ABSTRACT
BACKGROUND: Heart failure is characterised as a strong risk factor for systemic failure after cardiac surgery. However, the impact has never been substantiated. METHODS: Patients with heart failure (n = 48) - scheduled for elective ventricular reconstruction or external constraint device-were compared with a one-to-one matched control group of patients without heart failure undergoing cardiac surgery between 2006 and 2009. RESULTS: As expected, patients with heart failure more frequently experienced complications definitely related to pump failure (p = 0.01). However, complications not related to their pump failure were also more often observed, such as prolonged mechanical ventilation, sepsis and vasoplegia (p = 0.01). Overall, organ dysfunction-circulatory, renal, and pulmonary failure-was often observed in heart failure patients, contributing to a prolonged stay in the intensive care unit (p < 0.001) as well as in hospital (p = 0.01). CONCLUSION: The adverse postoperative course in patients with heart failure is not only directly related to circulatory failure, but merely reflects a systemic dysregulation. Our findings suggest that heart failure impacts outcome and should therefore be included in prevailing risk classification systems. Offensive perioperative treatment strategies, focused on the main complications in patients with heart failure, will lead to improved results after cardiac surgery.
ABSTRACT
Transesophageal echocardiography (TEE) is a valuable technique to assess mitral valve anatomy and the mechanism of mitral regurgitation (MR). We present the case of a 35-year-old woman with severe MR due to restrictive motion of the posterior mitral leaflet, who was referred for mitral annuloplasty. Under physiologic circumstances, a severe (grade 3+) MR was present, whereas in the operating room during general anesthesia, the MR had disappeared almost completely. The downgrading of MR due to general anesthesia and the associated mechanisms of this phenomenon are discussed in this case.
Subject(s)
Echocardiography, Transesophageal , Hemodynamics/physiology , Mitral Valve Insufficiency/diagnostic imaging , Adult , Anesthetics, General/pharmacology , Blood Flow Velocity , Female , Hemodynamics/drug effects , Humans , Mitral Valve/anatomy & histology , Mitral Valve Insufficiency/physiopathology , Mitral Valve Insufficiency/surgeryABSTRACT
BACKGROUND: The quantification of transvalvular blood flow through the mitral valve (MV) and regurgitant flow in particular is difficult with echocardiography, which is the method of choice to diagnose patients selected for valve repair or replacement. With magnetic resonance imaging, information on the intraventricular blood flow can be obtained. Several scanning techniques have attempted to assess the regurgitant flow. These techniques either do not directly assess the complete flow through the MV, or they do not measure the flow at the location of the valve. AIM: To investigate the accuracy of a novel method using three-directional velocity-encoded MRI to acquire the transvalvular blood flow directly from the intraventricular blood flow field, also representing the regurgitant flow during systole. METHODS: Ten volunteers without cardiac valvular disease were recruited. The transvalvular MV flow volume was measured with three-directional velocity-encoded MRI (3-dir MV flow). RESULTS: The transvalvular flow measurements correlate very well with the flow measured in the aorta (rp=0.92, p<0.01). The small differences (mean -5±7 ml) are insignificant (p=0.06) and demonstrate the high accuracy of the new method. Intra- and inter-observer studies showed non-significant mean differences of 0.9±5.1 ml and 1.3±5.6 ml, respectively, thereby proving the high reproducibility. CONCLUSION: Three-directional velocity-encoded MRI is a patient-friendly and easy-to-use method suitable for quantifying the regurgitant MV flow in clinical practice.
