Telltale atria—The meaning of adverse remodeling Eng, Marvin H.; Zahr, Firas
Catheterization and cardiovascular interventions,
January 1, 2023, 2023-01-00, 20230101, Volume:
101, Issue:
1
Journal Article
Peer reviewed
Key Points
Right atrial area index/left atrial area index ratio (RLR) above 0.6 was associated with higher mortality rates.
Elevated RLR are also associated with pulmonary hypertension.
Surgical data ...suggests that reverse atrial remodeling is possible and associated with improved outcomes.
Refinements of surgical techniques in liver transplant during the last 10 years have offered more successful outcomes for recipients with portal vein thrombosis. Patency of the portal vein after a ...thrombectomy can be neither adequately evaluated, nor objectively assessed; therefore, we suggest that rerouting part of the portal flow through a "passing loop," with or without augmenting the portal flow, may be a salvage procedure, when there is a possible postoperative rethrombosis of the portal vein.
Abstract Background A right ventricular assist device is a treatment option for patients with severe right ventricular failure after left ventricular assist device (LVAD) implantation. Recognition of ...risk factors for mortality after biventricular assist device (BiVAD) implantation is important for patient selection and optimal outcomes. Methods We reviewed our experiences between 1991 and 2005 in 44 patients who were supported by both an LVAD and a right ventricular assist device. Results Thirteen patients (30%) survived until heart transplantation, and 31 patients (70%) died while on support. The multivariate analysis shows that post-LVAD extracorporeal membrane oxygenation and worsening renal function are associated with the highest postoperative mortality. The univariate analysis also included previous thoracic surgery and ischemic cardiomyopathy as potential preoperative indicators for poor outcome after BiVAD implants. No differences were observed in the rates for the need of preoperative support with a ventilator, an intra-aortic balloon pump, or extracorporeal membrane oxygenation, or in the rates of postoperative complications between survivors and nonsurvivors. Conclusions BiVAD implantation remains one of the challenges in treating severe heart failure. Previous cardiac surgery, elevated creatinine, and post-LVAD extracorporeal membrane oxygenation were risk factors for mortality after BiVAD implantation. Dialated Cardiomyopathy on the other hand was associated with a more favorable outcome.
Saphenous vein grafts(SVG) pseudoaneurysms,especially giant ones,are rare and occur as a late complication of coronary artery bypass grafting. This condition affects both genders and typically occurs ...within the sixth decade of life. The clinical presentation ranges from an asymptomatic incidental finding on imaging studies to new onset angina,dyspnea,myocardial infarction or symptoms related to compression of neighboring structures. An 82-year-old woman presented with acute onset back pain,dyspnea and was noted to have significantly engorged neck veins. In the emergency department,a chest computed tomographic angiogram with intravenous contrast revealed a ruptured giant bilobed SVG pseudoaneurysm to the right posterior descending artery(RPDA). This imaging modality also demonstrated compression of the superior vena cava(SVC) by the SVG pseudoaneurysm. Coronary angiogram with bypass study was performed to establish the patency of this graft. Endovascular coiling and embolization of the SVG to RPDA was initially considered but disfavored after the coronary angiogram revealed preserved flow from the graft to this arterial branch. After reviewing the angiogram films,a surgical strategy was favored over a percutaneous intervention with a Nitinol self-expanding stent since the latter would have not addressed the superior vena cava compression caused by the giant pseudoaneurysm. Intraoperative transesophageal echocardiogram demonstrated SVCcompression by the giant pseudoaneurysm cranial lobe. Our patient underwent surgical ligation and excision of the giant pseudoaneurysm and the RPDA was regrafted successfully. In summary,saphenous vein grafts pseudoaneurysms can be life-threatening and its therapy should be guided based on the presence of mechanical complications,the patency of the affected vein graft and the involved myocardial territory viability.
Key Points
Left atrial function, as assessed by global longitudinal strain (GLS), is an important predictor of mortality and morbidity.
In patients with severe mitral regurgitation (MR) with reduced ...left ventricular systolic function (LVEF), effective treatment of the MR by mitral clip did not result in favorable left atrial or LV remodeling.
Despite effective and sustained treatment of MR, left ventricular diastolic pressure continued to increase during the follow‐up period.
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