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Objective:To explore the risk factors of early delayed recovery after right ventricular-extrapulmonary arterial(RV-PA)conduit reconstruction.Methods:From 2017 to 2021, the children with RV-PA conduit reconstruction, who were treated in our hospital were retrospectively analyzed.The demographic data and peri-operative clinical data of the patients were collected for statistical analysis.Results:Fifty-five patients were included in the study.The patients were sequenced by the length of ICU stay.The time at the 75th percentile was defined as the critical value for grouping.According to the ICU stay time of the children, they were divided into normal recovery group(ICU stay ≤7 days, n=40)and delayed recovery group(ICU stay>7 days, n=15).The mechanical ventilator time in the whole group was 24(0, 1 408)h, and the ICU stay time was 4(1, 67)d.Six cases required extracorporeal membrane oxygenation (ECMO) support, and two cases died.In the multivariate Logistic regression analysis of two groups, long cardiopulmonary bypass(CPB) time( OR=1.034, 95% CI 1.009-1.061, P=0.009)and poor right ventricular function( OR=9.536, 95% CI 1.010-90.037, P=0.049)were independent risk factors for early delayed recovery. Conclusion:The risk of RV-PA conduit reconstruction is high.The proportion of ECMO support is increased.The mortality rate is higher.Right heart dysfunction and prolonged CPB time are risk factors for delayed postoperative recovery.
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ObjectiveTo explore the application value of CT pulmonary angiography (CTPA) in assessing the severity of acute pulmonary embolism (APE) and right heart function in rehabilitation patients. MethodsFrom January, 2013 to January, 2020, 133 inpatients (94 positive and 39 negative) who underwent CTPA examination in Beijing Bo'ai Hospital were involved. Positive patients were further divided into mild, moderate and severe groups based on the pulmonary artery obstruction index (PAOI). The clinical parameters and right heart function indicators were compared. Spearman correlation analysis was used to analyze the correlation between PAOI, and clinical parameters and right heart function indicators, and Logistic regression analysis was used to predict the risk factors of APE. ResultsThere was significant difference in lower extremity venous thrombosis, D-dimer, oxygen partial pressure, PAOI and left process of interventricular septum among four groups (H ≥ 12.350, P < 0.01). PAOI was moderately positively correlated with D-dimer (r = 0.443, P < 0.001) and left process of interventricular septum (r = 0.520, P < 0.001), and was weakly positively correlated with lower extremity venous thrombosis (r = 0.399, P < 0.001), left pulmonary artery diameter (r = 0.213, P = 0.014) and inferior vena cava regurgitation (r = 0.229, P = 0.008). Lower extremity venous thrombosis (OR = 7.708, P < 0.001) and left process of interventricular septum (OR = 3.641, P = 0.008) were independent risk factors for the onset of APE. The combination of the two indicators was effective for diagnosis of APE, and AUC was 0.795 (95% CI 0.715 to 0.874). ConclusionCTPA may be applied to evaluate the severity of APE and right heart function in rehabilitation patients.
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@#Objective To investigate the effect of concomitant tricuspid valve repair during mitral valve surgery on the early and mid-term prognosis of the tricuspid valve and right heart function in the patients with moderate or less tricuspid regurgitation. Methods A retrospective study of 461 patients with mitral valve disease requiring cardiac surgery combined with moderate or less tricuspid regurgitation in our hospital from 2011 to 2014 was done. They were 309 males and 152 females with a median age of 53.00 (44.00, 60.00) years. According to whether they received tricuspid valve repair (Kay’s annuloplasty, DeVega’s annuloplasty or annular ring implantation), the patients were divided into a mitral valve surgery only group (a nTAP group, n=289) and a concomitant tricuspid valve repair group (a TAP group, n=172). At the same time, 43 patients whose tricuspid valve annulus diameter was less than 40 mm in the TAP group were analyzed in subgroups. Results The median follow-up duration was 3.00 years (range from 0.10 to 9.30 years). There was no perioperative death. Three months after surgery, the anteroposterior diameter of the right ventricle in the TAP group was significantly improved compared with that in the nTAP group [–1.00 (–3.00, 1.00) mm vs. 0.00 (–0.20, 2.00) mm, P=0.048]. Three years after surgery, the improvement of right ventricular anteroposterior diameter in the TAP group was still significant compared with the nTAP group [–1.00 (–2.75, 2.00) mm vs. 2.00 (–0.75, 4.00) mm, P=0.014], and the patients in the TAP group were less likely to develop moderate or more tricuspid regurgitation (3.64% vs. 35.64%, P<0.001). Annuloplasty ring implantation was more effective in preventing regurgitation progression (P=0.044). For patients with a tricuspid annulus diameter less than 40 mm, concomitant tricuspid valve repair was still effective in improving the anteroposterior diameter of the right ventricle in the early follow-up (P=0.036). Conclusion Concomitant tricuspid valve repair for patients with moderate or less tricuspid regurgitation during mitral valve surgery can effectively improve the tricuspid valve and right heart function in the early and mid-term after surgery. Annuloplasty ring implantation is more effective in preventing regurgitation progression. Patients whose tricuspid annulus diameter is less than 40 mm can also benefit from concomitant tricuspid repair.
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Pulmonary embolism is one of the common cardiothoracic vascular emergencies, and its main fatal complication is right ventricular dysfunction. CT pulmonary angiography is the preferred imaging method for clinical diagnosis of pulmonary embolism.This article reviews the imaging characteristics and mechanism of pulmonary embolism and right heart dysfunction in CT pulmonary angiography, the current clinical application status and limitations of CT pulmonary angiography, and the progress of CT pulmonary angiography technology.
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Objective To analyze the difference of echocardiography in patients with chronic Keshan disease (CKD) at different altitudes areas,explore the effects of altitude on the structure and functional of right heart in CKD patients,and provide a reference for imaging diagnosis of CKD.Methods According to the three step distribution of the terrain in China,30 cases of CKD patients in the first step (altitude ＞ 4 000 m) of Tibet autonomous region were randomly selected as the Tibetan plateau group.In the second step (altitude:1 000-2 000 m),31 cases were randomly selected in Gansu Province as the Loess plateau group.In the third step (altitude ＜ 500 m),42 cases were randomly selected in Shandong Province as the plain group.Echocardiography was used to analyze the morphology,hemodynamics and function of right heart.Results Right atrial transverse diameter (RATD),right ventricular transverse diameter (RVTD),right ventricular lateral wall thickness (RVWT) and main pulmonary artery diameter (MPAD) of the Tibetan plateau group,the Loess plateau group and the plain group (mm:49.75 ± 8.40,45.64 ± 7.63,43.56 ± 7.34;50.89 ± 7.13,46.56 ± 5.62,43.27 ± 6.01;4.75 ± 1.02,3.53 ± 0.61,3.37 ± 0.51;32.87 ± 3.62,28.93 ± 2.12,28.44 ± 2.71) were significant differences among the three groups (F =5.36,12.91,37.08,23.33,P ＜ 0.01).The above indexes of the Tibetan plateau group were higher than those of the Loess plateau group and the plain group (P ＜ 0.05).RVTD of Loess plateau group was higher than that of plain group (P ＜ 0.05).The fractional area change [FAC,(24.85 ± 2.75)％,(26.26 ± 3.42)％,(26.73 ± 3.14)％],tricuspid annular plane systolic excursion [TAPSE,(12.87 ± 1.12),(14.59 ± 1.63),(14.13 ± 1.31) mm] of the Tibetan plateau group,the Loess plateau group and the plain group were significant differences among the three groups (F =3.36,13.47,P ＜ 0.05 or ＜ 0.01);the above indexes of the Tibetan plateau group were lower than those of the Loess plateau group and the plain group (P ＜ 0.05).Tei index (0.87 ± 0.18,0.78 ± 0.16,0.71 ± 0.14),tricuspid flap diastolic maximum filling speed/tricuspid annulus early diastolic peak velocity (E/E',9.48 ± 1.22,8.64 ± 0.91,8.12 ± 1.13),systolic pulmonary artery pressure [SPAP,(49.58 ± 11.76),(44.35 ± 11.41),(42.67 ± 12.13) mmHg,1 mmHg =0.133 kPa] of the Tibetan plateau group,the Loess plateau group and the plain group were significant differences among the three groups (F =12.89,13.99,3.12,P ＜ 0.01 or ＜ 0.05);the Tei index and E/E'of the Tibetan plateau group were higher than those of the Loess plateau group and the plain group (P ＜ 0.05).Tei index,E/E'of the Loess plateau group were higher than those of the plain group (P ＜ 0.05).Conclusions The right heart structure and function of CKD patients are affected by the altitude of their residence.With the increase of altitude,the right heart is enlarged,the right ventricular systolic and diastolic functions are decreased,and SPAP is increased in CKD patients.
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Objective To investigate the effect of intratracheal instillation of curosurf on neonatal respiratory distress syndrome ( NRDS ) in children with right ventricular function.Methods 52 patients with NRDS were retrospectively selected and divided into two groups according to different treatment.The patients in the conventional group were treated with nasal airway ventilation.Based on the conventional group, the curosurf group was taken with curosurf.26 cases were in each group.The blood gas index (PaCO2, PaO2, pH), inflammatory reaction (TNF-α, IL-10), SF of the two groups were compared, the complications and curative effect of the two groups before and after treatment were taken for statistics.Results There was no significant difference in pH value between the two groups at each time point.The PaO2 expression levels in the curosurf group at different time points after treatment were significantly lower than the conventional group (P<0.05).The levels of TNF-αand IL-10 in the curosurf group were more stable than those in the control group at different time points after treatment (P<0.05), and the degree of SF increasing at different time points were higher (P<0.05).The total effective rate 80.77% of the curosurf group was significantly higher than that of the conventional group 61.54%(P<0.05).The total complication rate 19.24% had no significant differences with the conventional group 23.08%.Conclusion Intratracheal instillation of CsA in the treatment of NRDS has the advantages of simple operation, little side effect, rapid recovery of blood gas index and inflammatory factors, so it is a feasible method for clinical treatment of NRDS.
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Objective To evaluate the right heart function with echocardiography after right ventricle-pulmonary artery (RV-PA) anastomasis for right ventricle outflow (RVOT) reconstruction in patients with different types of pulmonary atresia and ventricle septal defect(PA/VSD).Methods From Nov 2002 to Aug 2013,31 patients with PA/VSD had undergone right ventricle-pulmonary anastomasis to reconstruct RVOT for radical or palliative repair.Related echocardiography indexs including strain/rate etc.were used to evaluate the right heart function and the progress of the right heart valves regurgitation.Results There were 3 early hospital deaths.No later death during follow-up.The echocardiography suggested the pulmonary artery and tricuspid regurgitation were more serious,however,the right heart function was relatively fine.The regurgitation of tricuspid valve was positive correlation with duration of follow-up (P =0.016).Conclusion The right heart function in follow-up keeps relatively well,and tricuspid valve regurgitation needs a long-term follow-up.
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Objective: To investigate the relationship between right ventricular (RV) glucose metabolism by18F-fludeoxyglucose positron emission tomography (18F-FDG PET) and right heart function in patients with dilated cardiomyopathy (DCM). Methods: The18F-FDG PET imaging was performed in 34 consecutive DCM patients, with the reference of Herrero method, the corrected RV standard uptake value (cRVSUV), corrected left ventricular standard uptake value (cLVSUV) and the ratio of RV to LV SUV (cR/L) were obtained. And all 34 patients received cardiac magnetic resonance imaging (cMRI) examination within 7 days, the left ventricular ejection fraction (LVEF) and RVEF were automatically calculated with Simpson’s principle. The pulmonary arterial systolic pressure was measured by echocardiography. Results: The corrected cRVSUV and cR/L by18F-FDG PET were negatively related to RVEF by cMRI, (r=-0.513, P Conclusion: Increased RV glucose metabolism closely related to RV dysfunction, the18F-FDG uptake value by PET might be used as an index for assessing the right heart function and prognosis in DCM patients.
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Objective To investigate the effect and mechanism of pulmonary artery pressure on exercise capacity after acute high altitude exposure .Methods A total of 231 persons were recruited in this study , whose vital signs,SaO2 and physical working capacity ( PWC170 ) exercise capacity were collected .The difference between groups with normal and increased MPAP was observed .Results mean pulmonary artery pressure ( MPAP ) and right ventricle ( RV )-Tei index increased substantially after acute high altitude exposure ,while PWC170 was remarkably decreased .Furthermore,it was found that those whose MPAP increased(MPAP≥25 mmHg)had higher RV-Tei and lower PWC170(P<0.01) in acute high altitude exposure group .Correlation analysis suggested that there were different levels of correlation between MPAP, RV-Tei and PWC170(P<0.01).Conclusion After acute high altitude exposure , the increased pulmonary artery pressure is one of the main causes of lowered exercise capacity .The mechanism may be associated with the decrease of right heart functions .
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Objective To study the evaluation function of Tei index for right heart function of elderly patients with chronic cor pulmonale .Methods Choosed 98 cases of elderly patients suspected chronic cor pulmonale and 68 cases of the medical health elder-ly population from March 2009 to March 2012 in our hospital as group A and B ,ultrasonic inspection and Tei index were measured , ultrasonic inspection indicators contains ,right room transverse diameter ,the main pulmonary artery diameter ,wall thickness and be-fore in pulmonary artery systolic pressure .Results A group of 31 patients(31 .6% ) with a clear cor pulmonale ultrasonic signs ,42 patients(42 .9% ) did not see clearly cor pulmonale ultrasonic signs ,but there was three tricuspid valve and (or) pulmonary valve re-gurgitation ,27 cases(25 .5% ) patients were not seen clear cor pulmonale ultrasonic signs ,and did not see the tricuspid valve and pulmonary valve regurgitation ,three types of Tei index patients were significantly higher than the group B (P<0 .05) .Conclusion Tei index can reflect patients right heart function and can be used as a sensitive index evaluation .
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Objective To monitor right heart hemodynamic changes of patients with lung cancer during and after the procedures of pneumonectomy and discuss the effect of pneumonectomy on right heart function and risk of postoperation morbidities. Method 16 patients with lung cancer were randomly selected and the clinical database was queried and Swan-Ganz catheter was applied awake from jugular vein to pulmonary artery ,measuring mean arterial pressure(MAP) ,heart rate(HR) ,central venous pressure(CVP) ,mean pulmonary artery pressure (MPAP),mean pulmonary capllary wedge pressure(MPCWP) ,and eardiaoc output(CO) and calculating cardiac index (CI),left ventricular-stroke work index (LVSWI), right ventricular stroke work index (RVSWI) , and stroke volume index(SVI) instantaneously before anaesthesia, after anaesthesia with single lung ventilation, after pulmonary artery and pulmonary vein occlusion and supine chest dosed during the procedure of pneumonectomy. Pre-and post-operative complications were recored. Results Cardiovascular complications occurred in 6 patients(37.5%) postoperatively. There were no operative or perioperative deaths. MPAP increased significantly after the procedure of pneumonectomy compared with that of preoperation, and MPAP > 26 mm Hg was in 4 patients who got cardiovascular complications postoperatively with morbidity of 100% ,which was "significantly higher than the morbidity of 16.7% (2/12) when MPAP < 25 mm Hg. Conclusion Pneumonectomy has significant effects on right heart hemodynemic changes and as MPAP increases postoperatively, the risk of cardiovascular complications becomes higher.
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The assessment of right heart function plays an important role in diagnoses, therapeutic decision-making, curative effects and prognoses of many congenital and acquired heart diseases. Recently, a lot of new techniques of echocardiography have been used to evaluate right heart function, such as DTI, MPI, 3-DE, AQ and CUS, which all have their own advantages and disadvantages.
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BACKGROUND: Hemodynamic derangement during the displacement of the beating heart in off-pump coronary artery bypass graft surgery (OPCAB) might be related with right ventricular (RV) dysfunction. This study evaluated the influence of displacing and stabilizing the heart, for the anastomosis of coronary arteries, on hemodynamic alterations and RV function in patients undergoing OPCAB. METHODS: Twenty patients with triple vessel coronary artery disease underwent OPCAB using single pericardial sutures: a tissue stabilizer was included. The hemodynamic variables and right ventricular ejection fraction (RVEF) were obtained using a right-heart ejection fraction thermodilution pulmonary artery catheter after the induction of anesthesia, before and after anastomosis of each coronary artery and after sternal closure. RESULTS: No significant hemodynamic changes were observed during the displacement of the heart or the placement of a stabilizer on all of the coronary arteries, except the obtuse marginal artery (OM) before anastomosis. RVEF, left ventricular stroke work index (LVSWI), stroke volume index and cardiac index (CI) decreased and mean pulmonary artery pressure increased significantly whist positioning the graft to the OM. Right ventricular volumes were not significantly changed, although central venous pressure and pulmonary capillary wedge pressure increased. Changing CI had a close relationship with LVSWI (r2 = 0.537, P <0.05) but not with RVEF (r2 = 0.118). These hemodynamic compromises recovered to baseline values after sternal closure. CONCLUSIONS: The displacement of the beating heart for positioning during anastomosis of the graft to the OM caused significant hemodynamic instability and LV functional changes in addition to RV functional changes seemed to be responsible for hemodynamic derangements.