Right atrial-left ventricular relationships in tricuspid atresia: Position of the presumed site of the atretic valve as determined by transillumination

Myxomas comprise 50% of all benign cardiac tumors in adults, with the right atrium as their second most frequent site of origin. Surgical resection is the only effective therapeutic option for patients with these tumors. The association between right atrial myxomas and severe left ventricular systolic dysfunction is extremely rare and makes treatment even more challenging. This was the case for our patient, a 47-year-old male with a right atrial mass and a severely impaired left ventricular function, with a 20% ejection fraction. Global enlargement of the heart was also noted, with moderate right ventricular dysfunction. The tumor was successfully excised using the on-pump beating heart technique, with an immediate postoperative improvement of the left ventricular ejection fraction to 35%. The technique proved useful, with no increased risk to the patient.

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External assessment of the EUROMACS right-sided heart failure risk score

Scientific Reports ◽

10.1038/s41598-021-94792-3 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Hirak Shah ◽

Thomas Murray ◽

Jessica Schultz ◽

Ranjit John ◽

Cindy M. Martin ◽

...

Keyword(s):

Heart Failure ◽

Right Ventricular ◽

Risk Score ◽

Pressure Ratio ◽

Area Under The Curve ◽

Left Ventricular ◽

Right Atrial ◽

Risk Scores ◽

External Assessment ◽

Failure Risk

AbstractThe EUROMACS Right-Sided Heart Failure Risk Score was developed to predict right ventricular failure (RVF) after left ventricular assist device (LVAD) placement. The predictive ability of the EUROMACS score has not been tested in other cohorts. We performed a single center analysis of a continuous-flow (CF) LVAD cohort (n = 254) where we calculated EUROMACS risk scores and assessed for right ventricular heart failure after LVAD implantation. Thirty-nine percent of patients (100/254) had post-operative RVF, of which 9% (23/254) required prolonged inotropic support and 5% (12/254) required RVAD placement. For patients who developed RVF after LVAD implantation, there was a 45% increase in the hazards of death on LVAD support (HR 1.45, 95% CI 0.98–2.2, p = 0.066). Two variables in the EUROMACS score (Hemoglobin and Right Atrial Pressure to Pulmonary Capillary Wedge Pressure ratio) were not predictive of RVF in our cohort. Overall, the EUROMACS score had poor external discrimination in our cohort with area under the curve of 58% (95% CI 52–66%). Further work is necessary to enhance our ability to predict RVF after LVAD implantation.

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The effects of doxorubicin on left and right atrial mechanics in patients with lymphoma

European Heart Journal ◽

10.1093/ehjci/ehaa946.3284 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

S Vahabi ◽

E Kharati-Koopaei ◽

M Stewart ◽

H Hancock ◽

M Norouzi ◽

...

Keyword(s):

Strain Rate ◽

Left Atrial ◽

Left Ventricular ◽

Right Atrial ◽

Lv Function ◽

Compensatory Mechanism ◽

Research Association ◽

Anthracycline Cardiotoxicity ◽

Diastolic Strain Rate ◽

Significant Change

Abstract Background Despite the associated dose-dependent cardiotoxicity, anthracyclines continue to form the backbone of modern chemotherapy regimens. Speckle Tracking Echocardiography (STE) has been a popular method of quantifying cardiac function but most studies have focused on left ventricular function. Research into the effects of anthracyclines on left atrial (LA) and right atrial (RA) function continues to be neglected. Purpose To investigate the effects of doxorubicin, a commonly used anthracycline, on both the LA and RA systolic and diastolic strain and strain-rate parameters in two groups of patients with lymphoma: Group 1 (G1) with a conventional drop in ejection fraction (EF <53%), and Group 2 (G2) without. Methods We retrospectively studied 46 patients treated for lymphoma between 2015 and 2018; G1 (n=12) and G2 (n=34). Echocardiograms performed at baseline (T0), mid-chemotherapy (T1), and post-chemotherapy (T2), were analysed by using offline vendor-independent software (TomTec, 2D Cardiac Performance Analysis). Using 2D STE, LA and RA reservoir, conduit and contractile strains, systolic and diastolic strain-rates were measured. Multi-level longitudinal model was used for statistical analysis.This study was ethically approved by the Health Research Association (REC Reference 18/SS/0139). Results Median age was 64 years (IQR 51–74 years) in G1, and 65 years (IQR 57–73 years) in G2. In G1, there was no significant change in LA reservoir strain with time, however a significant decline with an average mean difference of −7.52 was seen between T0 to T2 (p=0.016) in G2. LA conduit strain did not significantly change in either group with incremental doses of doxorubicin. However, LA contraction strain was seen to significantly increase in G1 between T1 to T2 (p=0.045) with an average change of 7.23. LA peak systolic strain rate, and late diastolic strain rate did not show any significant change with time in both groups. Yet, a significant increase was seen in LA early diastolic strain rate between T0 to T2 (p=0.017) in G1 but not G2. No significant changes were seen in the RA strain parameters in both groups. Conclusion In patient with a reduction in LV function, a significant change was noted in the left atrial contraction strain and early diastolic strain rate with incremental doses of doxorubicin. These changes shows the close relationship between the LA and LV, and the importance of LA in providing a compensatory mechanism for a decline in LV function secondary to anthracycline cardiotoxicity. Funding Acknowledgement Type of funding source: None

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Transcatheter closure of post-operative type 1 Gerbode defect by Amplatzer Duct Occluder 2

Cardiology in the Young ◽

10.1017/s1047951121002432 ◽

2021 ◽

pp. 1-3

Author(s):

Ahmet Vedat Kavurt ◽

İbrahim Ece ◽

Denizhan Bağrul

Keyword(s):

Transcatheter Closure ◽

Left Ventricular ◽

Amplatzer Vascular Plug ◽

Right Atrial ◽

Amplatzer Duct Occluder ◽

Vascular Plug ◽

Gerbode Defect ◽

Amplatzer Vascular Plug Ii

Abstract Acquired and congenital left ventricular to right atrial communication is rare, but nowadays, the frequency of the iatrogenic subgroup is increasing. Successful transcatheter closure of these defects with different devices has been reported. Herein, we presented successful closure of left ventricular to right atrial communication with Amplatzer Duct Occluder 2 after attempting to close with a failed Amplatzer Vascular Plug II device in a 7-year-old girl. This report supports that transcatheter closure of iatrogenic Gerbode defect with Amplatzer Duct Occluder 2 device is safe and effective.

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Right atrial vegetation in left ventricular-right atrial communication

Clinical Cardiology ◽

10.1002/clc.4960100114 ◽

1987 ◽

Vol 10 (1) ◽

pp. 61-62 ◽

Cited By ~ 3

Author(s):

T. Murata ◽

M. Fujino ◽

J. Sasaki ◽

M. Takii ◽

K. Arakawa

Keyword(s):

Left Ventricular ◽

Right Atrial

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Respiratory-related heart rate variability in progressive experimental heart failure

AJP Heart and Circulatory Physiology ◽

10.1152/ajpheart.01129.2004 ◽

2005 ◽

Vol 289 (4) ◽

pp. H1729-H1735 ◽

Cited By ~ 27

Author(s):

Sophie Motte ◽

Myrielle Mathieu ◽

Serge Brimioulle ◽

Anne Pensis ◽

Lynn Ray ◽

...

Keyword(s):

Heart Failure ◽

Heart Rate ◽

Heart Rate Variability ◽

Spectral Analysis ◽

Left Ventricular ◽

Right Atrial ◽

Left Ventricular Ejection ◽

Total Power ◽

Progressive Heart Failure ◽

Atrial Natriuretic

Heart failure is associated with autonomic imbalance, and this can be evaluated by a spectral analysis of heart rate variability. However, the time course of low-frequency (LF) and high-frequency (HF) heart rate variability changes, and their functional correlates during progression of the disease are not exactly known. Progressive heart failure was induced in 16 beagle dogs over a 7-wk period by rapid ventricular pacing. Spectral analysis of heart rate variability and respiration, echocardiography, hemodynamic measurements, plasma atrial natriuretic factor, and norepinephrine was obtained at baseline and every week, 30 min after pacing interruption. Progressive heart failure increased heart rate (from 91 ± 4 to 136 ± 5 beats/min; P < 0.001) and decreased absolute and normalized (percentage of total power) HF variability from week 1 and 2, respectively ( P < 0.01). Absolute LF variability did not change during the study until it disappeared in two dogs at week 7 ( P < 0.05). Normalized LF variability increased in moderate heart failure ( P < 0.01), leading to an increased LF-to-HF ratio ( P < 0.05), but decreased in severe heart failure ( P < 0.044; week 7 vs. week 5). Stepwise regression analysis revealed that among heart rate variables, absolute HF variability was closely associated with wedge pressure, right atrial and pulmonary arterial pressure, left ventricular ejection fraction and volume, ratio of maximal velocity of early (E) and atrial (A) mitral flow waves, left atrial diameter, plasma norepinephrine, and atrial natriuretic peptide (0.45 < r < 0.65, all P < 0.001). In tachycardia-induced heart failure, absolute HF heart rate variability is a more reliable indicator of cardiac dysfunction and neurohumoral activation than LF heart rate variability.

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