- Bioprosthetic tricuspid valve dysfunction in patients with transvalvular or epicardial pacing leads. [Journal Article]
- PCPacing Clin Electrophysiol 2018 Sep 17
- Dysfunction of native tricuspid valves (TV) due to transvenous pacing leads is well described. Patients with bio-prosthetic tricuspid valve (BTV) who need ventricular pacing are often advised epicard...
Dysfunction of native tricuspid valves (TV) due to transvenous pacing leads is well described. Patients with bio-prosthetic tricuspid valve (BTV) who need ventricular pacing are often advised epicardial lead placement to avoid potential damage to the BTV although there is no data to support this.
- Noninvasive determination of the pulmonary artery input impedance. [Journal Article]
- MHMed Hypotheses 2018; 120:7-13
- A reliable noninvasive method for the estimation of pulmonary function in healthy and diseased subjects should be of great importance in the prognosis, diagnosis, and treatment of pulmonary hypertens...
A reliable noninvasive method for the estimation of pulmonary function in healthy and diseased subjects should be of great importance in the prognosis, diagnosis, and treatment of pulmonary hypertension. Here we propose such a method, which is based on the parameter identification of the five-element Windkessel model of pulmonary circulation. The method requires the following input variables: the heart rate, the stroke volume, the Doppler echocardiographic measurements of the tricuspid regurgitation and the pulmonary valve velocity profiles, and estimations of the right atrium and the pulmonary vein pressure. The stroke volume is calculated as a product of the left ventricle outflow tract area and the velocity-time integral measured at the same place. The model parameter identification procedure is based on minimization of the root mean square error between the pulmonary artery root pressure calculated from the aforementioned Doppler velocity profiles (from the Bernoulli equation applied during the ejection phase) and the pressure from the Windkessel model during the same period. The output from the model contains the calculated pulmonary artery input impedance (i.e. the model parameters: pulmonary vascular resistance, pulmonary artery proximal and distal compliances, inertance, and characteristic impedance) and the pulmonary artery pressure profile during the whole heart period. Our method is applied to a subject with pulmonary hypertension. The right heart Swan-Ganz catheterization has been performed in this subject. The results obtained by using this method show that the five-element Windkessel model reconstructs the main features of the pulmonary artery input impedance very well: its modulus shows the minimum where the phase angle changes its sign. The pulmonary vascular resistance, the systolic, diastolic and mean pulmonary artery pressures obtained from the method are in good agreement with the values obtained invasively from the catheterization. Sensitivity analysis shows that the mean pulmonary pressure is fairly insensitive to slight overestimation/ underestimation of all input parameters, except for the right atrium pressure. The absolute error in the mean pulmonary artery pressure is nearly the same as the error in the right atrium pressure. Since the proposed method offers a deeper insight into the pulmonary circulation than the catheterization itself because it provides the proximal and distal compliance, the inertance and the characteristic impedance, it seems that it can serve in clinical practice as a good substitute for catheterization.
- Prevalence and Significance of Tricuspid Regurgitation Post-Endocardial Lead Placement. [Letter]
- JCJACC Cardiovasc Imaging 2018 Sep 06
- Tricuspid Regurgitation Pressure Gradient as a Useful Predictor of Adverse Cardiovascular Events and All-Cause Mortality in Patients With Atrial Fibrillation. [Journal Article]
- AJAm J Med Sci 2018; 356(2):147-151
- CONCLUSIONS: The TRPG is not only a useful predictor of adverse CV events and all-cause mortality in patients with AF, it may also provide additional prognostic values for CV outcome and all-cause mortality over conventional parameters in such patients.
- Tricuspid regurgitation caused by right ventricle compression by pectus excavatum. [Journal Article]
- ACAsian Cardiovasc Thorac Ann 2018 Sep 14; :218492318799928
- Echocardiographic evaluation of the right ventricular dimension and systolic function in dogs with pulmonary hypertension. [Journal Article]
- JVJ Vet Intern Med 2018 Sep 14
- CONCLUSIONS: The RVEDA index can be used to evaluate RV size in dogs. It can provide additional information in dogs with PH and predict R-CHF. Severity of TR is the main determinant of RV enlargement in dogs with PH.
- A meta-analysis of the prevalence of cardiac valvulopathy in hyperprolactinemic patients treated with Cabergoline. [Journal Article]
- JCJ Clin Endocrinol Metab 2018 Sep 11
- CONCLUSIONS: Treatment with low dose cabergoline in hyperprolactinemia appears to be associated with an increased prevalence of tricuspid regurgitation. The clinical significance of this is unclear and requires further investigation. 51.
- Percutaneous transhepatic biliary drainage catheter fracture: A case report. [Journal Article]
- AHAnn Hepatobiliary Pancreat Surg 2018; 22(3):282-286
- Percutaneous transhepatic biliary drainage (PTBD) is safe treatment for biliary decompression given certain indications. However, this is temporary until definitive drainage is established. We report...
Percutaneous transhepatic biliary drainage (PTBD) is safe treatment for biliary decompression given certain indications. However, this is temporary until definitive drainage is established. We report on a 76-year-old lady with recurrent pyogenic cholangitis and PTBD catheter fracture. She had hepatitis B virus-related Child-Pugh class A liver cirrhosis, hypothyroidism, hyperlipidaemia, and previous atrial fibrillation with a background of mild mitral, tricuspid and aortic valvular regurgitation. She had history of laparoscopic cholecystectomy in the past. She was deemed to be a high operative risk and declined hepatic resection. She had undergone multiple endoscopic and percutaneous biliary interventions to control sepsis and stone burden. A bilateral PTBD catheter was left in situ with plans for 3-monthly change. However, she defaulted follow-up and presented 11 months later with complaints of pain over the drain site and inability to flush the right catheter. Abdominal X-ray and computed tomography scans detected right catheter fracture at two places, making three fragments. She underwent percutaneous removal of the proximal fragment by an interventional radiology team. A temporary 4 Fr catheter was inserted to maintain biliary access. Endoscopic removal of the intra-biliary fragments was done the next day. Complete removal was confirmed on fluoroscopy. Finally, the 4 Fr catheter was replaced by a new 12 Fr catheter. The patient was discharged well.
- Utilization of extracorporeal membrane oxygenation for a severe cardiocirculatory dysfunction recipient in liver transplantation: A case report. [Journal Article]
- MMedicine (Baltimore) 2018; 97(37):e12407
- CONCLUSIONS: It is feasible to utilize ECMO as a cardiocirculatory function support in the LT. ECMO does not increase the risk of hemorrhage. ECMO can play an important role in ensuring the security of the liver recipients in the surgery and in the postoperative period.
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- A Partial Anomalous Pulmonary Venous Connection in a Severely Symptomatic Patient, Is Surgery Always Recommended? [Journal Article]
- CCureus 2018 Jul 11; 10(7):e2962
- Partial anomalous pulmonary venous connection (PAPVC) is a rare cardiac anomaly occurring when a pulmonary vein drains into the right atrium, coronary sinus or a systemic vein creating a left-to-righ...
Partial anomalous pulmonary venous connection (PAPVC) is a rare cardiac anomaly occurring when a pulmonary vein drains into the right atrium, coronary sinus or a systemic vein creating a left-to-right shunt. Symptoms develop from right-sided fluid overload and pulmonary vascular disease. We report a rare case of a severely symptomatic patient with an incidentally discovered PAPVC in the setting of underlying severe pulmonary hypertension from multifactorial severe restrictive lung disease. Despite his worsening symptoms, a multi-disciplinary meeting decided against surgical intervention. Nine months after the decision was made, the patient showed no signs or symptoms of clinical deterioration. Prior studies recommend surgery for PAPVCs with evidence of right ventricular dilation, mild-to-moderate tricuspid regurgitation, or early stages of pulmonary vascular disease. However, our case demonstrates how decision making should consider the shunt's contribution to the overall clinical picture and underlying comorbidities. If a decision is made to defer surgical intervention, strict follow up and repeat re-evaluations for possible risk re-stratification and surgery reconsideration are warranted.