Cardiac Myxomas: A Single?Center Case Series of 145 Patients Over a 32?Year Period Study

Background:Myxomas are the most common primary cardiac tumors that develop mostly at the atrial chambers of the heart and represent 0,25% of all cardiac diseases. Methods: This is a retrospective study aiming to analyze epidemiological and intraoperative data from cardiac myxoma cases in the hospital of the last 32 years. The study population was 145 cardiac surgical patients and was divided into 4 certain 8?year periods. 87,6% of cases had the myxoma located at left atrium and 97,2% of all patients fully recovered. 4,1% of patients relapsed and underwent a redo operation. Results: Mean CPB time and mean ICU length of stay increased during the 8?year periods (p < 0,001, P < 0,001, P = 0,002 and P = 0,003 respectively). In-hospital length of stay decreased to 5 days in the most recent period (p < 0,001). Cases significantly increased to 54 in the last 8?year period (p = 0,009). Conclusion: Improvement on cardiac imaging and a better accessibility may drive patients to earlier and safer diagnosis of myxomas preventing any deterioration of their condition. Improvement on postoperative care can also reduce in-hospital length of stay. Surgical excision is the treatment of choice and guaranteed survival at 97,2% of patients.

Direct Anastomosis of Persistent Left Superior Vena Cava to Right Superior Vena Cava in a Pediatric Patient with Tetralogy of Fallot: an Alternative Technique

ABSTRACT The presence of persistent left superior vena cava to the left atrium connection without an innominate vein may give rise to technical challenges during intracardiac repair. In this report, the end-to-side anastomosis technique of the persistent left superior vena cava to the right superior vena cava is discussed in a patient with tetralogy of Fallot associated with persistent left superior vena cava draining directly into the left atrium. A successful end-to-side anastomosis between the persistent left superior vena cava and the right superior vena cava was performed and short-term anastomosis patency was documented via angiography.

Clinical Effects of Surgical Left Atrial Reduction and Concomitant Mitral Valve Replacement in Patients with Giant Left Atrium

ABSTRACT Introduction: A giant left atrium may cause respiratory dysfunction and hemodynamic disturbance postoperatively. This retrospective study aimed to evaluate clinical effects of surgical left atrial reduction in concomitant cardiac valves operations. Methods: One hundred and thirty-five patients with heart valve diseases and giant left atriums from January 2004 to July 2021 were enrolled into this research. They were divided into the folded group (n=63) and the unfolded group (n=72). Patients in the folded group had undergone cardiac valve operations concomitantly with left atrial reductions. The perioperative characteristics were compared between both groups, and subgroup analysis was performed. Results: There were five deaths in the folded group and 25 deaths in the unfolded group (P<0.001). Complications including pneumonia, sepsis, multiple organs dysfunction syndrome, low cardiac output syndrome, and the use of continuous renal replacement therapy were significantly fewer in the folded group. The receiver operating characteristic curve of left atrial max. diameter predicting mortality was significant (area under the curve=0.878, P=0.005), and the cutoff point was 96.5 mm. The stratified analysis for sex showed that more female patients died in the unfolded group. Logistic regression for mortality showed that the left atrium unfolded, left atrial max. diameter, cardiopulmonary bypass time, and mechanical ventilation time increased the risk of death. Conclusion: Surgical left atrial reduction concomitantly with valves replacement could decrease mortality and was safe and effective in giant left atrium patients.

Comparative study the curative effect, ventricular remodeling and cardiac function of patients in different left atria size undergoing valve replacement with " X" ablation of posterior left atrium wall / 中华胸心血管外科杂志

Objective:To investigate the influence of left atrial size on the ablation efficacy, cardiac morphology and function after valve replacement combined with X-type radiofrequency ablation on posterior wall of left atrium.Methods:From January 2015 to December 2019, 416 patients with mitral valve disease complicated with atrial fibrillation were divided into two groups according to the size of left atrium(Anteroposterior diameter 60 mm). Valve replacement combined with " X" radiofrequency ablation on posterior wall of left atrium was performed. The clinical data were analyzed retrospectively.Results:Except for the AF types, gender, length of stay and postoperative complications, other clinical data, operative and perioperative indicators were better in small left atria group(SLA)than in large left atria group(LLA). The differences were statistically significant( P<0.05). Fractional shortening(FS), ejection fraction(EF) in SLA at any time point were higher than that in LLA, P<0.05. The sinus rhythm conversion rates, the change rate of LA anteroposterior diameter in SLA at postoperative time points were higher than that in LLA, P<0.05. There was no significant difference of cardiac troponin(cTn) and myoglobin(MYO) between the two groups in 6 months after operation, P>0.05. The B-type natriuretic peptide(BNP), cTn, MYO in the other time points were lower than that in LLA, P<0.05. Conclusion:Larger left atrium reduces the rate of sinus rhythm conversion and maintenance in patients undergoing valve replacement combined with fibrillation ablation. There were worse ventricular remodeling and cardiac function recovery. Preoperative evaluation of left atrial size is helpful for prognosis.

Stiff Left Atrium Syndrome After Atrial Fibrillation Ablation ­ A Diagnosis Not To Forget

Atrial fibrillation is the most prevalent arrhythmia in clinical practice and has different strategies for its control. Of these strategies, the percutaneous ablation of the pulmonary veins stands out, with robust results in relation to drug treatment. It is an invasive procedure and, therefore, not free from complications, which must be properly diagnosed and treated. Among the possible complications, there is stiff atrium syndrome, characterized by reduced atrial compliance caused by post-ablation fibrosis, which, in turn, leads to atrial filling dysfunction and the consequent increase in atrial and venous capillary pulmonary pressures. The case report demonstrates this infrequent but important complication, which presents good results for clinical treatment, in addition to the contribution of cardiac magnetic resonance in its diagnosis and in the assessment of arrhythmia recurrence rates.

Application value of 256-layer spiral CT left atrial pulmonary vein dual phase scanning imaging in radiofrequency ablation of nonvalvular atrial fibrillation / 中国医师进修杂志

Objective:To explore the application value of 256-layer spiral CT left atrial pulmonary vein dual phase scanning imaging (called simply CT dual phase scanning imaging) in radiofrequency ablation of nonvalvular atrial fibrillation.Methods:The clinical data of 74 patients with nonvalvular atrial fibrillation from October 2018 to September 2020 in Tiantan Hospital, Capital Medical University were retrospectively analyzed. All patients were examined by CT dual phase scanning imaging and transesophageal echocardiography (TEE). The result of TEE was as "gold standard", the value of CT dual phase scanning imaging in the diagnosis of left atrial pre-thrombotic state (PTS) and thrombus were assessed, and the variation of the pulmonary vein was observed.Results:CT dual phase scanning imaging in diagnosis of left atrial PTS had a sensitivity of 52.94% (9/17), a specificity of 92.45%(49/53), a negative predictive value of 85.96%(49/57), and a positive predictive value of 69.23%(9/13); it in diagnosis of left atrial thrombus had a sensitivity of 100.00% (4/4), a specificity of 90.74%(49/54), a negative predictive value of 100.00%(49/49), and a positive predictive value of 44.44%(4/9). The variation rate of the pulmonary vein was 21.62%(16/74).Conclusions:CT dual phase scanning imaging has relatively high values of sensitivity, specificity and negative predictive value in detecting left atrial PTS and thrombus. It can also evaluate the abnormal anatomical characteristics of the pulmonary vein, and find pulmonary vein variation. It provides a reliable basis for radiofrequency ablation of nonvalvular atrial fibrillation.

Aorto-Left Atrial Fistula after Aortic Valve Replacement : a Rare Complication / 日本心臓血管外科学会雑誌

A 60-year-old man underwent aortic valve replacement for aortic valve regurgitation, tricuspid valve annuloplasty, and coronary artery bypass grafting. Postoperative echocardiography revealed shunted flow from the noncoronary sinus of Valsalva into the left atrium. The pathogenesis of this complication is considered to be uncertain ; however, it might be due to some kind of intraoperative injury. Three weeks after the initial surgery, we reoperated to repair the aorto-left atrial fistula. According to the intraoperative findings, small slits were found on the left atrial surface close to the posteromedial side of the mitral valve and the noncoronary sinus of Valsalva. The fistula was closed with transmural mattress sutures. Post-operative echocardiography showed no shunt flow. Although an aorto-left atrial fistula is a rare complication after aortic valve replacement, reoperation might be mandatory if the shunt flow is considerable. Surgeons should keep in mind the possibility of intraoperative injury to surrounding structures when performing aortic valve replacement.

Função de reserva do átrio esquerdo na avaliação da função diastólica indeterminada / Left atrial reserve function in assessing indeterminate diastolic function

Fundamento: A elevação das pressões de enchimento secundária à disfunção diastólica do ventrículo esquerdo ocupa papel central na fisiopatologia da insuficiência cardíaca. Mesmo assim, as diretrizes internacionais falham em detectar a disfunção diastólica em uma parte dos casos. Objetivo: Avaliar a função de reserva do átrio esquerdo, estimada pelo strain longitudinal de pico do átrio esquerdo, nos casos de função diastólica indeterminada. Método: Estudo observacional com indivíduos em ritmo sinusal e fração de ejeção do ventrículo esquerdo preservada, submetidos ao ecocardiograma e divididos em três grupos conforme a análise conjunta da relação E/e´ e do volume de átrio esquerdo indexado: Grupo 1, se pressões de enchimento normais; Grupo 2, se pressões de enchimento elevadas e Grupo 3, se pressões de enchimento indeterminadas. Speckle tracking bidimensional foi empregado para medir o strain longitudinal de pico do átrio esquerdo. Análise de variância, teste t Student e curva receptor-operador (ROC) foram empregados na análise estatística. Resultado: Foram incluídos 58 pacientes, com 61 ± 14 anos, sendo 57% mulheres, com fração de ejeção do ventrículo esquerdo de 62 ± 7%. Os Grupos 2 e 3 tiveram strain longitudinal de pico do átrio esquerdo menor que o Grupo 1 (20 ± 5% versus 22 ± 6% versus 30 ± 8%, respectivamente, p=0,004), mas não diferiram entre si (p=0,93). O strain longitudinal de pico do átrio esquerdo foi preditor de pressões de enchimento elevadas (p=0,026, área sob a curva=0,80), obtendo-se sensibilidade de 60% e especificidade de 80% com valor de corte ≤ 20%. Conclusão: A função de reserva do átrio esquerdo dos indivíduos com função diastólica indeterminada é similar à dos indivíduos com disfunção diastólica avançada, conferindo ao strain longitudinal de pico do átrio esquerdo o potencial de auxiliar na reclassificação da função diastólica indeterminada.(AU)

Background: Elevation of left ventricular filling pressures secondary to diastolic dysfunction plays a central role in the pathophysiology of heart failure. However, international guidelines still fail to diagnose diastolic dysfunction in some cases. Objective: To evaluate left atrial reservoir function in indeterminate diastolic function Method: Observational study with individuals in sinus rhythm and preserved left ventricular ejection fraction, submitted to echocardiogram and divided into three groups according to the combined analysis of E/e´ ratio and indexed left atrium volume: Group 1, if normal left ventricular filling pressures; Group 2, if increased left ventricular filling pressures and Group 3, if indeterminate left ventricular filling pressures. Twodimensional speckle tracking was used to measure peak left atrial strain (LAS). Analysis of variance, Student's t test and receiver-operator curve (ROC) were used in the statistical analysis. Results: We included 58 patients who had 61 ± 14 years old, 57% of whom were women, and had average left ventricular ejection fraction 62 ± 7%. Groups 2 and 3 had lower LAS than Group 1 (20 ± 5% versus 22 ± 6% versus 30 ± 8%, respectively, p = 0.004), but did not differ between them (p = 0.93). LAS was a good predictor of elevated left ventricular filling pressures (p = 0.026; area under the curve = 0.80), obtaining sensitivity of 60% and specificity of 80% with a cut-off value ≤ 20%. Conclusion: The findings suggest that the left atrial reservoir function of individuals with indeterminate diastolic function is similar to that of individuals with advanced diastolic dysfunction, rendering LAS the potential to support the reclassification of indeterminate diastolic function.(AU)

Clinical value of left atrium-descending aorta distance measured on ultrasound images in the diagnosis of fetal total anomalous pulmonary venous connection / 中国基层医药

Objective:To investigate the clinical value of ultrasonic measurement of left atrium-descending aorta distance in the diagnosis of fetal total anomalous pulmonary venous connection (TAPVC).Methods:Pregnant women who underwent fetal anatomy scans in the second trimester of pregnancy in Central Hospital of Panyu District between January 2018 and June 2019 were included in this study using prospective and case-control study methods. The GE Voluson E8 and Philips EPIQ 7 ultrasound machines were used to measure the left atrium-descending aorta distance in the four-chamber view of the fetal heart. Pulmonary vein was carefully examined. Fetuses with isolated TAPVC were included in the positive group. The pregnancy outcomes were followed up during all participants. 200 healthy fetuses were randomly selected and included in the control group. The correlation between left atrium-descending aorta distance in normal fetuses and gestational weeks was analyzed. The average value of left atrium-descending aorta distances was compared between positive and control groups.Results:A total of 2 156 pregnant women received fetal anatomy scans, with the completion rate of 100%. Among them, 1 786 pregnant women were successfully followed up and 370 were lost to follow up. Among the 1 786 pregnant women, four fetuses were diagnosed with isolated TAPVC, consisting of three fetuses with intracardiac type TAPVC and one fetus with supracardiac type TAPVC, as confirmed by prenatal ultrasound. The left atrium-descending aorta distance in 200 normal fetuses was weakly related to gestational weeks ( r2 = 0.35, P < 0.000 1). The mean left atrium-descending aorta distance in the positive group was significantly greater than that in the control group (5.4 mm vs. 2.1 mm). Conclusion:Ultrasonic measurement of left atrial posterior spatial distance is simple and it is hardly affected by gestational weeks. It is innovative to diagnose TAPVC through quantitative analysis. The widening of left atrium-descending aorta distance has a certain value in suggesting fetal TAPVC. The sample size is small in this study. Multi-center studies involving larger sample sizes are needed to further validate the clinical significance of widened left atrium-descending aorta distance.

Cor triatriatum sinister, una anomalía clásica pero un tanto olvidada: A propósito de un caso / Cor triatriatum sinister, a classic but somewhat forgotten anomaly: Apropos of a case

RESUMEN Un corazón con tres aurículas, que sumaba cinco cámaras en total, fue un hecho que sorprendió a la medicina hace ya más de un siglo. Este raro defecto cardíaco congénito tiene muy baja incidencia, lo cual hace que sea muy poco conocido por las jóvenes generaciones de médicos dedicados a las enfermedades cardiovasculares. El cor triatriatum sinister generalmente se diagnostica en la temprana infancia y es considerado una causa congénita de estenosis mitral. La conducta quirúrgica es de elección para poder liberar el obstáculo al adecuado flujo sanguíneo a través de la aurícula izquierda. Se presenta el caso de un adulto joven con síntomas típicos de estenosis mitral, sin aparentes elementos claves al examen físico y con un ecocardiograma que evidencia esta anomalía, apenas vista y publicada en nuestro medio en pacientes adultos.

ABSTRACT A heart with three atria, totaling five chambers in all, was a fact that surprised medicine more than a century ago. This rare congenital heart defect has a very low incidence, which makes it very little known to the young generations of doctors dedicated to cardiovascular diseases. The cor triatriatum sinister is usually diagnosed in early childhood, and it is considered a congenital cause of mitral stenosis. Surgical approach is the choice to release the obstacle in order to adequate blood flow through the left atrium. We present the case of a young adult with typical symptoms of mitral stenosis, without apparent key elements on the physical examination and that the echocardiogram showed this anomaly, hardly seen and published in our field in adult patients.

Asociación de la dilatación auricular izquierda con los trastornos del sistema de conducción en pacientes con hipertensión arterial sistémica / Association of left atrial dilatation with conduction system disorders in patients with systemic arterial hypertension

La dilatación de la aurícula izquierda (AI) se considera un predictor ecocardiográfico para la remodelación auricular y la fibrilación auricular. Por ende, hemos investigado la correlación existente entre la dilatación de la AI con las arritmias cardíacas y los trastornos del sistema de conducción en pacientes con hipertensión arterial (HTA). En este estudio observacional y prospectivo hemos investigado las variaciones electrocardiográficas, mediciones ecocardiográficas y Holter ECG de 24 hs en pacientes hipertensos y no hipertensos ambulatoria y hospitalizados que acuden a un hospital terciario entre marzo a septiembre del 2018. Se estudiaron 104 pacientes, 65 hipertensos conocidos y 39 no hipertensos como grupo control. El diámetro promedio de la AI fue significativamente mayor (p=0,03) en pacientes hipertensos que los no hipertensos (37±8 mm vs. 34±5 mm). Se encontró una asociación significativa entre hipertensión y la aurícula izquierda dilatada (>40 mm) (p= 0,026 OR: 3,25 IC95%: 1,01-11,02). La dilatación de la AI tuvo una especificidad de 73% y un valor predictivo negativo de 98% relacionado con la presencia de trastornos del sistema de conducción y arritmias cardiacas en pacientes con HTA. Se encontró asociación entre la hipertensión arterial y la dilatación de la aurícula izquierda. La dilatación de la aurícula izquierda tiene una elevada especificidad y un alto valor predictivo negativo en la detección de la presencia de prolongación del intervalo QT, ensanchamiento del complejo QRS, dispersión de la onda P, y trastornos del sistema de conducción y arritmias cardiacas en pacientes con hipertensión arterial(AU)

Dilation of the left atrium (LA) is considered an echocardiographic predictor for atrial remodeling and atrial fibrillation. Therefore, we have investigated the correlation between dilatation of the LA with cardiac arrhythmias and conduction system disorders in patients with systemic arterial hypertension. In this observational and prospective study we have investigated electrocardiographic variations, echocardiographic measurements and Holter ECG of 24 hours in hypertensive patients who attend a tertiary hospital from March 2018 to September 2018 as outpatients and inpatients. One hundred four patients were studied, 65 known to be hypertensive and 39 non-hypertensive subjects as control group. The diameter of the LA ​​had a mean value of 37±8 in hypertensive patients, while in non-hypertensive patients was 34±5 ​​(p = 0.03). A significant association was found between hypertension and increased diameter of the LA (p = 0.04 OR: 2.6 CI 0.88-7.7). Dilatation of the LA had a specificity of 73% and a negative predictive value of 98% related to the presence of conduction system disorders and cardiac arrhythmias in patients with hypertension. A significant relationship between arterial hypertension and dilatation of the left atrium was observed. The dilatation of the left atrium has a high specificity and a high negative predictive value in the detection of the presence of prolongation of the QT interval, widening of the QRS complex, dispersion of the P wave, and disorders of the conduction system and cardiac arrhythmias in patients with hypertension(AU)

Age-wise Variations in the Dimensions of Left atrium and left ventricle in 100 apparently healthy individuals

Introduction: The study on the measurements of the chambers of the heart is very important, which gives details of anatomy, physiology and also pathological conditions of the heart. This knowledge also helps in diagnosis, treatment and follow-up of cardiovascular diseases. Materials & methods: The present study was conducted on 100 apparently normal people attending Out-patient and In-patient sections in Cardiology Department at Osmania General Hospital and CARE hospitals, Hyderabad from October 2012 to September 2013. Results & conclusion: In the present study it was found that the dimensions of left atrium and left ventricle increased with increase in age, which falls in line with previous studies performed on the same criteria.

A Study Of Left Atrial Area And Volume On Echocardiography Among Atrial Fibrillation Cases With Various Aetiology

Background: Atrial fibrillation (AF) is the most common arrhythmia. It is associated with significant morbidity and mortality. The size and volume of left atrium is an important development of atrial fibrillation which land up subjects into various complications so present study was carried out to study echocardiography findings (size and volume) among AF Cases with various underlying aetiology. Material and methods: A cross-sectional observational study was conducted for duration of 2 years to measure left atrial size and volume by echocardiography in patients of atrial fibrillation in various diseases. Aproforma was designed to collect the desired information from the patients. The preformed structured proforma consisted of recording of investigations was used as data collection tool. All efforts were made to diagnose the aetiology of atrial fibrillation. Results: A total of 50 cases of AF were studied with mean age of study participants 53.68±12.74 yrs (range 25-80yrs) and F: M-1.3:1. Major risk factors found were RHD (44%) Hypertension (28%) IHD (24%) and DM (14%).Mean LAvolume and size on echo measurement was 78.16ml and 2 28.88cm .There was significant dilatation of LAamong RHD with p<0.05 among major risk factors found in study.

Remodelado reverso de la aurícula izquierda posablación de venas pulmonares en la fibrilación auricular: una serie de casos / Reverse remodeling of left atrium post pulmonary veins ablation in atrial fibrillation: case series / Remodelação reversa do átrio esquerdo pós-ablação de veias pulmonares na fibrilação atrial: uma série de casos

Resumen: El aislamiento de las venas pulmonares usando sistemas de navegación en tercera dimensión (3D) es una técnica de uso universal que ha demostrado tasas de éxito significativas en la ablación de la fibrilación auricular (FA). Sin embargo, el remodelado que sufre la aurícula izquierda (AI) posterior a la ablación ha sido escasamente evaluado. Ocho pacientes fueron sometidos a ablación de las venas pulmonares con sistema de mapeo electroanatómico entre marzo de 2016 y marzo de 2017. Se evaluó la AI con ecocardiograma preprocedimiento, y uno y tres meses luego de este, utilizando las siguientes variables: volumen auricular izquierdo en biplano, fracción de eyección de AI (FEAI) y strain reservorio de AI en pared lateral. Para determinar la existencia de recurrencia se realizó Holter de 24 horas e interrogatorio telefónico a los tres y seis meses posablación. Se evidenció remodelado reverso estructural y funcional de la AI en seis pacientes. Aquellos con recurrencia de FA no presentaron remodelado reverso y mostraron mayor deterioro de la función auricular previo a la ablación. Estos hallazgos permiten plantearnos algunas hipótesis a investigar sobre los predictores de recurrencia.

Summary: Electrical isolation of the pulmonary veins using third dimension navigation systems is a universal technique that has showed a significant success in atrial fibrillation ablation. Nevertheless, the reverse remodeling suffered by the left atrium after ablation has been scarcely evaluated. Eight patients underwent the ablation of the pulmonary veins with electroanatomic map system, between March 2016 to March 2017. The left atrium was evaluated by echocardiogram pre procedure, and one and three months after ablation, using the following variables: left atrial volume in biplane, ejection fraction of the left atrium and reservoir strain of the left atrium in the lateral wall. To determine the existence of recurrence, Holter of 24 hours was applied and phone calls three and six months after were made. There was evidence of a reverse remodeling structural and functional of the left atrium in six patients. Those with recurrence of atrial fibrillation did not show reverse remodel and showed higher deterioration of the auricular function prior to the ablation. These findings let us make some hypotheses and investigate about recurrence predictors.

Resumo: O isolamento das veias pulmonares, utilizando sistemas de navegação em terceira dimensão, é uma técnica de uso universal que tem sucesso significativo na ablação de fibrilação atrial. No entanto, o remodelamento do átrio esquerdo após a ablação tem sido pouco avaliado. Oito pacientes foram submetidos a ablação de veias pulmonares utilizando mapeamento eletro-anatômico entre março de 2016 e março de 2017. O átrio esquerdo foi avaliado com ecocardiograma no pré-procedimento, e um e três meses após o mesmo, usando as seguintes variáveis: volume do átrio esquerdo em biplano, fração de ejeção do átrio esquerdo e tensão do reservatório do átrio esquerdo na parede lateral. Para determinar a existência de recorrência, Holter de 24 horas e interrogatório por telefone foram realizados três e seis meses após a ablação. A remodelação reversa estrutural e funcional do átrio esquerdo foi observado em seis pacientes. Aqueles com recidiva de fibrilação atrial não apresentaram remodelamento reverso e mostraram maior deterioração da função atrial antes da ablação. Estas descobertas permitem propor algumas hipóteses para investigar sobre os preditores de recorrência.

Demographic and Clinical Features of Left Atrial Tumors in South Indian Population: A Case Series

Myxomas are the most common type of primary cardiac tumor. They cause a variety of clinical manifestations depending on size and anatomical location. Sometimes, manifestations are atypical challenging differential diagnosis and the therapeutic approach. Left atrial myxomas are commonly missed clinically and often lead to grave consequences. We present here a series of 6 cases of left atrial myxomas with demographic and clinical characterization of the patients that were managed successfully.

Study on the measurement of cardiac CT in patients with acute pulmonary embolism / 中华急诊医学杂志

Objective To measure and analyze cardiac ventricular sizes of acute pulmonary embolism patients,and compared with normal group,to investigate the morphological changes of heart in patients with acute pulmonary embolism.Methods 75 patients with acute pulmonary embolism were analyzed retrospectively and were divided into two groups according to the score of embolism index:more than or equal to 50％ (group c,33 cases) and less than 50％ (group b,42cases) and compared with normal group (group a,56 cases) to analyze the changes of cardiac ventricular transversal diameter(LR) and anteroposterior diameter (AP).Results The group c compared with group a and b,the right ventricular LR and AP,and the right atrium LR increased significantly (P＜0.05),the left ventricular LR decreased significantly (P＜0.05).The group b compared with the group a,the right ventricular LR and the right atrium AP increased significantly (P＜0.05),the left atrium LR decreased significantly (P＜0.05).The left atrial AP,group b was larger than that of group a and group c (P＜0.05).The left ventricular AP,there was no significant difference between the three groups.The atrial ratio (RA/LA) and the ventricle ratio (RV/LV)of the three groups were significantly different (P＜0.05).According to the product of two lines of the same heart cavity (RL × AP),compared with group a and b,the left atrium and ventricle of group c decreased (P＜0.05),the right atrium and ventricle enlarged (P＜0.05).Compared with group a,the left ventricular angle of group c decreased significantly (88.97±5.47 vs 97.91±7.66,P＜0.001),there was no significant difference between the group b and c (P＞0.05).After the treatment of acute pulmonary embolism,the right ventricular RL × AP is significantly reduced(4 209.57±844.63 vs 5 090.58±1312.69,P=-0.002),the ventricle ratio (RV/LV) is significantly reduced(0.80±0.13 vs 0.93±-0.19,P=0.003.Conclusions The size and shape of heart cavity varied with different pulmonary embolism index,and we can make preliminary observation and evaluate treatment efficacy by using chest CT scan.

Cor triatriatum sinester. A propósito de un caso / Cor triatriatum sinester. Apropos of a case

RESUMEN El cor triatriatum es una anomalía congénita rara. Su prevalencia es de un 0,1% entre todos los pacientes con cardiopatías congénitas. La aurícula queda dividida en dos partes por una membrana fibromuscular; una cámara proximal y otra distal que se comunican entre sí por dos o más orificios con distintos grados de obstrucción. Es más frecuente encontrarlo en la aurícula izquierda (cor triatriatum sinester). Se diagnostica generalmente en la infancia o durante la edad adulta, muchas veces de manera fortuita mediante un ecocardiograma de rutina. Las manifestaciones clínicas en esta rara enfermedad dependerán del grado de obstrucción de la membrana en la aurícula, así como de las cardiopatías congénitas asociadas.

ABSTRACT Cor triatriatum is a rare congenital defect, (estimated incidence of 0.1% of all patients with congenital heart diseases). The atrium is divided into two compartments by a fibromuscular membrane; a proximal and a distal chamber that communicate with each other through two or more perforations with varying degrees of obstruction. It is more commonly found in the left atrium (cor triatriatum sinester) and usually diagnosed in childhood or during adulthood, often incidentally by a routine echocardiogram. Clinical symptoms in this rare disease depend on the severity of obstruction of the membrane in the atrium, as well as the associated congenital heart diseases.

Watch out for left atrial roof thrombus

Rheumatic mitral stenosis is often associated with thrombus formation in the left atrium (LA), especially in patients with atrial fibrillation. Although thrombus can occur anywhere within the LA, the most common site is the left atrial appendage. Therefore, it is important to carefully screen the entire LA during perioperative transesophageal echocardiography to exclude thrombus.

Esophageal positions relative to the left atrium; data from 293 patients before catheter ablation of atrial fibrillation

Aims Three-dimensional rotational angiography (3DRA) of the left atrium (LA) and the esophagus is a simple and safe method for analyzing the relationship between the esophagus and the LA during catheter ablation of atrial fibrillation. The purpose of this study is to describe the location of the esophagus relative to the LA and mobility of the esophagus during ablation procedure. Methods From 3/2011 to 9/2015, 3DRA of the LA and esophagus was performed in 326 patients before catheter ablation of atrial fibrillation. 3DRAwas performed with visualization of the esophagus via peroral administration of a contrast agent. The positions of the esophagus were determined at the beginning of the procedure, for part of patients also at the end of procedure with contrast esophagography. Results The most frequent position is behind the center of the LA (91 pts., 31.9%) The least frequent position is behind the right pulmonary veins (27 pts., 9.4%). The average shift of the esophagus position was 3.36 ± 2.15 mm, 3.59 ± 2.37 mm and 3.67 ± 3.23 mm for superior, middle and inferior segment resp. Conclusions The position of the esophagus to the LA is highly variable. The most common position of the esophagus relative to the LA is behind the middle and left part of the posterior wall of the LA. The least frequently observed position is behind the right pulmonary veins. No significant position change of esophagus motion from before to after the ablation procedure in the majority (≥95%) of the patients was observed.

Factors Associated with Cheyne-Stokes Respiration in Acute Ischemic Stroke

BACKGROUND AND PURPOSE: Cheyne-Stokes respiration (CSR) is frequently observed in patients with acute stroke. There have been conflicting opinions about the associations of CSR with the location and size of the lesion. We aimed to better define the clinical relevance and pathogenesis of CSR in acute stroke. METHODS: We investigated patients who had been admitted with acute ischemic stroke and received an overnight sleep apnea test. We collected data on demographics, risk factors, etiologic subtypes, initial vital signs, clinical course of the stroke, and parameters associated with respiratory events during the sleep apnea test. We performed a multivariate logistic regression analysis to determine the factors associated with CSR. RESULTS: Among 182 patients, 35 patients showed CSR in sleep apnea testing. Large-artery atherosclerosis or cardioembolism, bilateral hemispheric involvement, atrial fibrillation, low left-ventricle ejection fraction (LVEF), and left atrium (LA) enlargement were all associated with the presence of CSR. Multivariate analysis revealed that the previous modified Rankin Scale (mRS) score, bilateral hemispheric involvement, low LVEF, and LA enlargement were significantly associated with CSR. Subgroup analysis with large-artery atherosclerosis without cardiac disease revealed that the previous mRS score is the only independent factor associated with CSR. CONCLUSIONS: CSR frequently occurs in strokes involving large arteries or due to cardioembolism, regardless of the location and severity of the stroke. Predisposing conditions such as preexisting neurologic disability, low LVEF, and LA enlargement are associated with CSR in acute stroke.