Identifying Recipients Who are at High Risk of Receiving a Donor Heart with Undersized Right Ventricle

Background and Objectives: bedside cardiac ultrasound is a widely adopted method in Emergency Departments (ED) for extending physical examination and refining clinical diagnosis. However, in the setting of hemodynamically-stable pulmonary embolism, the diagnostic role of echocardiography is still the subject of debate. In light of its high specificity and low sensitivity, some authors suggest that echocardiographic signs of right ventricle overload could be used to rule-in pulmonary embolism. In this study, we aimed to clarify the diagnostic role of echocardiographic signs of right ventricle overload in the setting of hemodynamically-stable pulmonary embolism in the ED. Materials and Methods: we performed a systematic review of literature in PubMed, Web of Science and Cochrane databases, considering the echocardiographic signs for the diagnosis of pulmonary embolism in the ED. Studies considering unstable or shocked patients were excluded. Papers enrolling hemodynamically stable subjects were selected. We performed a diagnostic test accuracy meta-analysis for each sign, and then performed a critical evaluation according to pretest probability, assessed with Wells’ score for pulmonary embolism. Results: 10 studies were finally included. We observed a good specificity and a low sensitivity of each echocardiographic sign of right ventricle overload. However, once stratified by the Wells’ score, the post-test probability only increased among high-risk patients. Conclusions: signs of echocardiographic right ventricle overload should not be used to modify the clinical behavior in low- and intermediate- risk patients according to Wells’ score classification. Among high-risk patients, however, echocardiographic signs could help a physician in detecting patients with the highest probability of pulmonary embolism, necessitating a confirmation by computed tomography with pulmonary angiography. However, a focused cardiac and thoracic ultrasound investigation is useful for the differential diagnosis of dyspnea and chest pain in the ED.

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Coronary steal phenomenon following right ventricle decompression and revascularization of atretic left coronary ostium - case report

10.21203/rs.3.rs-481291/v1 ◽

2021 ◽

Author(s):

Jacek Pająk ◽

Maciej Aleksander Karolczak ◽

Michał Buczyński ◽

Wojciech Mądry ◽

Darren James Grégoire ◽

...

Keyword(s):

Case Report ◽

High Risk ◽

Myocardial Ischemia ◽

Right Ventricle ◽

Ventricular Pressure ◽

Coronary Ostium ◽

Hybrid Strategy ◽

Steal Phenomenon ◽

Heart Defect ◽

Coronary Steal

Abstract BackgroundCoronary steal phenomenon and myocardial ischemia is a complication following decompression of a hypertensive right ventricle in patients with left coronary-cameral fistulae.Case presentationWe present a 12-year-old girl with a complex heart defect successfully operated on using a hybrid surgical-interventional approach to decompress the ventricle, embolize the fistula and reconstruct the atretic left coronary ostium.ConclusionsA novel hybrid strategy is the best solution for coronary-cameral fistulas reliant on high ventricular pressure at high risk for coronary steal phenomenon.

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Abstract 636: Conduction Delay in Right Ventricle as a Marker for Identifying High-Risk Patients in Brugada Syndrome

Circulation ◽

10.1161/circ.118.suppl_18.s_590-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Atsushi Doi ◽

Masahiko Takagi ◽

Keiko Maeda ◽

Hiroaki Tatsumi ◽

Kenji Shimeno ◽

...

Keyword(s):

High Risk ◽

Risk Stratification ◽

Right Ventricle ◽

Right Ventricular ◽

Brugada Syndrome ◽

Challenge Test ◽

Conduction Delay ◽

High Risk Patients ◽

Coupling Interval ◽

Risk Patients

BACKGROUND In Brugada syndrome (BS), abnormal conduction delay in right ventricle has been reported. However, the meaning of the conduction delay for risk stratification in BS is still unclear. OBJECTIVES To evaluate the significance of conduction delay in patients with BS as a marker for risk stratification. METHODS Twenty-four patients with BS in whom pilsicainide challenge test was performed (documented VF: N = 7, syncope: N = 7, and asymptomatic: N = 10) were paced from right ventricular apex (RVA), using a basic cycle length of 500ms (8 beats) and a single extrastimulus. A 2.5-French 16-electrode catheter was positioned into the coronary sinus and the great cardiac vein to record intracardiac electrograms on the epicardial sites in right ventricular outflow tract area (RVOT) and lateral left ventricle (l-LV). We measured the conduction time from the stimulus artifact at RVA to the epicardial ventricular electrogram at RVOT or l-LV. The conduction delay between RVA and RVOT (CD-RV) or between RVA and l-LV (CD-LV) was defined as the time interval between the ventricular response at RVOT (RV-V1V2) or at l-LV (LV-V1V2) and the stimulus coupling interval (S1S2) at RVA, respectively (CD-RV; RV-V1V2 minus S1S2, and CD-LV; LV-V1V2 minus S1S2). We also measured 12-lead ECG parameters at baseline and after pilsicainide challenge test, and evaluated the differences of the ECG parameters before and after pilsicainide challenge test. RESULTS Max CD-RV was significantly larger than max CD-LV in all patients (28±9 vs 19±7 ms, p<0.05). Max CD-RV in patients with documented VF was significantly larger than that in patients without (35±10 vs 25±7 ms, p<0.05). However, there was no significant difference in max CD-RV and CD-LV between patients with induced VF and those without (30±9 and 20±5 vs 26±7 and 21±7 ms, p=NS). There was significant positive correlation between max CD-RV and the differences in QRS duration in leads V1, V2, and V6 after pilsicainide administration (r = 0.51, 0.53, and 0.48, respectively, p<0.05). CONCLUSIONS The conduction delay in right ventricle (RV) was a useful marker for identifying high-risk patients in BS. The conduction delay at RV may be related to depolarization abnormality due to sodium channel dysfunction in BS.

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HIGH RISK DONOR HEART TRANSPLANTATION IS NOT ASSOCIATED WITH WORSE GRAFT SURVIVAL

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(15)60786-0 ◽

2015 ◽

Vol 65 (10) ◽

pp. A786

Author(s):

Sachin Kumar ◽

Sadeer G. Al-Kindi ◽

Mobolaji Ige ◽

Chantal Elamm ◽

Mahazarin Ginwalla ◽

...

Keyword(s):

High Risk ◽

Heart Transplantation ◽

Graft Survival ◽

Donor Heart

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Conduction Delay in Right Ventricle as a Marker for Identifying High-Risk Patients With Brugada Syndrome

Journal of Cardiovascular Electrophysiology ◽

10.1111/j.1540-8167.2009.01677.x ◽

2009 ◽

Vol 21 (6) ◽

pp. 688-696 ◽

Cited By ~ 9

Author(s):

ATSUSHI DOI ◽

MASAHIKO TAKAGI ◽

KEIKO MAEDA ◽

HIROAKI TATSUMI ◽

KENJI SHIMENO ◽

...

Keyword(s):

High Risk ◽

Right Ventricle ◽

Brugada Syndrome ◽

Conduction Delay ◽

High Risk Patients ◽

Risk Patients

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Pulmonary embolism: old problem, new approaches to treatment

Clinical Medicine (Russian Journal) ◽

10.30629/0023-2149-2020-98-8-606-611 ◽

2021 ◽

Vol 98 (8) ◽

pp. 606-611

Author(s):

V. P. Tyurin ◽

A. G. Pronin

Keyword(s):

Pulmonary Embolism ◽

High Risk ◽

Thrombolytic Therapy ◽

Right Ventricle ◽

Anticoagulant Therapy ◽

Interventricular Septum ◽

Early Death ◽

Risk Of Death ◽

Arterial Blood ◽

The Right

There is no indication when to perform thrombolytic or anticoagulant therapy in patients with moderate-high risk of early death in accordance with the stratification of the European society of cardiology. The purpose of the study: to establish clinical, laboratory, and instrumental criteria for the choice of therapy volume optimization in patients with moderate-high risk of early death. Material and methods. The study included 154 patients with pulmonary embolism (PE) of high, moderate-high, moderate-low risk of death. An analysis was performed to determine the most significant indications for thrombolytic therapy in PE. Results. The presence of established «undoubted» criteria indicates the need for thrombolytic therapy. These include an increase in the size of the right ventricle compared to the left, paradoxical movement of the interventricular septum, hypokinesia of the right ventricle on еchocardiography. «Questionable» criteria were also identified: more than 50 mm Hg increased pulmonary artery pressure, more than 20 mm dilation of the inferior Vena cava, more than 3 cm dilatation of the right ventricle on еchocardiography, deep SIQIII on ECG, syncopal states in the anamnesis, increased NT-proBNP values, less than 90% arterial blood saturation. Thrombolytic therapy is indicated for patients with a combination of 2 or more of these criteria, in other cases anticoagulant therapy is prescribed. Conclusion. The use of established criteria makes it possible to differentiate treatment of patients with moderate-high risk of early death and reduce the likelihood of developing chronic post-thromboembolic pulmonary hypertension by 2.9 times.

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