blood cardioplegia. [source] Nocturia: An austrian study on the multifactorial etiology of this symptom,,NEUROUROLOGY AND URODYNAMICS, Issue 5 2009H. Christoph Klingler Abstract Aims To identify the different factors contributing to nocturia in a clinical setting. Patients and Methods Three hundred twenty-four patients (133 women, 191 men; mean age 63 years) were entered into this multi-institutional study. When presenting with nocturia we obtained detailed medical history and performed urine analysis, post-void residual volume and renal ultrasonography. Bothersome score and quality of life were evaluated using visual analogue scale and Kings' Health Questionnaire (KHQ), respectively. Patients were asked to complete a 48-hr voiding diary (VD). Nocturia and its associated problems were evaluated using KHQ and VD in conjunction with concurrent health variables. Results Mean nocturia was 2.8 in men versus in 3.1 women. Fifty percent of patients were aged >65 years, 60% had daytime lower urinary tract symptoms (LUTS) as well as nocturia, 33% had cardiac pathologies and 7% had peripheral edema. Principal causes for nocturia were global polyuria in 17%, nocturnal polyuria (NP) in 33% and reduced functional capacity <250 ml in 16.2%; 21.2% had mixed forms of NP and reduced bladder capacity and 12.6% suffered from other causes. Mean bothersome score was higher in women (P,<,0.001) and in patients with NP (P,=,0.012). Quality of life was significantly lower in women (P,=,0.001), in patients aged >65 years (P,=,0.029) and in those with reduced functional capacity (P,<,0.001). Mean voided 24-hr urine was higher in women (P,=,0.033) and in patients aged <65 years (P,=,0.019). Conclusions Nocturia had a high impact on bothersome score, strong associations with poor health and other LUTS. NP was the predominant cause of nocturia. Neurourol. Urodynam. 28:427,431, 2009. © 2009 Wiley-Liss, Inc. [source] National guidelines for adult autopsy cardiac dissection and diagnosis , are they achievable?HISTOPATHOLOGY, Issue 1 2008A personal view Adult autopsy cardiac pathology has been previously a quiet backwater of ischaemic heart disease and the occasional cardiomyopathy. This has changed to an increasingly tense area, following recent genetic discoveries and some medicolegal cases. All autopsy pathologists should consider their dissection protocols and check that they are able to deliver the increasingly detailed information that clinicians, geneticists and families require. This text has suggestions about the practical realities of cardiac dissection, cardiac histology and the need for other tests alongside illustrations aimed to assist case consideration. [source] Fibrosis in heart disease: understanding the role of transforming growth factor-,1 in cardiomyopathy, valvular disease and arrhythmiaIMMUNOLOGY, Issue 1 2006Razi Khan Summary The importance of fibrosis in organ pathology and dysfunction appears to be increasingly relevant to a variety of distinct diseases. In particular, a number of different cardiac pathologies seem to be caused by a common fibrotic process. Within the heart, this fibrosis is thought to be partially mediated by transforming growth factor-,1 (TGF-,1), a potent stimulator of collagen-producing cardiac fibroblasts. Previously, TGF-,1 had been implicated solely as a modulator of the myocardial remodelling seen after infarction. However, recent studies indicate that dilated, ischaemic and hypertrophic cardiomyopathies are all associated with raised levels of TGF-,1. In fact, the pathogenic effects of TGF-,1 have now been suggested to play a major role in valvular disease and arrhythmia, particularly atrial fibrillation. Thus far, medical therapy targeting TGF-,1 has shown promise in a multitude of heart diseases. These therapies provide great hope, not only for treatment of symptoms but also for prevention of cardiac pathology as well. As is stated in the introduction, most reviews have focused on the effects of cytokines in remodelling after myocardial infarction. This article attempts to underline the significance of TGF-,1 not only in the post-ischaemic setting, but also in dilated and hypertrophic cardiomyopathies, valvular diseases and arrhythmias (focusing on atrial fibrillation). It also aims to show that TGF-,1 is an appropriate target for therapy in a variety of cardiovascular diseases. [source] Bilateral Axillary Artery Perfusion to Reduce Brain Damage during Cardiopulmonary BypassJOURNAL OF CARDIAC SURGERY, Issue 2 2010Kazuhiro Kurisu M.D. The aim of the present study was to examine the value of bilateral axillary artery perfusion during thoracic aortic and cardiac surgery, and to evaluate the clinical results with a particular focus on cerebral damage. Methods: From March 2002 through December 2007, 24 patients (16 male and eight female; age range, 43 to 84 years) underwent bilateral axillary artery perfusion through side grafts during cardiopulmonary bypass. Aortic surgery, including total arch replacement, hemiarch replacement, and ascending aortic replacement, was performed in 21 patients. Bilateral axillary artery perfusion was also used in three complicated valve surgeries after expanding its indication to cardiac pathology with a diseased aorta, two redo cases with severe atherosclerotic vascular disease, and one case with a porcelain aorta. Results: Bilateral axillary artery perfusion was successful in all patients. There were no complications related to this procedure except in one patient, who suffered from a local fluid retention in one wound, requiring puncture drainage. There was no hospital mortality. No strokes were identified by either clinical assessments or diagnostic imaging. Conclusions: Bilateral axillary artery perfusion is a useful method for protection of the brain during either thoracic aortic or cardiac surgery when the patients have an extensively diseased aorta.,(J Card Surg 2010;25:139-142) [source] Impact of Tricuspid Regurgitation and Prior Coronary Bypass Surgery on the Geometry of the Coronary Sinus: A Rotational Coronary Angiography StudyJOURNAL OF CARDIOVASCULAR ELECTROPHYSIOLOGY, Issue 4 2010DAN BLENDEA M.D., Ph.D. Coronary Venous Geometry in Patients Undergoing CRT.,Introduction: The coronary sinus (CS) is often distorted in patients with advanced cardiomyopathy, making CS cannulation difficult. The objective of this study was to examine the impact of the underlying cardiac pathology on the variability of the CS anatomy, using rotational coronary venous angiography (RCVA). Methods and Results: Seventy-nine patients undergoing RCVA for cardiac resynchronization therapy (CRT) were evaluated: age 63 ± 15 years, 43% with prior coronary artery bypass grafting (CABG). Aspects of the CS anatomy which could impact cannulation were examined: the CS ostial angle, the posterior displacement of the CS away from the atrioventricular groove, a measure of CS curvature, and the presence of stenoses and aneurysmal dilatations. The CS ostial angle was variable (65,151°, mean 119 ± 19°, <90° in 8 patients) and decreased significantly (P = 0.0022) with increasing severity of tricuspid regurgitation (TR), reaching 94 ± 18° in patients with severe TR. The posterior displacement of the CS was significantly more accentuated in patients with prior CABG when compared with the patients without CABG (7.1 ± 3.7 vs 4.5 ± 2.8 mm; P = 0.0246). The decrease in luminal diameter at the CS,great cardiac vein (GCV) junction was 2.0 ± 1.0 mm, being more pronounced in patients with prior CABG versus nonCABG (26 vs 20%; P = 0.042). Stenoses and aneurysmal dilatations of the CS,GCV were encountered in 4 (5%) and 6 (8%) of patients, respectively, all of them with prior CABG, representing 12% and 18% of the CABG group. Conclusion: The CS anatomy in patients undergoing CRT is variable, and is impacted by the severity of the underlying TR and history of a prior CABG. (J Cardiovasc Electrophysiol, Vol. 21, pp. 436,440, April 2010) [source] Delayed ventricular fibrillation following blunt chest trauma in a 4-year-old childPEDIATRIC ANESTHESIA, Issue 4 2006RIAD TOME MD Summary A 4-year-old boy who was involved in a motor vehicle accident as a pedestrian and suffered blunt chest trauma was admitted to the emergency room. Unpredictable delayed ventricular fibrillation was diagnosed and treated successfully 2 h later. This case cannot be classified as commotio cordis as the ventricular fibrillation (VF) developed so long after the sustained chest injury. At the same time, other possible etiologies of VF such as cardiac pathology or electrolyte and metabolic disorders had been ruled out. Thus, an etiological link between the chest trauma and the subsequent VF could not be ruled out and is in fact plausible despite the late onset. [source] Microvolt T-Wave Alternans during Holter Monitoring in Children and AdolescentsANNALS OF NONINVASIVE ELECTROCARDIOLOGY, Issue 2 2010Leonid Makarov M.D. Background: Time-domain microvolt T-wave alternans (TWA) has been described as a noninvasive marker of sudden cardiac death in adults. The incidence of TWA in pediatric populations has not been defined well. The aim of the study was to determine peculiarities of TWA in children. Methods: We examined 68 healthy patients,newborns (20) and children in age group of 7,17 years (48),and 85 pediatric patients: ventricular premature beats,65; dilated cardiomyopathy (DCMP),2; long QT syndrome (LQTS),10; Brugada syndrome (BrS),5, catecholaminergic ventricular tachycardia (CVT),3. All underwent Holter monitoring (HM) with definition of the peak value of TWA by modified moving average method. Results: In healthy newborns, TWA was 32 ± 8 (12,55) ,V (HR 123,156 bmp). In healthy children (7,17 years) it was 30 ± 11 (10,l 55) ,V, (HR 64,132 bmp) without any differences between boys and girls. In all group of patients, TWA were significantly higher (P < 0.05) than in healthy. Circadian peak of TWA was found (90%) in a second part of day and at sleep (8%). Among them 60% (LQTS, BrS, and DCPM) had TWA > 55 ,V. Conclusion: Time-domain TWA during HM in children was independent of age, gender, and heart rate. In 94% healthy children, values of TWA do not exceed 55 ,V but 20,50% children with cardiac pathology had TWA more than 55 ,V. Night circadian type of TWA in diseases with risk of life-threatening arrhythmias associated with TWA was more than 55 ,V. Ann Noninvasive Electrocardiol 2010;15(2):138,144 [source] | ||||||||||