ABSTRACT
In this study, we aim to elucidate the clinical impact and long-term course of tricuspid regurgitation (TR), taking into account its dynamic nature, after biatrial orthotopic heart transplant (OHT). All consecutive adult patients undergoing biatrial OHT (1984-2017) with an available follow-up echocardiogram were included. Mixed-models were used to model the evolution of TR. The mixed-model was inserted into a Cox model in order to address the association of the dynamic TR with mortality. In total, 572 patients were included (median age: 50 years, males: 74.9%). Approximately 32% of patients had moderate-to-severe TR immediately after surgery. However, this declined to 11% on 5 years and 9% on 10 years after surgery, adjusted for survival bias. Pre-implant mechanical support was associated with less TR during follow-up, whereas concurrent LV dysfunction was significantly associated with more TR during follow-up. Survival at 1, 5, 10, 20 years was 97% ± 1%, 88% ± 1%, 66% ± 2% and 23% ± 2%, respectively. The presence of moderate-to-severe TR during follow-up was associated with higher mortality (HR: 1.07, 95% CI (1.02-1.12), p = 0.006). The course of TR was positively correlated with the course of creatinine (R = 0.45). TR during follow-up is significantly associated with higher mortality and worse renal function. Nevertheless, probability of TR is the highest immediately after OHT and decreases thereafter. Therefore, it may be reasonable to refrain from surgical intervention for TR during earlier phase after OHT.
Subject(s)
Male , Adult , Humans , Middle Aged , Tricuspid Valve Insufficiency/diagnostic imaging , Heart Transplantation , Echocardiography , Ventricular Dysfunction, Left , Retrospective Studies , Treatment OutcomeABSTRACT
After surgical excision of myxoma recurrence usually happens adjacent to the initial origin site. We report a case of recurrent myxomas in a young male patient that had biatrial recurrence with one tumor originating very unusually from the base of the anterior mitral leaflet. Intraoperative transesophageal echocardiography was instrumental in localizing the site of the origin of left atrial myxoma from the base of the anterior mitral leaflet and in detecting an additional myxoma attached to the wall of the right atrium.
ABSTRACT
Objective To investigate the merit and feasibility of vasoactive drugs by the double atrial infusion in children with congenital heart disease combined with pulmonary hypertension.Methods Ninety cases of congenital heart disease combined with pulmonary hypertension were randomly selected.One group(45 cases) was infused by double atrialadministration,which left atrium for catecholamines,and right atrial infusion for highly targeted expansion of pulmonary vascular drugs,such as prostaglandin E1.Another group(45 cases) was infused through the right atrium by a central venous to catecholamines and pulmonary vascular dilatation drugs.Cardiac output(CO) and cardiac index were measured by thermal dilution method and systemic vascular resistance and pulmonary vascular resistance(PVR) were calculated.Results Three cases were dead in early postoperative period(1 week),which were central intravenous group.2 cases with total anomalous pulmonary venous drainage had low co after operation,include 1 case through the left atrium,and the other case through central venous administration,and were recovered.There was no long-term mortality.There was no significant difference in CPB time,blocking time,the amount and timing of vasoactive drugs in two groups (P ＞ 0.05).Conclusion Double atrial infusion of vasoactive drugs can significantly reduce the mean pulmonary artery pressure and pulmonary vascular resistance,and increase CO,which is better than the traditional central intravenous methods.The treatment method is of very important significance.Thus double atrial infusion is safe and feasible.
ABSTRACT
Objective To investigate the effects of biatrial infusion on pulmonary artery pressure (PAP)after cardiopulmonary bypass (CPB) in patients undergoing mitral valve replacement.Methods Twenty NYHA Ⅱ or Ⅲ patients aged 22-53 yr weighing 34-57 kg undergoing mitral valve replacement complicated by pulmonary hypertension (mean pulmonary artery pressure (MPAP) ＞ 50 mm Hg) were randomly divided into 2 groups ( n = 10 each): infusion via right atrium group (group R) and infusion via both atria group (group B). After induction of anesthesia, a three cavity floating Swan-Ganz catheter was placed via right internal jugular vein to monitor CVP,PAP, pulmonary capillary wedge pressure (PCWP) and CO. The patients received infusion of prostaglandin E1 30-150 ng· kg- 1 · min - 1 and phenylephrine 0.2-0.6 μg· kg- 1 · min- 1 via central veins in group R and infusion of prostaglandin E1 30-150 ng·kg-1 ·min-1 via central veins and phenylephrine 0.2-0.6 μg·kg-1 ·min-1 via left atrium in group B. MAP, HR, MPAP, PCWP, CVP and CO were recorded 5 min before administration (T0), and 5,10, 30 and 60 min after administration (T1-4). Pulmonary vascular resistance index (PVRI), systemic vascular resistance index (SVRI) and CI were also calculated. Results D:\1111111111\MDB\zhmzxzz98201008.mdbCompared with the value at T0, MAP, MPAP, PCWP and PVRI were significantly decreased, while CI was increased at T1-4 in group R, and MAP, CI and SVRI were significantly increased, while HR, MPAP, PCWP, CVP and PVRI decreased at T1-4 in group B ( P ＜ 0.05).MAP, CI and SVRI were significantly higher, while HR, MPAP, PCWP, PVRI and CVP lower in group B than in group R ( P ＜ 0.05). Conclusion Biatrial infusion can effectively reduce PAP and pulmonary vascular resistance after CPB in patients undergoing mitral valve replacement.