Long-term morphologic and hemodynamic evaluation of the left ventricle after cardiopulmonary bypass

Background and Purpose: Hemodynamic evaluation of moyamoya patients is crucial to decide the treatment strategy. Recently, CO2-triggered BOLD MRI has been shown to be a promising tool for the hemodynamic evaluation of moyamoya patients. However, the longitudinal reliability of this technique in follow-up examinations is unknown. This study aims to analyze longitudinal follow-up data of CO2-triggered BOLD MRI to prove the reliability of this technique for long-term control examinations in moyamoya patients. Methods: Longitudinal CO2 BOLD MRI follow-up examinations of moyamoya patients with and without surgical revascularization have been analyzed for all 6 vascular territories retrospectively. If revascularization was performed, any directly (by the disease or the bypass) or indirectly (due to change of collateral flow after revascularization) affected territory was excluded based on angiography findings (group 1). In patients without surgical revascularization between the MRI examinations, all territories were analyzed (group 2). Results: Eighteen moyamoya patients with 39 CO2 BOLD MRI examinations fulfilled the inclusion criteria. The median follow-up between the 2 examinations was 12 months (range 4–29 months). For 106 vascular territories analyzed in group 1, the intraclass correlation coefficient was 0.784, p < 0.001, and for group 2 (84 territories), it was 0.899, p < 0.001. Within the total follow-up duration of 140 patient months, none of the patients experienced a new stroke. Conclusions: CO2 BOLD MRI is a promising tool for mid- and long-term follow-up examinations of cerebral hemodynamics in moyamoya patients. Systematic prospective evaluation is required prior to making it a routine examination.

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Mid- to long-term follow-up of pulmonary valve replacement with BioIntegral injectable valve

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa337 ◽

2020 ◽

Author(s):

Simone Ghiselli ◽

Cristina Carro ◽

Nicola Uricchio ◽

Giuseppe Annoni ◽

Stefano M Marianeschi

Keyword(s):

Cardiopulmonary Bypass ◽

Right Ventricular ◽

Tetralogy Of Fallot ◽

Valve Replacement ◽

Pulmonary Valve ◽

Pulmonary Stenosis ◽

Pulmonary Regurgitation ◽

Pulmonary Valve Replacement

Abstract OBJECTIVES Chronic pulmonary valve (PV) regurgitation is a common late sequela after repair of congenital heart diseases like tetralogy of Fallot or pulmonary stenosis, leading to right ventricular dilatation and failure and increased late morbidity and mortality. Timely reoperation may lead to a complete right ventricular recovery. An injectable PV allows pulmonary valve replacement, with or without cardiopulmonary bypass, under direct observation, thereby minimizing the impact of surgery on cardiac function. The aim of this study was to evaluate the feasibility and mid- to long-term clinical outcomes with this device. METHODS From April 2007 to October 2019, a total of 85 symptomatic patients with severe pulmonary regurgitation or pulmonary stenosis underwent pulmonary valve replacement with an injectable stented pulmonary prosthesis. Data were collected from the international proctoring registry. Mean patient age was 26.7 years. The underlying diagnosis was repaired tetralogy of Fallot in 69.4% patients; moderate or severe pulmonary regurgitation was present in 72.9%. All patients had echocardiographic scans before the operation and during the follow-up period. A total of 54.1% patients also had preoperative/postoperative cardiac magnetic resonance imaging (MRI) or catheterization; 25.9% had off-pump implants. In 53% patients, pulmonary valve replacement was associated with the repair of other cardiac defects. RESULTS Minor postoperative complications were observed in 10.8% patients. The overall mortality rate was 2.3%; mortality after valve replacement was linked to a severe cardiac insufficiency and it was not related to a prosthesis failure; 1 prosthesis was explanted from 1 patient because of endocarditis, and 6% of patients developed PV stenosis; minor complications occurred in 4.8%. The mean follow-up period was 4.8 years (2 months–12.7 years); 42% of the patients were followed for more than 5 years. Follow-up echocardiography and cardiac MRI showed a significant reduction in RV size and low gradients across the PV. CONCLUSIONS An injectable PV may be implanted without cardiopulmonary bypass and in a hybrid operating theatre with minimal surgical impact. The bioprosthesis, available up to large sizes, has a low profile, laminar flow and no risk of coronary artery compression. Incidence of endocarditis is rare. The lack of a suture ring permits the implant of a relatively larger prosthesis, thereby avoiding a right ventricular outflow tract obstruction. This device permits future percutaneous valve-in-valve procedures, if needed. Results concerning durability are encouraging, and mid- to long-term haemodynamic performance is excellent.

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Long-term prognostic significance of three-dimensional echocardiographic parameters of the left ventricle and left atrium

European Journal of Echocardiography ◽

10.1093/ejechocard/jep198 ◽

2009 ◽

Vol 11 (3) ◽

pp. 250-256 ◽

Cited By ~ 51

Author(s):

S. Caselli ◽

E. Canali ◽

M. L. Foschi ◽

D. Santini ◽

E. Di Angelantonio ◽

...

Keyword(s):

Left Ventricle ◽

Left Atrium ◽

Prognostic Significance ◽

Three Dimensional ◽

Echocardiographic Parameters

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Effects of Simulated Clinical Cardiopulmonary Bypass and Cardioplegia on Mass of the Canine Left Ventricle

The Annals of Thoracic Surgery ◽

10.1016/s0003-4975(10)62553-2 ◽

1985 ◽

Vol 39 (2) ◽

pp. 139-148 ◽

Cited By ~ 10

Author(s):

Harry M. Rosenblum ◽

George B. Haasler ◽

William D. Spotnitz ◽

Harold L. Lazar ◽

Henry M. Spotnitz

Keyword(s):

Cardiopulmonary Bypass ◽

Left Ventricle

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Long-term outcome of off-pump palliation for hypoplastic left ventricle with glutaraldehyde fixation of the ductus arteriosus

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2014.06.071 ◽

2014 ◽

Vol 148 (4) ◽

pp. e200-e202

Author(s):

Ryan J. Williams ◽

Daniel S. Levi ◽

Jamil Aboulhosn ◽

Hillel Laks

Keyword(s):

Left Ventricle ◽

Ductus Arteriosus ◽

Glutaraldehyde Fixation ◽

Term Outcome ◽

Long Term Outcome ◽

Off Pump ◽

Hypoplastic Left Ventricle

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Angiographic long-term follow-up of primary apical ballooning of the left ventricle

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-005-9049-4 ◽

2006 ◽

Vol 22 (3-4) ◽

pp. 349-352 ◽

Cited By ~ 6

Author(s):

Massimo Giordan ◽

Gianluca Rigatelli ◽

Paolo Cardaioli ◽

Francesca Di Marco

Keyword(s):

Left Ventricle ◽

Apical Ballooning ◽

Long Term Follow Up

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Isolated left ventricular apical hypoplasia in a young child

BMJ Case Reports ◽

10.1136/bcr-2020-239297 ◽

2021 ◽

Vol 14 (1) ◽

pp. e239297

Author(s):

H Ravi Ramamurthy ◽

Onkar Auti ◽

Vimal Raj ◽

Kiran Viralam

Keyword(s):

Left Ventricle ◽

Left Ventricular ◽

Long Term Outcomes ◽

Wave Inversion ◽

St Segment ◽

Cardiac Apex ◽

The Right ◽

First Time ◽

Left Lead

A 16-month-old, healthy, asymptomatic male child presented with a diagnosis of dilated cardiomyopathy. Cardiovascular examination and chest radiograph were normal. ECG revealed sinus rhythm, and the augmented vector left lead showed raised ST segment, T wave inversion and q waves. Echocardiography showed a globular left ventricle with notched cardiac apex, abnormal echogenicity in the left ventricular apical myocardium, single papillary muscle and normal biventricular function. Cardiac MRI scan revealed a globular left ventricle with fibrofatty changes and retraction of the apex, the papillary muscles closely approximated, and the right ventricle wrapping around the apex of the left ventricle. This is described as isolated left ventricular apical hypoplasia. Diagnosis of this rare entity can be made by MRI, and it has been diagnosed largely in adults. The pathophysiology and long-term outcomes are unknown. We characterise the echocardiography findings of this rare anomaly in a child for the first time in the literature.

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Abstract 19408: Impact of Perioperative Liver Dysfunction on In-hospital Mortality and Long-term Survival in Infective Endocarditis Patients

Circulation ◽

10.1161/circ.132.suppl_3.19408 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Mahmoud Diab ◽

Christoph Sponholz ◽

Michael Bauer ◽

Andreas Kortgen ◽

Philipp Scheffel ◽

...

Keyword(s):

Cardiopulmonary Bypass ◽

Infective Endocarditis ◽

Hospital Mortality ◽

Organ Failure ◽

Liver Dysfunction ◽

Cox Regression ◽

Term Survival ◽

Long Term Survival ◽

Aureus Infection

Background: Infective endocarditis (IE) is a dangerous disease with high mortality (20-40%). A leading cause of death is multi-organ failure (MODS) with liver dysfunction (LD) as major contributor. Data on LD in IE patients are scarce. We assessed the impact of preoperative - and newly occurring LD on in-hospital mortality and long-term survival in IE patients. Methods: We retrospectively reviewed our database for surgery of left-sided endocarditis between 1/07 and 4/13. We used the hepatic Sepsis-related Organ Failure Assessment (hSOFA) score to assess the degree of LD. We performed Chi-Square, Cox regression and multivariate analyses. Results: The 308 patients had a mean age of 62 ±13.9. Preoperative LD (hSOFA > 0, Bilirubin > 32 μmol/L) was present in 1/4 (n=81) of patients and was associated with severely elevated in-hospital mortality (51.9% vs.14.6% without preoperative LD, p<0.001). Newly-occurring postoperative LD developed in another quarter (n=57 of 227 patients without LD) of patients and was associated with elevated in-hospital mortality (24.6% vs. 11.2%, p<0.001). Kaplan-Meyer 5-year survival was significantly better in patients without LD (51% vs. 19.9%, p<0.01). Survival curves were practically identical after the perioperative phase was over (Fig.). Quality of life in survivors was also the same. Cox regression analysis revealed preoperative LD as independent predictor of long-term survival (adjusted hazard ratio 1.695, 95% confidence interval 1.160-2.477, p=0.009) and duration of cardiopulmonary bypass (CPB) and S. aureus infection as independent predictors of newly-occurring postoperative LD. Conclusions: LD in patients with endocarditis is a significant independent risk factor for in-hospital mortality. A considerable fraction of patients develop LD perioperatively, which is associated with cardiopulmonary bypass-duration and S. aureus infection. However, after surviving surgery, prognosis no longer seems to be predicted by LD.

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