- StatPearls [BOOK]
- BOOKStatPearls Publishing: Treasure Island (FL)
- Papillary muscle rupture is a rare and potentially fatal complication often following a myocardial infarction or secondary to infective endocarditis. Acute rupture frequently results in severe mitral...
Papillary muscle rupture is a rare and potentially fatal complication often following a myocardial infarction or secondary to infective endocarditis. Acute rupture frequently results in severe mitral valve regurgitation and subsequent acute life-threatening cardiogenic shock and pulmonary edema. There are 5 papillary muscles in the heart originating from the ventricular walls. These muscles attach to the tricuspid and mitral valve leaflets via the chordae tendineae and functionally prevent regurgitation of ventricular blood via tensile strength by preventing prolapse or inversion of the valves during systole. Three of these papillary muscle and chordae tendineae complexes are attached to the tricuspid valve (anterior, posterior, septal), and 2 are attached to the mitral valve (anterolateral and posteromedial). Papillary muscle dysfunction leads to regurgitation of blood through the valves causing backflow of blood that can lead to the left or right-sided heart failure. Literature first identifies papillary muscle rupture as early as 1948. Visualization via 2-dimensional echocardiography was first reported in 1981. Transesophageal echocardiography was first used in 1985 in identifying the condition.
- Mechanical Circulatory Support of the Right Ventricle for Adult and Pediatric Patients With Heart Failure. [Journal Article]
- AJASAIO J 2018 May 10
- The clinical implementation of mechanical circulatory assistance for a significantly dysfunctional or failing left ventricle as a bridge-to-transplant or bridge-to-recovery is on the rise. Thousands ...
The clinical implementation of mechanical circulatory assistance for a significantly dysfunctional or failing left ventricle as a bridge-to-transplant or bridge-to-recovery is on the rise. Thousands of patients with left-sided heart failure are readily benefitting from these life-saving technologies, and left ventricular failure often leads to severe right ventricular dysfunction or failure. Right ventricular failure (RVF) has a high rate of mortality caused by the risk of multisystem organ failure and prolonged hospitalization for patients after treatment. The use of a blood pump to support the left ventricle also typically results in an increase in right ventricular preload and may impair right ventricular contractility during left ventricular unloading. Patients with RVF might also suffer from severe pulmonary dysfunction, cardiac defects, congenital heart disease states, or a heterogeneity of cardiophysiologic challenges because of symptomatic congestive heart failure. Thus, the uniqueness and complexity of RVF is emerging as a new domain of significant clinical interest that motivates the development of right ventricular assist devices. In this review, we present the current state-of-the-art for clinically used blood pumps to support adults and pediatric patients with right ventricular dysfunction or failure concomitant with left ventricular failure. New innovative devices specifically for RVF are also highlighted. There continues to be a compelling need for novel treatment options to support patients with significant right heart dysfunction or failure.
- The prognostic value of the relationship between right atrial and pulmonary capillary wedge pressure in diverse cardiovascular conditions. [Journal Article]
- AHAm Heart J 2018; 199:31-36
- CONCLUSIONS: In patients undergoing right catheterization for diverse indications, the mean RA and PCW pressures correlated moderately well, but there was discordance in a sizable minority, in whom assessment of left-sided filling pressures using estimated jugular venous pressure may be misleading. Elevated right atrial pressure is a marker for in-hospital mortality.
- Surgical Management of Tricuspid Valve Infective Endocarditis: A Systematic Review and Meta-Analysis. [Journal Article]
- ATAnn Thorac Surg 2018 May 08
- CONCLUSIONS: Tricuspid valve repair and replacement offer similar long term survival. Valve repair may offer greater freedom from recurrent IE and reoperation as well as need for pacemaker and should be the preferred approach for patients with tricuspid valve IE.
- One-year results of transcatheter treatment of severe tricuspid regurgitation using the edge-to-edge repair technique. [Journal Article]
- EEuroIntervention 2018 May 08
- CONCLUSIONS: Transcatheter edge-to-edge repair can be successfully applied for the treatment of TR. At one-year follow-up, TR repair appeared to be durable and associated with persistent clinical benefit. Further studies with larger patient populations and longer follow-up have to define the role of this novel treatment option for patients with right-sided heart failure and severe TR.
- Single-Beat Estimation of Right Ventricular Contractility and Its Coupling to Pulmonary Arterial Load in Patients With Pulmonary Hypertension. [Journal Article]
- JAJ Am Heart Assoc 2018 May 08; 7(10)
- CONCLUSIONS: The novel single-beat approach provided an accurate estimation of indexes for the PRSW relationship and ventriculoarterial coupling. It may be particularly useful in assessing RV adaptation to increased pressure overload.
- Right ventricular dysfunction during acute respiratory distress syndrome and veno-venous extracorporeal membrane oxygenation. [Review]
- JTJ Thorac Dis 2018; 10(Suppl 5):S674-S682
- Severe ARDS can be complicated by right ventricular (RV) failure. The etiology of RV failure in ARDS is multifactorial. Vascular alterations, hypoxia, hypercapnia and effects of mechanical ventilatio...
Severe ARDS can be complicated by right ventricular (RV) failure. The etiology of RV failure in ARDS is multifactorial. Vascular alterations, hypoxia, hypercapnia and effects of mechanical ventilation may play a role. Echocardiography has an important role in diagnosing RV failure in ARDS patients. Once extracorporeal membrane oxygenation (ECMO) is indicated in these patients, the right ECMO modus needs to be chosen. In this review, the etiology, diagnosis and management of RV failure in ARDS will be briefly outlined. The beneficial effect of veno-venous (VV) ECMO on RV function in these patients will be illustrated. Based on this, we will give recommendations regarding choice of ECMO modus and provide an algorithm for management of RV failure in VV ECMO supported patients.
- Corrigendum to "Mismatch between right- and left-sided filling pressures in heart failure patients with preserved ejection fraction" [Int. J. Cardiol. 257 (2018) 143-149]. [Published Erratum]
- IJInt J Cardiol 2018 May 03
- Syncope and right-sided heart failure due to right ventricular outflow tract obstruction by giant sinus of Valsalva aneurysm. [Journal Article]
- CJCardiol J 2018; 25(2):281-282
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- Multiple admissions to the coronary care unit due to falsely elevated cardiac troponin. [Journal Article]
- PProc (Bayl Univ Med Cent) 2018; 31(2):197-199
- The measurement of cardiac troponin, released from injured cardiomyocytes, is of paramount importance in the diagnosis of acute myocardial infarction. Elevated troponin can be encountered, however, i...
The measurement of cardiac troponin, released from injured cardiomyocytes, is of paramount importance in the diagnosis of acute myocardial infarction. Elevated troponin can be encountered, however, in patients with cardiomyopathy, significant cardiac arrhythmias, vasculitis, right-sided heart strain, critical systemic illnesses, stroke, drug toxicity (such as Adriamycin), poisons (such as snake venoms), renal failure, seizure, and rhabdomyolysis. If the clinical picture is not consistent with any of these causes, a false-positive result should be considered. We herein describe a 94-year-old man with a prior history of coronary artery disease who presented with altered mental status and was found to have a persistently high troponin level resulting in three admissions to the coronary care unit for various noncardiac complaints. Because of discordance between clinical and laboratory data, immunological interference due to heterophile antibodies in the locally used assay (AccuTnI+3, Beckman Coulter) was suspected. The same serum sample tested on a different assay (Elecsys Troponin I Assay, Roche) resulted in an undetectable cardiac troponin I level, thus confirming the diagnosis.