ABSTRACT
Aortic stenosis (AS) leads to pulmonary hypertension (PH) and right ventricle (RV) failure. Our goal was to describe mortality related to postoperative complications in PH patients undergoing transcatheter aortic valve replacement (TAVR). Ninety-three TAVR patients were analyzed (controls, sPAP < 50 mmHg; cases, sPAP ≥ 50 mmHg). Significant findings in cases included increased mortality (365 days), post-TAVR atrioventricular block (AVB) and acute kidney injury (AKI), and increased mean length of stay (LOS). This novel study highlights complications of PH as independent risk factors for death and significant morbidity post TAVR. Optimization of preoperative volume status and RV afterload reduction, while addressing AVB and AKI, may play a vital role in reducing mortality and LOS.
ABSTRACT
PURPOSE: Right ventricular (RV) dysfunction is an independent predictor of morbidity and mortality in acute respiratory distress syndrome (ARDS). Our goal was to describe morphologic changes in the RV using objective measures on transthoracic echocardiography (TTE) that occur following ARDS. METHODS: We retrospectively measured changes in the following RV parameters from a pre-ARDS TTE to an ARDS TTE: tricuspid annular plane systolic excursion (TAPSE), myocardial performance index (MPI), fractional area change (FAC), systolic pulmonary artery pressure (SPAP), peak tricuspid regurgitant (TR) velocity, and septal shift. RESULTS: Over 24 months, 14 patients met inclusion/exclusion criteria. Mean TAPSE decreased from 22.4 mm pre-ARDS to 16.3 mm during ARDS, P<.001. Mean MPI increased from 0.19 to 0.38, P=.001. Mean FAC decreased from 60.8% to 41.2%, P=.003. Peak TR velocity increased from 2.67 m/s pre-ARDS to 3.31 m/s during ARDS, P=.02. SPAP and septal shift demonstrated trends but not statistically different between pre-ARDS and ARDS states. TAPSE correlated with ARDS severity (PaO2 /FiO2 ratios), P=.004, and was lower among 30-day nonsurvivors compared with survivors, P=.002. CONCLUSIONS: Mild RV dysfunction is common after ARDS onset. RV morphologic changes coupled with dysfunction can be detected noninvasively through TTE changes with TAPSE, MPI, and FAC. Mild RV dysfunction by TAPSE is associated with ARDS severity and mortality.
Subject(s)
Early Diagnosis , Echocardiography/methods , Heart Ventricles/diagnostic imaging , Respiratory Distress Syndrome/complications , Female , Heart Ventricles/physiopathology , Humans , Male , Middle Aged , Respiratory Distress Syndrome/physiopathology , Retrospective Studies , Stroke Volume , Systole , Ventricular Dysfunction, Right/etiology , Ventricular Dysfunction, Right/physiopathologyABSTRACT
BACKGROUND: To evaluate postdiscovery outcome of coronary artery fistulae (CAF). CAF treatment sequelae and risk factors for coronary thrombosis have not been adequately evaluated. METHODS: Outcome on follow-up of 16 patients with CAF was reviewed. Risk factors for adverse coronary events were assessed based on type, size, and treatment of CAF. RESULTS: Median age was 10 years (0.01-56). Seven patients had large, four medium, and five small sizes CAF. Eight had proximal and 8 distal type CAF. There were 7 in the intervention group (IG) and 9 in nonintervention (NIG). In the IG, 1 had myocardial infarction (MI) <24 hr with distal thrombosis following large distal type CAF closure. Follow-up angiograms in 6 pts showed; decrease in conduit coronary artery size towards normal in 4, 1 had discrete intimal stenosis, persistent coronary dilatation in 1, thrombosis of residual proximal fistula segment without MI in 2, evidence of revascularization in 2 and neovascularization in 1 patient. In the NIG, 6 of the 9 pts available for follow-up were asymptomatic. Angiogram available in 1 patient showed persistent coronary dilatation with partial closure. CONCLUSION: Post-CAF treatment sequelae include thrombosis and MI, revascularization, persistent coronary dilatation, remodeling, and decrease in conduit coronary artery size towards normal. The large size distal type of CAF may be at highest risk for coronary thrombosis post closure. The optimal treatment approach to various morphologies of CAF at various ages remains to be determined.
