Comparison of Effects of Sevoflurane Versus Propofol on Left Ventricular Longitudinal Global and Regional Strain in Patients Undergoing On?Pump Coronary Artery Bypass Grafting

Background:Assessment of myocardial deformation by quantifying peak systolic longitudinal strain (PSLS) is a sensitive and robust index to detect subclinical myocardial dysfunction. We hypothesize that sevoflurane by virtue of anesthetic preconditioning preserves myocardial function better than propofol. Aims: The authors have assessed the effects of sevoflurane and propofol on global longitudinal strain (GLS) as a primary outcome in patients undergoing on?pump coronary artery bypass grafting. Our secondary aim was to assess the pattern of regional distribution of segmental PSLS between the groups. Materials and Methods: Fifty patients with normal left ventricular function undergoing coronary artery bypass grafting were analyzed in this prospective observational study. Consecutive patients received either propofol (P) or sevoflurane (S) anesthesia. Measurements: Trans?esophageal echocardiographic images (mid?esophageal four?chamber, two?chamber, and three?chamber (long?axis)) were recorded during the precardiopulmonary bypass (CPB) and post?CPB period. Strain analysis (GLS/segmental PSLS) was done offline by investigators blinded to the study. The inotropic score, duration of inotropic support, and mechanical ventilation required were recorded. Results: Following cardiopulmonary bypass and coronary revascularization, GLS reduced significantly in both the groups (P < 0.05). In the S?group, significant reduction in segmental strain was observed only in apical segments including apex, whereas in P?group significant reduction in segmental strain was seen in mid? and apical segments. The postoperative VIS, duration of inotropes/vasopressor required, and mechanical ventilation were similar in both the groups. Conclusions: There are no significant differences in global left ventricular function as assessed by GLS between patients anesthetized with sevoflurane or propofol. However, regional PSLS was better preserved in the S?group compared to P?group

Quantitative assessment of left ventricular longitudinal and circumferential strain in elderly patients with acute myocardial infarction using speckle-tracking imaging on echocardiography / 中华老年医学杂志

Objective:To quantitatively evaluate the left ventricular circumferential and longitudinal strain after percutaneous coronary intervention(PCI)in elderly patients with acute myocardial infarction(AMI)using speckle-tracking imaging(STI)on echocardiography.Methods:A prospective case-control study was conducted on 47 elderly patients diagnosed with ST-elevation AMI and undergoing percutaneous coronary interference(PCI)in our hospital from August 2017 to June 2020 as PCI-study group.The 35 normal subjects matched for age and sex were as a normal-control group.The longitudinal peak systolic strain(LPSS)and circumferential peak systolic strain(CPSS)were measured using STI at one week and three months after PCI in the two groups.Results:The values of LPSS and CPSS were apical segment > middle segment > basal segment, which was the similar between LPSS and CPSS.Compared with normal-control group, AMI-PCI group showed that CPSS and LPSS in each segment were significantly reduced at 1 week and 3 months after operation.Compared with the control group, all the CPSS and LPSS values were significantly decreased in AMI group at one week after PCI(-12.3±2.7)% vs.(-22.5±1.7)%( t=19.62, P<0.01); (-12.9±3.2)% vs.(-23.1±2.6)%( t=15.43, P<0.01). Both LPSS and CPSS values were improved at a certain extent at three months after PCI compared with AMI group at one week after PCI.The complete CPSS and LPSS values were significantly increased in AMI group at three months after PCI compared with one week after PCI(-16.8±2.6)% vs.(-12.3±2.7)%, ( t=8.23, P<0.01); (-17.0±3.3)% vs.(-12.9±3.2)%( t=6.11, P<0.01). But, there were still significant differences compared with the NC group(-16.8±2.6)% vs.(-22.5±1.7)%( t=11.29, P<0.01); (-17.0±3.3)% vs.(-23.1±2.6)%( t=9.04, P<0.01). Conclusions:The longitudinal and circumferential strain of left ventricle were severely damaged in elderly patients with AMI.The speckle-tracking imaging technique can be used to quantitatively evaluate the left ventricular strain and its improved situation after PCI in elderly AMI patients.

Mecánica rotacional ventricular izquierda invertida en un paciente con lipedema (del estudio de MAGYAR-Path) / Left ventricular twist rotation mechanics in a patient with lipoedema (MAGYAR-Path Study)

Resumen El lipedema es un trastorno crónico que se caracteriza por una hiperplasia del tejido adiposo subcutáneo simétrico, deformante, asociado a hematomas y dolor, que afecta fundamentalmente a mujeres tras la pubertad, que suele ser familiar y tiene influencia hormonal. Sin tratamiento, el lipedema puede progresar a linfedema, y se ha asociado al aumento en la rigidez de la aorta. La mecánica rotacional del ventrículo izquierdo (VI) tiene un papel significativo en la circulación normal. En circunstancias normales, la base del VI rota en el sentido de las agujas del reloj, mientras que el ápex del VI rota en sentido contrario, provocando un movimiento como de retorcer una toalla llamado torsión del VI. En el presente caso, mediante ecocardiografía speckle-tracking tridimensional se reveló una torsión del VI demostrando un ápex VI en el sentido de las agujas del reloj y la rotación antihoraria de la base del VI en un paciente con características clínicas de lipedema.

Abstract Lipoedema is a chronic disorder that is characterised by a symmetric, deforming, hyperplasia of the subcutaneous adipose tissue, and is associated with haematomas and pain. It mainly affects women after puberty, is usually familial and is influence by hormones. Untreated, the lipoedema can progress to lymphoedema, and has been associated with the increase in aortic stiffness. The mechanical rotation of the left ventricle (LV) has an important role in normal circulation. In normal circumstances, the base of the LV rotates clockwise, while the LV apex rotates in the opposite direction, leading to a movement like wringing a towel, called LV twist. In the present case, using three-dimension speckle-tracking echocardiography, an LV twist is observed, showing an LV apex in the clockwise direction and the anti-clockwise rotation of the LV base in a patient with clinical characteristics of lipoedema.

Spectrum of Congenital Heart Disease in a Tertiary Care Center

Background: Congenital heart disease (CHD) is not an uncommon entity in our country. The prevalence of CHD is 9.3 Per 1000life birth in Asia which is found to be highest globally. Not much of Indian data is available particularly from south part of thecountry. So we conduct a retrospective study to know the spectrum of congenital heart disease in our set up.Methods: This is a retrospective hospital based study carried out over a period of 12 months (2018 January – 2019 January)where all suspected children (< 12 years) of CHD were subjected to echocardiographic study. The age, sex, clinical presentationand echo findings were well documented.Results: The total number CHD diagnosed were 124 and were more common among males (54.5%) with male to female ratiois 1.2:1.Congenital heart diseases were diagnosed more commonly between 1 month to 1 Year (45.9%). The commonest typeof acyanotic CHD in our study was ventricular septal defect (VSD) (32.3%) and cyanotic CHD is tetralogy of Fallot (8.06%). Themajor clinical finding was a detection of a murmur (84.4%) followed by tachycardia (41.5%) and tachypnea (36.3%).Conclusions: In this era of most accurate diagnostic modalities, any clinical suspicion of congenital heart disease should beconfirmed by echocardiography to hasten the diagnosis, timely management and prevention of complications.

A study to assess valvular heart disease in a tertiary care hospital: a single centre finding

Background: Diseases of the heart valves constitute a major cause of cardiovascular morbidity and mortality worldwide with an enormous burden on healthcare resources. The present study was undertaken to study incidence and demography of valvular heart disease, to assess echocardiography and colour doppler findings of patients with valvular heart disease and to find out complications in patients with valvular heart disease.Methods: A hospital based longitudinal case study was undertaken at medicine department of Dr. V.M. Government Medical College, Solapur, Maharashtra, India for a period of two years. One hundred and twenty-four (124) patients attending OPD participated in the study.Results: In the present study, out of 124 patients, mitral valve was most commonly involved, 105(84.67%) and the least common involved was tricuspid 1(0.81%). The most common aetiology was rheumatic origin 75(94.94%). In the present study the most common complication was pulmonary hypertension 69(55.65%), followed by congestive cardiac failure (33.87%), acute pulmonary edema (12.09%), infective endocarditis (4.84%), cerebrovascular accident (4.03%), left atrial thrombus (3.23%) and death (3.23%).Conclusions: Multiple valves were affected in more than a third of all cases, although recent research in India continue to demonstrate a declining trend in the prevalence of RHD, rheumatic involvement is still the dominant form of valvular heart disease in India.

Leiomiomatosis intravascular gigante con extensión a cavidades cardíacas / Giant intravascular leiomyomatosis intravascular with extension to the cardiac cavities

Resumen Se presenta el caso de inusual crecimiento intracardíaco de leiomiomatosis intravascular gigante en una mujer de 38 años, en quien durante evaluación prequirúrgica de cirugía abdominal se documentó de manera incidental una masa en cavidades cardiacas derechas. Dada su presentación infrecuente y las dificultades en el abordaje diagnóstico y terapéutico, se realiza posterior revisión de la literatura.

Abstract The case is presented of an unusual intracardiac growth of a giant intravascular leiomyomatosis in a 38 year-old woman. During a pre-surgical evaluation for abdominal surgery, the incidental finding of a mass in the right cardiac cavities was noted. Given its uncommon presentation and the difficulties in the diagnostic and therapeutic approach, a subsequent review of the literature was performed.

Treatment of CO2 embolism in laparoscopic hepatectomy / 中华肝胆外科杂志

Objective To study the diagnosis and treatment of CO2 embolism in laparoscopic hepatectomy (LH).Methods A retrospective study was conducted on 80 patients who underwent various types of LH from June 2016 to November 2017.The clinical data of 4 patients who suffered from severe CO2 embolism were analyzed.Results The operation time of 80 patients varied from 65 min to 345 min (average 170 min).Tbe amount of blood loss ranged from 50 ml to 2 500 ml (average 450 ml).28 patients (35％) required blood transfusion.Two patients were converted to open operation because of uncontrollable bleeding.Four patients suffered from severe CO2 embolism with significant changes in circulation and respiration.After active and effective treatment,none required open conversion and all recovered well.Conclusions Any sudden respiratory and circulatory changes during LH should lead us to think of severe CO2 embolism.Timely and effective treatment could convert a dangerous situation to become safe.

Remembranza de una visita del Comandante en Jefe Fidel Castro Ruz al Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres / Remembrance of Commander in Chief Fidel Castro Ruz visit to Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital

Se reseña de manera historiográfica y documental uno de los momentos en que el líder histórico de la Revolución Cubana compartió con trabajadores del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres. Se trata de la visita que efectuó en julio de 1988 para inaugurar el moderno equipo de tomografía axial computarizada. La ciudad de Santiago de Cuba conmemoraba el 35 aniversario del Asalto al Cuartel Moncada y fue el marco escogido para la inauguración. Se destaca el intercambio sostenido por Fidel con los especialistas en Imagenología y sus conocimientos sobre el tema.

In this work there is a historical and documental review of one of the moments in which the Cuban revolution historical leader shared with the workers of Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital. It is about the visit on July, 1988 to inaugurate the modern equipment of CT scan. Santiago de Cuba was commemorating the 35th anniversary of the Assault to the Moncada Garrison and it was the event chosen for the inauguration. The exchange of Fidel with the Imagenology specialists and the wide knowledge he had on the subject are remarkable.

Clinical study on risk factors correlated with senile degenerative aortic valve calcification by color Doppler echocardiograph / 国际生物医学工程杂志

Objective To investigate the value of the senile degenerative aortic valve calcification (AVC) and to analyze the correlative risk factors by color Doppler echocardiograph.Methods Aortic valves of 110 cases with AVC (study group) and 110 cases without AVC (control group) were observed by color Doppler echocardiograph.All the patients with AVC have been excluded of congenital and other acquired valves' diseases.The aortic valve' s shape and the diameters of aortic root were measured.At the same time,the peak systolic and diastolic velocities of aorta were detected.The different features were compared between the two groups.Results Test results showed significant differences in study group:Anteroposterior diameter of aortic annulus and the area of aortic valve were decreased by calcification; The anteroposterior diameter of aortic sinus increased and aorta transvalvular pressure gradient augmented; Detection rate of atherosclerosis (AS) of aorta and the peripheral artery stenosis of the study group were higher than that of control group; The AS increased pulse pressure and aggravated AVC; Correlative risk factors,in addition to age,included hypertension,hypercholesterolemia,osteoporosis,and so on.The correct diagnosis of the correlated diseases were on the basis of clinical examines.The rate of AVC with multi-factor was higher than that with single-factor.In addition,gender difference and the diameters of ascending aortic showed no significant difference in two groups.Relationship between diabetes of correlative factors and the rate of AVC showed no significant difference in two groups.Conclusion Morphologic abnormality and malfunction of aortic valve and the large artery in elder patients were caused by senile degenerative AVC.The more correlative risk factors,the worse showed.

Segmental Tissue Doppler Image-Derived Tei Index in Patients With Regional Wall Motion Abnormalities

BACKGROUND AND OBJECTIVES: Although the Tei index is a useful predictor of global ventricular function, it has not been investigated at the level of regional myocardial function. We therefore investigated the segmental tissue Doppler image derived-Tei index (TDI-Tei index) in patients with regional wall motion abnormalities. SUBJECTS AND METHODS: We prospectively studied 17 patients (mean age 62+/-9 years, 5 women) with left ventricular (LV) regional wall motion abnormalities. The Tei index, defined as the sum of isovolumetric contraction time (IVCT) and isovolumetric relaxation time (IVRT) divided by ejection time (ET), was measured in the basal and mid segments of the LV walls from standard apical views (4-, 2-, and 5-chamber views). We also obtained TDI velocity data in each segment. LV wall motion was classified as normal, hypokinetic, or akinetic, based on visual analysis. The TDI-Tei index, peak systolic myocardial velocity (Sm), early diastolic myocardial velocity (Em), and late diastolic myocardial velocity (Am) were analyzed in a total of 203 segments. RESULTS: Mean LV ejection fraction was 41.8+/-8.5%. TDI-Tei indices of dysfunctional segments (akinesis or hypokinesis, n=63) were significantly higher than those of normal segments (n=140) (0.714+/-0.169 vs. 0.669+/-0.135, p=0.041, respectively). Average values of TDI-Tei index, Sm, Em, and Am were 0.742+/-0.201, 4.206+/-1.336, 5.258+/-1.867, and 5.578+/-2.354 in akinetic segments; 0.677+/-0.101, 4.908+/-1.615, 5.369+/-2.121, and 5.542+/-2.492 in hypokinetic segments; and 0.669+/-0.135, 5.409+/-1.519, 6.108+/-2.356, and 6.719+/-2.466 in normal segments, respectively. A significant negative correlation was apparent between the TDI-Tei index and Sm (r=-0.302, p<0.001). CONCLUSION: These data suggest that the value of the segmental TDI-Tei index differs significantly according to regional function grade.

Analysis of the occurrence of patent foramen ovale in young patients with ischemic stroke / 中国脑血管病杂志

Objective: To investigate the occurrence of patent foramen ovale (PFO) in young patients with ischemic stroke. Methods: A total of 198 consecutive young patients with ischemic stroke were selected from either the outpatient or inpatient department of Xuanwu Hospital, Capital Medical University from October 2006 to January 2010. They were divided into a PFO group (n = 125) and a non-PFO group (n =73) according to whether the existence of PFO on tranesophageal echocardiography. The occurrence of PFO was observed by tranesophageal echocardiography and right heart contrast echocardiography. The examinations of the related risk factors were performed in all the patients. Results: Circled digit oneThe patients in the PFO group were younger than those in the non-PFO group (37±10 vs. 43±10). The diffe-rence was statistically significant (P<0.05). Circled digit twoThe stroke-related risk factors, such as the proportions of patients with hypertension, diabetes mellitus, smoking history, and hypercholesterolemia in the PFO group were lower than those in the non-PFO group. The differences were statistically significant (P<0.05). Circled digit three Eighteen patients (14.4%) were complicated with atrial septal aneurysm in the PFO group, and only 5 patients(6.8%) in the non-PFO group. The difference was statistically significant (P=0.018). Circled digit fourThe proportion of patients without any risk factors in the PFO group was higher than that in the non-PFO group. The difference was statistically significant (P<0.05). Conclusion: PFO may be an important cause of ischemic stroke in young patients.

Optimally Timed Rate-adaptive Atrioventricular Delay in AV Sequential Pacing

BACKGROUND: Although the net atrioventricular compliance can be obtained by invasive catheterization (Ccath) in mitral stenosis (MS), feasibility of noninvasive echocardiographic calculation of the compliance (Cecho) and its hemodynamic significance were not tested. METHODS: Using valve area by 2D planimetry (A2D) and deceleration slope (dv/dt) of transmitral velocity decay in continuous wave Doppler echocardiographic tracing, Cecho was defined as -A2D/(gamma dv/dt), which was compared with Ccath obtained directly during the catheterization in 30 MS patients with sinus rhythm. Exercise Doppler echocardiography with symptom-limited treadmill was performed in 66 patients with moderate to tight MS: mean mitral gradient (MG) and peak pressure gradient of tricuspid regurgitation (PGTR) at baseline and immediately after exercise were obtained using continuous wave Doppler echocardiographic tracing. Hemodynamic variables including Cecho, MG, PGTR and mitral valve area were analyzed to determine the association with patients' exercise tolerance. RESULTS: Cecho in 30 patients with tight MS (valve area 0.9+/-0.2 cm 2) was 4+/-1 ml/mmHg (2-7 mmHg), which showed a significant correlation with Ccath (r=0.48, p=0.01). Exercise time in 66 patients with moderate to tight MS showed significant negative correlation with resting MG, resting and postexercise PGTR, and positive correlation with Cecho: exercise time in those patients did not show any significant correlation with resting valve area. In multivariate analysis, Cecho and postexercise PGTR were independent factors determining exercise time in MS. CONCLUSIONS: The net atrioventricular compliance in MS can be calculated by noninvasive echocardiography, and it is an important hemodynamic factor determining exercise tolerance in MS.

Intraoperative Management of Myocardial Ischemia with Transesophageal Echocardiography during Coronary Bypass Surgery / 대한마취과학회지

BACKGROUND; Regional wall motion abnormalities(RWMA) detected by intraoperative transesophageal echocardiography(TEE) are thought to be sensitive indicators of myocardial ischemia. The present study was undertaken to elucidate management of RWMA with an immediate regraft in the area of RWMA or conventional drug therapy. METHOD; Twenty-six patients undergoing coronary artery bypass graft surgery were examined with TEE. After induction of anesthesia, TEE probe was inserted into esophagus and connected to Echo system. LV short axis views at the mid-papillary muscle level were viewed and recorded. TEE showed postbypass RWMA in 6 cases and one patient who did not have the TEE developed postbypass RWMA viewed by the epicardial echocardiography. Regraft was performed at the area of RWMA in 3 patients. The remainder was treated with intraaortic balloon pump(IABP) and/or inotropics. RESULTS; The patients with regraft showed an immediate improvement of the new RWMAs. The patients treated with IABP and/or inotropics had improvement of hemodynamics but did not show any improvement of the RWMAs. All seven patients developed hypotension and ST segment changes. All patients with the conventional treatment and two out of 3 regraft patients developed the postoperative myocardial infarctions. CONCLUSIONS; In conclusion this study demonstrated that patients experiencing persistent RWMA would be more likely to have myocardial infarction than those having only transient changes and that TEE would be an excellent tool for early detection of myocardial ischemia and might improve treatment of ischemic events.

Long-term follow-up of tricuspid valve function by color Doppler echocardiography after mitral valve replacement / 中华胸心血管外科杂志

Objective To investigate the long-term morphologic and functional changes of the tricuspid valve after mitral valve replacement. Methods The tricuspid valve function was evaluated by Doppler echocardiography in 903 patients who underwent mitral valve replacement during recent 10 years. Tricuspid regurgitation and annular dilatation in various degrees were found in all patients preoperatively. 686 patients underwent Kay annuloplasty or DeVega annuloplasty, 106 patients underwent tricuspid ring annuloplasty, and 201 untreated. Results Among 201 patients who did not undergo tricuspid annuloplasty, severe tricuspid regurgitation developed in 46 during 2 to 3 years follow-up. One out of 16 patients who underwent tricuspid ring annuloplasty developed moderate tricuspid regurgitation 2 years after operation. Of 686 patients who underwent Kay annuloplasty or DeVega annuloplasty, 150 developed moderate or severe tricuspid regurgitation during 3~5 years after operation. Conclusion Tricuspid annular dilatation, right heart impairment and severe pulmonary hypertension are responsible for the development of late tricuspid regurgitation after mitral valve replacement. For the patient who underwent mitral valve replacement ,tricuspid annuloplasty should be performed when annular dilatation was found, even without tricuspid regurgitation and tricuspid ring annuloplasty should be performed in patient with severe tricuspid regurgitation and obvious tricuspid annular dilatation.

Intraoperative transesophageal echocardiography during cardiovascular surgery:experience from 493 cases / 中华麻醉学杂志

From June 1997 to June 2001 intraoperative transesophageal echocardiography(TEE)was used in 493 patients undergoing different cardiovascular operations including correction of congenital heart defect, coronary artery bypass grafting(CABG),cardiac valve replacement and major vascular surgery.The clinical data of these cases were complete and detailed enough for retrospective review.Their cardiac functions were graded to be classⅡ-Ⅳaccording to New York Heart Association(NYHA)classification.The patients ranged in age between 1.6-74 yrs and weighed between 8.5-92 kg.The probe of TEE was inserted in esophagus after tracheal intubation.Preoperative diagnosis was found to be wrong by TEE in 20 cases(4.1%).Additional defect was found in 51 cases(10.3%).The type of operation planned before operation was altered in 52 cases(10.5%). During the operation real time TEE revealed that the operation performed failed to achieve the goal and revision surgery was needed in 24 cases(4.9%).Abnormal hemodynamics and cardiac function were found by TEE after the heart resumed spontaneous beat in 17 cases(3.5%)and appropriate treatment was instituted.Oral and pharyngeal mucous membrane bleeding occurred in 7 cases.There were no serious complications attributable to TEE.Intraoperative TEE is a very useful tool in formulating the surgery,monitoring hemodynamics and assessing immediate results of surgery and is safe and reliable in the hands of trained anesthesiologists.