Peripartum cardiomyopathy [a literature review]

Heart failure [HF] is a serious and growing public health concern, whichhas many causes. Pregnancy is a critical condition with significanthemodynamic and immunologic changes. Peripartum cardiomyopathy[PPCM] is a disease of unknown cause in which left ventricular [LV]dysfunction occurs during the last trimester of pregnancy or the earlypuerperium. PPCM is known to be the most common cardiovascularcause of severe complications in pregnancy. Risk factors for peripartumcardiomyopathy include advanced maternal age, twin pregnancy,smoking, pregnancy-related hypertension and preeclampsia, multiparity,African descent, and long-term tocolysis. Oxidative stress and someinflammatory markers have been diagnosed in PPCM pathophysiology.Recent observations have suggested that bromocriptine might favorrecovery of LV systolic function in patients with PPCM. Patientsdeveloped peripartumcardiomiopathy treated with bromocriptine showedsignificantly improved LV ejection fraction and heart failure symptoms.This article tries to have a short review on this clinical scenario

Congenital aortocaval fistula from right subclavian artery to superior vena cava in an adult with tetralogy of fallot

Congenital aortocaval fistula in association with complex congenital heart disease has never been described before. We represent an adult with tetralogy of fallot and an undiagnosed subclavian artery to superior vena cava fistula in previous catheterisms. He underwent surgical correction, successfully. After 8 months post operation he was doing well with improved functional capacity and no cyanosis

Liver function tests and uric acid serum levels in relation to hemodynamic profile: a comparison between heart failure and pulmonary arterial hypertension patients

Systemic venous congestion has been considered the main cause of liver dysfunction in heart failure patients. In this study, we assessed the relation of liver function tests to hemodynamic profile in patients with systolic heart failure [SHF] and primary pulmonary arterial hypertension [PAH]. Fifty patients with left ventricular ejection fraction < 35% and 27 patients with mean PAH> 25 mmHg were enrolled. Hemodynamic indices, including PAP, right atrial and ventricular pressures [RAP and RVP], pulmonary capillary wedge pressure [PCWP], and cardiac simultaneously. Fifty age- and sex-matched normal controls were also studied. CO was significantly lower in the HF group [P= 0.006]. Multivariate analysis showed a significant correlation between total bilirubin level and mean PAP [R=0.04, P=0.004], RAP [R=0.33, P<0.03], RVP [R=0.43, P<0.004], PCWP [R=0.36,P<0.01], and direct bilirubin with mean PAP [R=0.01, P=0.02], RVP[R=0.33, P<0.03], PCWP[R=0.32, P<0.03], and CI [R=0.33, P<0.01]. In the PAH group, such correlations were mostly absent. Systemic venous congestion, more prominent in PAH, might not play the main role in deteriorating liver function. Further studies are needed to determine whether hepatic blood flow, which is significantly decreased in SHF, is a more important factor

Incidental finding of Cor triatriatum sinistrum in a middle-aged man candidated for coronary bypass grafting [with three-D imaging]

Cor triatriatum sinistrum is a rare congenital cardiac malformation, accounting for about 0.1-0.4% of all congenital heart diseases and characterized by the presence of a fibromuscular membrane that subdivides the left atrium into two chambers in the classical form. While classic cor triatriatum in most patients can be observed during the neonatal period or early infancy, it is very rare in adults. We herein present an incidental finding of cor triatriatum sinistrum in a middle-aged man with coronary artery disease scheduled for coronary artery bypass graft surgery. The patient was admitted for exertional dyspnea and chest pain of a three-month duration. He had a past medical history of mild hyperlipidemia and mild hypertension. Transthoracic two-D echocardiography [TTE] demonstrated a visible presence of a membranous band in the mid portion of the left atrium with obvious obstruction by color and Doppler flow measurements, confirmed by three-D echocardiography. Selective coronary angiography also revealed a severe ostioproximal stenosis of the left anterior descending artery of up to 99%. On-pump coronary artery bypass grafting was performed without complications, during which the anastomosis of the left internal mammary artery to the left anterior descending artery and the removal of the membrane were done

Relation Between Capillary Wedge Pressure Measured by Echocardiography Through Tissue Doppler Imaging [TDI] Method and Catheterism in Patients with Mitral Valve Stenosis

Considering suggested formula in the references and PCWP measured by catheterism, in the present study the relation between pulmonary capillary wedge pressure [PCWP] measured the flow velocity of mitral valve and mitral annulus motion through tissue doppler imaging is evaluated. 52 cases of severe MS were admitted for Balloon Mitral Valvolotomy [BMV] are included in this study. Mean age was 35 +/- 5 years consisting of 40 females and 12 males. Valve area, Pulmonary artery systolic pressure [PAP], E [Maximum Velocity of mitral valve at the beginning of diastole] and Em [Maximum rate of mitral annular motion at the beginning of diastole which is recorded through septal or lateral wall cumulus site] velocity and left atrial [LA] size were also measured by echocardiography and PCWP and PAP through catheterism. All patients had normal ejection fraction [EF] and coronary arteries; there was no other valvular diseases and shunts. There was a significant correlation between PAP in echocardiography and catheterism. Mean PAP was 53 +/- 19 mmHg in echocardiography and 53.9 +/- 17.8mmHg in catheterism. There wasn't any correlation between PCWP in echocardiography and catheterism [P=0.33] and also no relation between PCWP and mitral valve area [MVA] or LA size [P=0.2]. E/Em ratio increased in severe MS cases. E/Em ratio and suggested formula would overestimate the wedge pressure so echocardiography is not a reliable method for measuring PCWP in severe MS. Em velocity and E/Em ratio may be used for estimating MS severity