Precisión diagnóstica de la circunferencia de cuello para la predicción de sobrepeso y obesidad en estudiantes universitarios mexicanos / Diagnostic accuracy of neck circumference for the prediction of overweight and obesity in Mexican university students

Introducción. La circunferencia de cuello es una medida de fácil acceso y bajo costo, que podría ayudar a la identificación del sobrepeso u obesidad. Objetivo. Determinar la precisión diagnóstica de la circunferencia de cuello para la predicción de sobrepeso y obesidad en estudiantes universitarios mexicanos y analizar la correlación entre la circunferencia de cuello con otros indicadores antropométricos y la presión arterial como factor de riesgo cardiovascular. Materiales y métodos. Estudio transversal, analítico en 236 universitarios. Se realizaron mediciones antropométricas y presión arterial. Se realizaron análisis de las curvas ROC para obtener la sensibilidad y especificidad de los puntos de corte para la predicción de sobrepeso u obesidad y correlaciones de Pearson de circunferencia de cuello vs variables antropométricas. Resultados. Se observó, en hombres y mujeres, una correlación fuerte entre circunferencia de cuello y peso [r= 0,74 y r= 0,82 (p<0,01), respectivamente], seguida por IMC [r= 0,77 y r= 0,75 (p<0,01), respectivamente], circunferencia de cintura [r= 0,73 y r= 0,77 (p<0,01), respectivamente] e ICT [r= 0,71 y r= 0,73 (p<0,01), respectivamente]; se encontraron correlaciones moderadas para porcentaje de masa grasa y tensión arterial. La circunferencia de cuello vs circunferencia de cintura fue la mejor prueba de predicción para asociar el sobrepeso u obesidad tanto en hombres (AUC= 0,93; 89,3% sensibilidad y 82,3% especificidad) como mujeres (AUC= 0,95: 94,3% sensibilidad y 82,3% especificidad). Conclusiones. Los puntos de corte de la circunferencia de cuello presentan una adecuada capacidad para predecir el sobrepeso y obesidad en jóvenes adultos mexicanos(AU)

Introduction. Neck circumference is an easily accessible and low-cost measure, which could help in the identification of overweight or obesity. Objective. To determine the diagnostic accuracy of neck circumference for the prediction of overweight and obesity in Mexican university students and to analyze the correlation between neck circumference and other anthropometric indicators and blood pressure as a cardiovascular risk factor. Materials and methods. Cross-sectional, analytical study in 236 university students. Anthropometric and blood pressure measurements were taken. ROC curve analysis was performed to obtain the sensitivity and specificity of the cut-off points for the prediction of overweight or obesity and Pearson correlations of neck circumference vs anthropometric variables. Results. A strong correlation was observed, in men and women, between neck circumference and weight [r= 0.74 and r= 0.82 (p<0.01), respectively], followed by BMI [r= 0.77 and r= 0.75 (p<0.01), respectively], waist circumference [r= 0.73 and r= 0.77 (p<0.01), respectively] and ICT [r= 0.71 and r= 0.73 (p<0.01), respectively]; moderate correlations were found for percent fat mass and blood pressure. Neck circumference vs waist circumference was the best predictive test for associating overweight or obesity in both men (AUC= 0.93; 89.3% sensitivity and 82.3% specificity) and women (AUC= 0.95: 94.3% sensitivity and 82.3% specificity). Conclusions. Neck circumference cut-off points present adequate ability to predict overweight and obesity in Mexican young adults(AU)

Asociación del índice de masa corporal y relación cintura/estatura con la presión arterial como factor de riesgo metabólico en estudiantes universitarios / Body mass index and waist / height ratio association with blood pressure as a metabolic risk factor in college students

Los problemas relacionados con los trastornos metabólicos se han incrementado en la actualidad en población joven. Promover un estilo de vida saludable en estudiantes universitarios puede ayudar a prevenir diabetes, enfermedades cardiovasculares y diferentes tipos de cáncer. Objetivo. Calcular el Índice de Masa Corporal (IMC) de universitarios para identificar la prevalencia de obesidad e hipertensión como factores de riesgo metabólico. Materiales y método. Se utilizó muestreo probabilístico aleatorio simple (n= 282, edad 19,1 ± 1,8, 54,6% mujeres, 48,5% hombres). Se realizaron mediciones de peso y estatura para calcular el IMC, circunferencia de cintura y presión arterial. Resultados. Los resultados promedio para mujeres y hombres respectivamente fueron: IMC 24,0 ±5,5 y 25,2 ±5,2 kg/m2 (p= 0,25); cintura 76,25 ± 11,87 y 82,32 ± 15,85 cm (p= 0,001), indicando un riesgo bajo en 73,1% de mujeres y 82,5% de hombres; y presión arterial 127,73/86,03 y 142,3/94,2 mmHg (p= 0,001). La probabilidad de tener hipertensión arterial fue mayor al tener una relación cintura/estatura (RCE) alterada en mujeres y hombres (OR=3,037; IC95% 1,385-6,657 y OR=3,664; IC95% 1,249-2,179, respectivamente). Conclusiones. La población universitaria presenta factores de riesgo que pueden derivar en enfermedades crónicas no transmisibles en un futuro próximo, por lo cual es necesario modificar sus estilos de vida. La RCE es un buen predictor de riesgo de hipertensión en esta población(AU)

The problems related to metabolic disorders have now increased in the young population. Promoting a healthy lifestyle in college students can help prevent diabetes, cardiovascular disease, and different types of cancer. Objective. To calculate the Body Mass Index (BMI) in college students to identify the prevalence of obesity and hypertension as metabolic risk factors. Materials and methods. Simple random probability sampling was used (n = 282, age 19,1 ± 1,8, 54,6% women, 48,5% men). BMI was calculated with weight and height, waist circumference, and blood pressure. Results. The average results for women and men respectively were: BMI 24,0 ± 5,5 and 25,2 ± 5,2 kg/m2 (p = 0,25); waist 76,25 ± 11,87 and 82,32 ± 15,85 cm (p = 0,001), indicating a low risk in 73,1% of women and 82,5% of men; and blood pressure 127,73 / 86,03 and 142,3 / 94,2 mm Hg (p = 0,001). The probability of having arterial hypertension was higher when there was an altered waist / height ratio (WHR) in women and men (OR = 3,037; 95% CI 1,385-6,657 and OR = 3,664; 95% CI 1,249-2,179, respectively). Conclusions. The university population presents risk factors that could lead to chronic diseases. It is necessary to modify their lifestyles to prevent future diseases. WHR is a good predictor of hypertension risk in this population(AU)

Natriuretic Peptide and Clinical Evaluation in the Diagnosis of Heart Failure Hemodynamic Profile: Comparison with Tissue Doppler Echocardiography / Peptídeo Natriurético e Avaliação Clínica no Diagnóstico do Perfil Hemodinâmico da Insuficiência Cardíaca: Comparação com Ecodopplercardiograma Tecidual

Abstract Background: Physical examination and B-type natriuretic peptide (BNP) have been used to estimate hemodynamics and tailor therapy of acute decompensated heart failure (ADHF) patients. However, correlation between these parameters and left ventricular filling pressures is controversial. Objective: This study was designed to evaluate the diagnostic accuracy of physical examination, chest radiography (CR) and BNP in estimating left atrial pressure (LAP) as assessed by tissue Doppler echocardiogram. Methods: Patients admitted with ADHF were prospectively assessed. Diagnostic characteristics of physical signs of heart failure, CR and BNP in predicting elevation (> 15 mm Hg) of LAP, alone or combined, were calculated. Spearman test was used to analyze the correlation between non-normal distribution variables. The level of significance was 5%. Results: Forty-three patients were included, with mean age of 69.9 ± 11.1years, left ventricular ejection fraction of 25 ± 8.0%, and BNP of 1057 ± 1024.21 pg/mL. Individually, all clinical, CR or BNP parameters had a poor performance in predicting LAP ≥ 15 mm Hg. A clinical score of congestion had the poorest performance [area under the receiver operating characteristic curve (AUC) 0.53], followed by clinical score + CR (AUC 0.60), clinical score + CR + BNP > 400 pg/mL (AUC 0.62), and clinical score + CR + BNP > 1000 pg/mL (AUC 0.66). Conclusion: Physical examination, CR and BNP had a poor performance in predicting a LAP ≥ 15 mm Hg. Using these parameters alone or in combination may lead to inaccurate estimation of hemodynamics.

Resumo Fundamento: Exame físico e peptídeo natriurético do tipo B (BNP) foram usados para estimar a hemodinâmica e adequar a terapia de pacientes com insuficiência cardíaca aguda descompensada (ICAD). Entretanto, correlação entre esses parâmetros e a pressão de enchimento do ventrículo esquerdo é controversa. Objetivo: Avaliar a acurácia diagnóstica do exame físico, da radiografia de tórax (RT) e do BNP para estimar a pressão atrial esquerda (PAE) avaliada pelo ecodopplercardiograma tecidual. Métodos: Pacientes admitidos com ICAD foram avaliados prospectivamente. As características diagnósticas dos sinais físicos de insuficiência cardíaca, RT e BNP para predizer elevação da PAE (> 15 mmHg), isolados ou combinados, foram calculadas. Teste de Spearman foi usado para analisar a correlação entre variáveis de distribuição não normal. O nível de significância foi 5%. Resultados: Este estudo incluiu 43 pacientes com idade média de 69,9 ± 11,1 anos, fração de ejeção ventricular esquerda de 25 ± 8.0%, e BNP de 1057 ± 1024,21 pg/mL. Individualmente, todos os parâmetros clínicos, RT e BNP apresentaram fraco desempenho para predizer PAE ≥ 15 mmHg. O escore clínico de congestão teve o pior desempenho [área sob a curva receiver operating characteristic (AUC) 0,53], seguindo-se escore clínico + RT (AUC 0,60), escore clínico + RT + BNP > 400 pg/mL (AUC 0,62) e escore clínico + RT + BNP > 1000 pg/mL (AUC 0,66). Conclusão: Exame físico, RT e BNP tiveram desempenho fraco para predizer PAE ≥15 mmHg. O uso desses parâmetros isoladamente ou em combinação pode levar a estimativa imprecisa do perfil hemodinâmico. (Arq Bras Cardiol. 2018; 110(3):270-277)

Endovascular Treatment of Idiopathic Intracranial Hypertension with Stenting of the Transverse Sinus Stenosis / 신경중재치료의학

For many years, the pathophysiology of idiopathic intracranial hypertension (IIH) was interpreted as “secondary intracranial hypertension,” and IIH was considered to be caused by brain edema due to obstructive sleep apnea. Another theory proposed cerebrospinal fluid (CSF) absorption impairment due to excessive medication with vitamin A derivatives. Other reports pointed out the importance of obesity, which may cause an impairment of intracranial venous drainage due to elevated right atrial pressure. Patients with medically refractory IIH have traditionally undergone a CSF diversion. Venous outlet impairment on IIH has recently been reported as a causative or contributory cause, and thus focused venoplasty of the stenotic sinus with a stent has emerged as a new treatment strategy. We report the cases of two patients who presented with headache and papilledema with IIH. They successfully underwent stent placement at the stenosis of the transverse sinus and experienced complete resolution of symptoms.

Hemodynamic and Histopathologic Benefits of Early Treatment with Macitentan in a Rat Model of Pulmonary Arterial Hypertension

BACKGROUND AND OBJECTIVES: Macitentan (MAC) reduces morbidity and mortality among advanced-stage pulmonary arterial hypertension (PAH) patients. However, data regarding the histopathologic and hemodynamic benefits of MAC treatment at an early stage of PAH is lacking. METHODS: One week after monocrotaline (MCT) injection, rats were randomly assigned to MAC (n=16), MAC combined with sildenafil (SIL) (MAC+SIL, n=16), or normal saline (MCT, n=16). Twelve sham rats (Sham) were included for comparison. Right ventricular (RV) systolic function was assessed via echocardiography as the RV fractional area change (RV-FAC). An invasive pressure-volume analysis using a Millar conductance catheter was performed 7 weeks after MCT injection. Rats were subsequently euthanized for histopathologic analysis. RESULTS: RV-right atrial pressure gradient on echocardiography was significantly increased 3 weeks after MCT injection, but was maintained in the Sham. RV-FAC was less deteriorated in the MAC, compared to that in the MCT (44±3% vs. 25±7%, p 0.05 vs. the MAC). On invasive hemodynamic analyses, RV end-systolic (196±78 µL) and end-diastolic volumes (310±86 µL), pulmonary artery systolic pressure (89±7.2 mmHg), and end-systolic pressure-volume relationship (−254±25.1) were significantly worse in the MCT vs. in the MAC (101±45 µL, 235±55 µL, 40±10.5 mmHg, and −145±42.1, respectively) and MAC+SIL (109±47 µL, 242±46 µL, 38±9.2 mmHg, and −151±39.2, respectively) (all p 0.05). On histopathology, both RV and lung fibrosis were significantly reduced in the MAC and MAC+SIL vs. in the MCT (all p < 0.05); the 2 treatment groups did not differ. CONCLUSIONS: MAC treatment at an earlier stage significantly attenuated experimental PAH progression hemodynamically and histopathologically.

Redefining Effusive-Constrictive Pericarditis with Echocardiography

BACKGROUND: Effusive-constrictive pericarditis (ECP) is traditionally diagnosed by using the expensive and invasive technique of direct pressure measurements in the pericardial space and the right atrium. The aim of this study was to assess the diagnostic role of echocardiography in tuberculous ECP. METHODS: Intrapericardial and right atrial pressures were measured pre- and post-pericardiocentesis, and right ventricular and left ventricular pressures were measured post-pericardiocentesis in patients with tuberculous pericardial effusions. Echocardiography was performed post-pericardiocentesis. Traditional, pressure-based diagnostic criteria were compared with post-pericardiocentesis systolic discordance and echocardiographic evidence of constriction. RESULTS: Thirty-two patients with tuberculous pericardial disease were included. Sixteen had ventricular discordance (invasively measured), 16 had ECP as measured by intrapericardial and right atrial invasive pressure measurements and 17 had ECP determined echocardiographically. The sensitivity and specificity of pressure-guided measurements (compared with discordance) for the diagnosis of ECP were both 56%. The positive and negative predictive values were both 56%. The sensitivity of echocardiography (compared with discordance) for the diagnosis of ECP was 81% and the specificity 75%, while the positive and the negative predictive values were 76% and 80%, respectively. CONCLUSION: Echocardiography shows a better diagnostic performance than invasive, pressure-based measurements for the diagnosis of ECP when both these techniques are compared with the gold standard of invasively measured systolic discordance.

Noninvasive estimation of left atrial pressure with transesophageal echocardiography.

Background: The pulmonary artery catheter (PAC) has historically been used to measure cardiac filling pressures of which pulmonary capillary wedge pressure (PCWP) has been used as a surrogate of left atrial pressure (LAP) and left ventricular end‑diastolic pressure. Increasingly, the use of the PAC has been questioned in the perioperative period with multiple large studies unable to clearly demonstrate benefit in any group of patients, resulting in a declining use in the perioperative period. Alternative methods for the noninvasive estimation of left‑sided filling pressures are required. Echocardiography has been used to provide noninvasive estimation of PCWP and LAP, based on evaluating mitral inflow velocity with the E and A waves and looking at movement of the mitral annulus with tissue Doppler (e’). Aim: The aim of our study was to assess the relationship between PCWP and E/e’ in cardiac surgical patients with transesophageal echocardiography (TOE). Design: A prospective observational study. Setting: Cardiac surgical patients in a single quaternary referral university teaching hospital. Methods: The ratio of mitral inflow velocity (E wave) to mitral annular tissue velocity (e’) (the E/e’ ratio) and PCWP of 91 patients undergoing general anesthesia and cardiac surgery were simultaneously recorded, with the use of TOE and a PAC. Results: The correlation between E/e’ and PCWP was modest with a Spearman rank correlation coefficient of 0.29 (P = 0.005). The area under the receiver operating characteristic curve for using E/e’ to predict elevated PCWP (≥18 mmHg) was 0.6825 (95% confidence interval: 0.57–0.80), indicating some predictive utility. The optimum threshold value of E/e’ was 10 which had 71% sensitivity and 60% specificity to predict a PCWP ≥18 mmHg. Conclusions: Noninvasive measurements of E/e’ in general cardiac surgical patients have only a modest correlation and does not reliably estimate PCWP.

Pulmonary hypertension due to acute respiratory distress syndrome

Our aims were to describe the prevalence of pulmonary hypertension in patients with acute respiratory distress syndrome (ARDS), to characterize their hemodynamic cardiopulmonary profiles, and to correlate these parameters with outcome. All consecutive patients over 16 years of age who were in the intensive care unit with a diagnosis of ARDS and an in situ pulmonary artery catheter for hemodynamic monitoring were studied. Pulmonary hypertension was diagnosed when the mean pulmonary artery pressure was >25 mmHg at rest with a pulmonary artery occlusion pressure or left atrial pressure <15 mmHg. During the study period, 30 of 402 critically ill patients (7.46%) who were admitted to the ICU fulfilled the criteria for ARDS. Of the 30 patients with ARDS, 14 met the criteria for pulmonary hypertension, a prevalence of 46.6% (95% CI; 28-66%). The most common cause of ARDS was pneumonia (56.3%). The overall mortality was 36.6% and was similar in patients with and without pulmonary hypertension. Differences in patients' hemodynamic profiles were influenced by the presence of pulmonary hypertension. The levels of positive end-expiratory pressure and peak pressure were higher in patients with pulmonary hypertension, and the PaCO2 was higher in those who died. The level of airway pressure seemed to influence the onset of pulmonary hypertension. Survival was determined by the severity of organ failure at admission to the intensive care unit.

The potential mechanism of the detrimental effect of defibrillation prior to cardiopulmonary resuscitation in prolonged cardiac arrest model / 한국실험동물학회지

Defibrillation is no longer universally recommended as initial intervention for the reversal of ventricular fibrillation (VF) after a prolonged and untreated cardiac arrest. We sought to examine this issue in an animal model where a prolonged untreated VF was induced. The aim of this study was to investigate the potential mechanism of the detrimental effect of defibrillation prior to cardiopulmonary resuscitation (CPR) in prolonged cardiac arrest model. VF was electrically induced in 32 domestic male swine weighing 40+/-3 kg and remained untreated for 15 minutes. The animals were then randomly allocated to either the initial defibrillation group or the chest compression group. Mean aortic pressure, right atrial pressure and coronary perfusion pressure (CPP) were continuously measured during the performance. The dimensions of the left ventricle (LV) were assessed by echocardiographic methods. The CPP induced by CPR after defibrillation was significantly lower in the initial defibrillation group than in the chest compression group; 1 minute after defibrillation (9+/-3 mmHg vs. 14.8+/-7 mmHg (P<0.05)), and after 5 minutes 16+/-5 mmHg vs. 21.7+/-1 mmHg (P<0.05). The LV volumes were reduced from 18+/-2 mmHg to 14+/-1 mmHg after defibrillation (P<0.05). In brief, this study showed that the conducting defibrillation prior to chest compression may cause a contracture of the LV, resulting in lowering CPP, thus dropping the efficiency of chest compression in a prolonged cardiac arrest model.

Isolated dilatation of the inferior vena cava

The diameter and collapsibility of the inferior vena cava (IVC) should be interpreted in consideration with other clinical and echocardiographic parameters before drawing definitive diagnostic conclusions. We report a case of a 46-year-old female with isolated IVC dilation and diminished inspiratory collapse without other abnormalities, and provide a brief review of the literature.

Crisis hipertensiva: parte I / Hypertensive crisis: part I

Antecedentes: Actualmente la hipertensión arterial afecta más de 1 billón de personas y es responsable de aproximadamente 7.1 millones de muertes por año a nivel mundial. La crisis hipertensiva, hace referencia a tres entidades médicas bien definidas: la Hipertensión Arterial Severa, la Urgencia Hipertensiva y la Emergencia Hipertensiva. Fuentes: Artículos publicados en los últimos 10 años por expertos en el tema. Desarrollo. Las crisis hipertensivas tienen como característica común la presencia de cifras tensionales elevadas, pero difieren en cuanto a: la severidad de la elevación de la presión arterial, manifestaciones clínicas, los medicamentos de elección a utilizar en su tratamiento, la presión arterial meta a alcanzar y la velocidad en que se podrá llegar a dicha meta en cada una de estas entidades. Por tal motivo el conocimiento adecuado que posea el médico tratante sobre cada uno de estos aspectos es un factor determinante que garantiza el tratamiento óptimo y buen pronóstico de los pacientes que están cursando con una crisis hipertensiva. Conclusión: Esta revisión actualizada brinda: (a) una descripción general de los diferentes tipos de crisis hipertensivas, haciendo énfasis en sus criterios diagnósticos, (b) información actualizada sobre los esquemas de manejo y los medicamentos utilizados en el tratamiento de la Hipertensión Arterial Severa y de la Urgencia Hipertensiva y (c) una descripción práctica y detallada de los distintos medicamentos hasta ahora disponibles para el tratamiento de las Emergencias Hipertensivas. Luego en el siguiente número de esta revista se les proporcionará una revisión amplia y actualizada de los diferentes tipos de Emergencias Hipertensivas con relación al órgano blanco involucrado y sus respectivos esquemas de manejo...

Continuous "Over and Over" Suture for Tricuspid Ring Annuloplasty

BACKGROUND: A ring implantation in the tricuspid annulus requires many interrupted mattress sutures for correction of tricuspid regurgitation (TR). In this study, tricuspid ring annuloplasty was performed by 2-0 polypropylene continuous suture instead of multiple interrupted 2-0 polyester mattress sutures, and the efficacy of the method was evaluated. MATERIALS AND METHODS: This study included 20 patients who underwent tricuspid ring annuloplasty by continuous suture between May 2009 and July 2010. Four of the patients had an isolated TR, and the rest had a left-sided cardiac lesion. The concomitant tricuspid annuloplasty was performed after the left-sided heart surgery was completed and a Duran flexible ring prosthesis was used. RESULTS: There was no perioperative mortality or conduction problem. More than a moderate degree of TR was improved to less than a mild degree after the procedure. After the ring annuloplasty, the right atrial volume decreased from 123.7+/-69.2 mL to 74.5+/-37.4 mL, and the mean right atrial pressure was lowered from 18.7+/-12.2 mmHg to 8.9+/-5.5 mmHg. CONCLUSION: The continuous "over and over" suture may be a useful procedure for fixing the ring to the annulus and making an intentional annular placation in performing tricuspid ring annuloplasty.

Masking of Pressure Overload in a Patient with Pulmonary Thromboembolism Accompanied by Atrial Septal Aneurysm / 전남의대학술지

A pulmonary thromboembolism (PTE) causes a dramatic pressure overload to the right heart. Previous case reports have shown that elevated right atrial pressure secondary to a PTE can cause right-to-left shunting in the presence of an atrial septal aneurysm (ASA). A 57-year-old female with diabetes, hypertension, and an old cerebral infarction was admitted to our hospital with acute PTE. Initial transthoracic echocardiography (TTE) showed an ASA swing from the right side to the left side, and right-to-left shunting was detected immediately in the agitated saline test. However, definite signs of pressure overload of the right heart were not detected in the TTE. This educational case shows that right-to-left shunting via a patent foramen ovale in the ASA can cause normal right atrial pressure, thus masking the pressure overload of the right heart in a patient with PTE.

Masking of Pressure Overload in a Patient with Pulmonary Thromboembolism Accompanied by Atrial Septal Aneurysm / 전남의대학술지

A pulmonary thromboembolism (PTE) causes a dramatic pressure overload to the right heart. Previous case reports have shown that elevated right atrial pressure secondary to a PTE can cause right-to-left shunting in the presence of an atrial septal aneurysm (ASA). A 57-year-old female with diabetes, hypertension, and an old cerebral infarction was admitted to our hospital with acute PTE. Initial transthoracic echocardiography (TTE) showed an ASA swing from the right side to the left side, and right-to-left shunting was detected immediately in the agitated saline test. However, definite signs of pressure overload of the right heart were not detected in the TTE. This educational case shows that right-to-left shunting via a patent foramen ovale in the ASA can cause normal right atrial pressure, thus masking the pressure overload of the right heart in a patient with PTE.

The Effect of Decreases in Left Ventricle Volume and Area During Ventricular Fibrillation on Resuscitation Outcomes

PURPOSE: Dynamic changes in the dimensions of the left ventricle (LV) during cardiac arrest might influence the efficacy of CPR. However, the relationship between change in LV dimensions during cardiac arrest and CPR hemodynamics and outcomes have not yet been addressed. In the present study, we investigated changes in left ventricular volume and area during prolonged, untreated ventricular fibrillation (VF); we related those change to coronary perfusion pressure (CPP) during CPR and resuscitation outcomes. METHODS: In 12 domestic male pigs weighing 40+/-3 kg, VF was electrically induced and left untreated for 15 min. CPR was performed for 5 min prior to defibrillation. CPR was continued until the return of spontaneous circulation (ROSC) or for a maximum of 15 minutes. Mean aortic pressure and right atrial pressures were measured and CPP was calculated. LV dimensions were continuously assessed by echocardiographic measurement during the 15 minutes of interval VF. RESULTS: Six animals were successfully resuscitated. During the 15 minute interval of VF, LV area and volume were reduced in all animals. In animals that were not resuscitated, LV dimensions were significantly lower than those in resuscitated animals (p<0.01). These differences were observed after 10 minutes of VF. The animals with greater reduction in LV dimension during VF achieved significantly lower CPP during CPR in contrast to animals with larger LVs during VF. CONCLUSION: Greater decreases in LV volume and area during cardiac arrest are associated with low CPP during CPR and poor resuscitation outcomes. LV dimensions prior to starting CPR might therefore modulate the effectiveness of resuscitation interventions.

A case of displaced pulmonary artery catheter into hepatic vein in mitral insufficiency patient: A case report / 대한마취과학회지

A 47-year-old woman was scheduled for mitral valvoplasty. Before induction of anesthesia, a pulmonary artery catheter (PAC) was placed via right internal jugular vein. Central venous pressure or right atrial pressure was traced until about 60 cm of PAC insertion and right ventricular pressure curve appeared without arrhythmias. We withdrew and advanced the catheter several times, but pressure tracing showed the same pattern. And we could not obtain the pulmonary artery pressure. We decided to leave the PAC in the right ventricle. No ventricular arrhythmia was detected. Postoperative chest x-ray revealed that PAC traveled through inferior vena cava and looped in the hepatic vein with the tip of the catheter in the right ventricle. Under fluoroscopic guidance, PAC was inserted to the pulmonary artery. No sign of hepatic vein obstruction was detected.

Effect of Left Atrial Decompression by Percutaneous Balloon Mitral Commissurotomy on the Atrial Electrophysiologic Properties

BACKGROUND AND OBJECTIVES: Atrial dilatation contributes to the inducibility of atrial fibrillation (AF) by changing the atrial electrophysiological properties. There has been no report regarding the electrophysiologic data of the left atrium (LA), where the most significant electrophysiological impact might be expected to occur in case of mitral stenosis (MS). We investigated the electrophysiological changes after reduction of the LA pressure in patients who were undergoing percutaneous balloon mitral commissurotomy (PBMC). SUBJECTS AND METHODS: We studied 26 patients (21 women, age range: 50+/-12 years) with MS, including 7 sinus rhythm (SR) patients. The effective refractory period (ERP), the monophasic action potential duration (MAPD90), and the conduction time (CT) were measured simultaneously in both atriums at 600, 500, 400 and 300 ms of drive cycle length (DCL). The restitution slope (RS) was also calculated by the S1S2 method. The atrial fibrillation cycle length (AFCL) and dominant frequency (DF) for the cases of AF were also calculated. All the measurements were repeated after PBMC. RESULTS: The mean LA pressure was significantly reduced after PBMC in both the AF and SR patients (17.0+/-5.5 mmHg vs 10.4+/-4.0 mmHg, respectively, p<0.01, 17.6+/-7.1 mmHg vs 9.0+/-2.8 mmHg, respectively, p<0.01). A significant increase of ERP was observed in the LA after PBMC, but not in the right atrium (RA). The increase of MAPD90 after PBMC was significant in the LA at all the tested DCLs, but not in the RA. The CT was also significantly decreased at all the tested DCLs after PBMC. The RS of the LA decreased from 1.71+/-0.82 to 0.76+/-0.33 after PBMC (p=0.056). However, no significant changes of the AFCL or DF after PBMC were observed in the AF group. CONCLUSION: Chronic atrial stretch altered the atrial electrophysiological milieu, especially in the LA, which was partially reversible in SR patients. This result supports the theoretical basis for the beneficial effects of early intervention to reduce the atrial pressure overload in MS patients.

B-type Natriuretic Peptide (BNP) as a Predictive Marker after Heart Transplantation / 대한흉부외과학회지

BACKGROUND: B-type natriuretic peptide (BNP) is a cardiac hormone that is primarily synthesized by the ventricular cardiac myocytes. Increased plasma BNP levels have been observed in patients suffering with congestive heart failure, ventricular hypertrophy and myocaridits and also during heart transplantation rejection. We investigated the serum BNP level as a predictive marker for rejection after heart transplantation. MATERIAL AND METHOD: To test the usefulness of measuring the BNP level in cardiac transplant patients, consecutive blood samplings for BNP, right ventricular endomyocardial biopsies, hemodynamic measurements and transthoracic echocardiogram were all done in 10 such patients between January 2004 and August 2005 at the Department of Thoracic and Cardiovascular Surgery in Asan Medical Center. Two groups were identified with using the median value: the low BNP group (n=28, BNP: 290 pg/mL). We retrospectively analyzed rejection, the ejection fraction, tricuspid regurgitation, left ventricular hypertrophy, the pulmonary capillary wedge pressure and the right atrial pressure between the 2 groups. RESULT: There were no differences in age, gender, rejection, the ejection fraction, tricuspid regurgitation, left ventricular hypertrophy and the right atrial pressure between the 2 groups (p>0.05). However, a higher pulmonary capillary wedge pressure and a higher mean pulmonary atrial pressure were observed in the high BNP group (p12 mmHg) with a sensitivity of 83.3% and a specificity of 91.1% (AUC: 0.900+/-0.045, p<0.001). CONCLUSION: The BNP level after heart transplantation does not show any significant correlation with rejection, yet it might be a predictive marker of ventricular diastolic dysfunction.

Comparison of Long-Term(Over 10 Years) Outcome of Percutaneous Mitral Balloon Valvuloplotomy between Moderate and Severe Mitral Stenosis

BACKGROUND AND OBJECTIVES: Percutaneous mitral balloon valvuloplotomy (PMV) is a safe and effective procedure for the treatment of mitral stenosis (MS); however, its long-term results according to the severity of MS remain unknown. The aim of this study was to compare the long-term results of PMV between moderate and severe MS. SUBJECTS AND METHODS: The immediate and long-term outcomes of 786 patients (198 male, mean age; 43 years) who underwent PMV at a single referral center, between 1988 and 2000, were analyzed. The clinical and echocardiographic data were compared between moderate (n=357) and severe MS (n=429). RESULTS: Optimal results were gained in 618 (79%) patients, including 80 and 76% moderate and severe MS cases, respectively (p=0.13). Acute complications occurred in 85 patients (11%), but without significant difference between the two groups. After a mean follow-up period of 94 months (range, 6 to 210 month), the 5 year event-free survival rate was better in moderate (88%) than in severe MS (79%), but the 10 year event-free survival rates were no different (65% vs. 65%). Independent predictors for better prognosis were a lower echo score ( or =1.7 cm2)(p=0.002, HR=0.65), less mitral regurgitation (