Fetal Echocardiography in Predicting Postnatal Outcome in Borderline Left Ventricle

2021 ◽  
Author(s):  
Carina Nina Vorisek ◽  
Lucy Bischofsberger ◽  
Andrii Kurkevych ◽  
Uygar Yürökür ◽  
Aline Wolter ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Fetal Echocardiography ◽  
Entire Cohort ◽  
Receiver Operating Characteristic Curves ◽  
Sphericity Index ◽  
Significant Difference ◽  
Echocardiographic Parameters ◽  
Z Scores ◽  
Postnatal Outcome ◽  
One Year

Abstract Objectives Prenatal prediction of postnatal univentricular versus biventricular circulation in patients with borderline left ventricle (bLV) remains challenging. This study investigated prenatal fetal echocardiographic parameters and postnatal outcome of patients with a prenatally diagnosed bLV. Methods We report a retrospective study of bLV patients at four prenatal centers with a follow-up of one year. BLV was defined as z-scores of the left ventricle (LV) between –2 and –4. Single-ventricle palliation (SVP), biventricular repair (BVR), and no surgical or catheter-based intervention served as the dependent outcome. Prenatal ultrasound parameters were used as independent variables. Cut-off values from receiver operating characteristic curves (ROC) were determined for significant discrimination between outcomes. Results A total of 54 patients were diagnosed with bLV from 2010 to 2018. All were live births. Out of the entire cohort, 8 (15 %) received SVP, 34 (63 %) BVR, and 12 (22 %) no intervention. There was no significant difference with regard to genetic or extracardiac anomalies. There were significantly more patients with endocardial fibroelastosis (EFE) in the SVP group compared to the BVR group (80 % vs. 10 %), (p < 0.001). Apex-forming LV (100 % vs. 70 %) and lack of retrograde arch flow (20 % vs. 80 %) were associated with no intervention (p < 0.001). With respect to BVR vs. SVP, the LV sphericity index provided the highest specificity (91.7 %) using a cutoff value of ≤ 0.5. Conclusion The majority of bLV patients maintained biventricular circulation. EFE, retrograde arch flow, and LV sphericity can be helpful parameters for counseling parents and further prospective studies can be developed.

scholarly journals The effect of gene polymorphism of certain cytokines on echocardiographic parameters in patients with chronic rheumatic heart disease

2019 ◽  
pp. 42-47
Author(s):  
V. S. Petrov
Keyword(s):  
Heart Disease ◽  
Left Ventricle ◽  
Rheumatic Heart Disease ◽  
Left Ventricular ◽  
Right Heart ◽  
Linear Dimensions ◽  
Tnf Α ◽  
Significant Difference ◽  
Echocardiographic Parameters ◽  
Rheumatic Heart

Aim.To assess the effect of polymorphism of tumor necrosis factor-а (TNF-α) cytokines and interleukin (IL-17A, IL-17F, IL-10) on echocardiographic parameters in patients with chronic rheumatic heart disease (RHD).Material and methods. A total of 128 patients with RHD were examined, average age was 58,96±0,34 years. Echocardiography was performed on a Philips Affinity 50 machine. Genotyping was carried out using polymorphic TNF-α markers (G308A, IL-10 G1082A, IL-17A G197A, IL-17F А161Н0 by polymerase chain reaction with an electrophoretic scheme for detecting the result of “SNP-EXPRESS”.Results. RHD homozygotes for TNF-а A308A had the largest linear dimensions of the left ventricle (left ventricle end-diastolic dimension (LVED) — 5,80±0,22 cm, left ventricle end-systolic dimension (LVES) — 3,93±0,27 cm), as well as the studied homozygous for IL-17A A197A (LVED — 5,81±0,13 cm, LVES — 3,78±0,11 cm). In group of TNF-α G308G homozygotes, values of right heart (right ventricle — 2,75±0,05 cm, right atrium — 4,80±0,11 cm) were the largest and mitral valve orifice area (MVOA) was smallest — 1,52±0,04 cm2. Heterozygous patients with IL-17F Д161Н also had a greater dilatation of the ventricles compared with homozygotes of IL-17F Н161Н, in which parameters were close to normal (LVED 5,58±0,05 cm, LVES 3,68±0,04 cm). There was no statistically significant difference in linear sizes of the left and right heart in patients with IL-10 polymorphism. IL-10 polymorphism patients had statistically significant MVOA differences: minimum MVOA in G1082A heterozygotes — 1,40±0,06 cm2and maximum — 1,64±0,04 cm2in G1082G homozygotes. IL-10 G1082G homozygotes was characterized by maximum values of interventricular septum — 1,13±0,04 cm, left ventricular posterior wall — 1,10±0,03 cm.Conclusion. Homozygosity of TNF-α A308A and IL-17A A197A in RHD patients leads to the largest linear sizes of the left ventricle, and homozygosity for TNF-а G308G — to the maximum sizes of the right heart and left atrium against the background of the minimum sizes of MVOA. IL-10 polymorphism has not effect on heart linear dimensions, but IL-10 G1082G leads to maximum MVOA size.

scholarly journals Comparative assessment of the indices of the left ventricle post-infarction remodelling of the left ventricle and its dependence on the strategy of acute myocardial infarction management

2013 ◽  
Vol 20 (3) ◽  
pp. 75-78
Author(s):  
D. M. Zhidovich ◽  
L. V. Shcheglova
Keyword(s):  
Myocardial Infarction ◽  
Acute Myocardial Infarction ◽  
Left Ventricle ◽  
Thrombolytic Therapy ◽  
Comparative Assessment ◽  
Dynamic Monitoring ◽  
Sphericity Index ◽  
Significant Difference ◽  
Group Ii ◽  
Left Ventricle Remodelling

Comparative assessment of the indices of post-infarction remodelling of the left ventricle was carried out in the patients with myocardium reperfusion (thrombolytic therapy) and without reperfusion. ECG was performed for all patients on admission to the hospital and then 3 and 6 months later. The results obtained demonstrated that after the acute period of myocardial infarction there was no difference between the parameters under control. At the same time the results of dynamic monitoring confirmed that later on the patients felt some peculiarities during the left ventricle remodelling process. Three months later there was an increase of the left ventricle sphericity index during the systoly in the patients of group II. Six months later the patients of group II showed significant difference in five indices of remodelling versus the patients on thrombolitic therapy.

Abstract 2601: Staged Left Ventricular Recruitment in Patients with Hypoplastic Left Heart Disease and Borderline Left Ventricle

Circulation ◽  
2008 ◽  
Vol 118 (suppl_18) ◽  
Author(s):  
Sitaram M Emani ◽  
Wayne Tworetzky ◽  
Doff B McElhinney ◽  
Brian Schroeder ◽  
David Zurakowski ◽  
...  
Keyword(s):  
Left Ventricle ◽  
Multivariable Analysis ◽  
Left Ventricular ◽  
Left Heart ◽  
Hypoplastic Left Heart ◽  
Entire Cohort ◽  
Z Scores ◽  
Group 2 ◽  
Stage 1 ◽  
Group 1

Although hypoplastic left heart (LH) disease occurs as a spectrum, the initial management in neonates with hypoplastic LH syndrome and a borderline left ventricle (LV) is dichotomous: single ventricle palliation (SVP) or biventricular (BiV) repair. Once SVP is pursued, rarely are attempts made to salvage the LH or achieve subsequent BiV conversion. Staged LV recruitment may be achieved in selected patients following SVP by a surgical strategy consisting of relief of inflow and outflow tract obstructions, resection of endocardial fibroelastosis (EFE), and promotion of flow through the LV. All patients with hypoplastic LH and borderline LV (LV end diastolic volume [LVEDV] z scores between −5 and −0.5) who underwent stage 1 procedure between 1995 and 2007 were retrospectively analyzed. Patients with ventricular septal defects and valvular atresia were excluded. Those who underwent LV recruitment (Group 1, n=27) were compared to those who did not (Group 2, n=30). LV recruitment consisted of one or more procedures for EFE resection (27/27), mitral (MV) valvuloplasty (16/27), aortic (AoV) valvulo-plasty (21/27), atrial septal defect restriction (13/27), and augmentation of pulmonary blood flow (12/27). Predictors of increase in LVEDV were determined by multivariable analysis. Mean initial z scores for LVEDV, AoV, and MV for the entire cohort were −2.8 ± 1.2, −2.9 ± 1.0, and −2.0 ± 1.3 respectively, with no significant differences between groups. Stage 1 mortality was 2/27 in Group 1 and 2/30 in Group 2. LVEDV, AoV, and MV z scores increased significantly over time in Group 1, whereas they declined in Group 2 (slope of LVEDV z score regression = 0.76/yr vs. −0.06/yr, P <0.001), with restriction of the atrial septum at any stage being the strongest independent predictor of increase in LVEDV ( P <0.001). To date, BiV conversion has been achieved in 5/27 Group 1 patients and none in Group 2 ( P =0.015). In patients with borderline LH disease who undergo a stage I procedure during the neonatal period, it is possible to increase LH dimensions using a strategy of AoV and MV valvuloplasty, EFE resection, and modulation of LV filling. In a subset of patients, this strategy has allowed establishment of biventricular circulation.

scholarly journals P929 Routine Left Atrium Strain in acute STEMI: to do or not to do

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Tadic ◽  
A Ilic ◽  
M Stefanovic ◽  
A Stojsic-Milosavljevic ◽  
S Stojsic ◽  
...  
Keyword(s):  
Cardiac Index ◽  
Left Ventricle ◽  
Adverse Events ◽  
Left Atrium ◽  
Volume Index ◽  
Lv Function ◽  
Maximal Volume ◽  
Echocardiographic Parameters ◽  
One Year

Abstract Introduction and purpose Left atrium strain (LAS) is a very useful, modern method of establish left atrium (LA) function and rarely use in predicting adverse events (AE) in acute anterior ST-elevated myocardial infarction (STEMI). The purpose of our study was to compare LAS among other echocardiographic parameters of LA and left ventricle (LV) function, in patients that developed AE (heart failure, all cause mortality, reinfarction and rehospitalization) after acute anterior STEMI during one year follow up. Methods All 101 patients with a first acute anterior STEMI treated by primary PCI had early echocardiography in first 24 hours. After one year follow up, patients were divided in two groups: AE group (27 patients; 27%) and non-AE group (74 patients; 73%). We compared: LA size, LA maximal volume index, LAS, systolic and diastolic left ventricle parameters, between groups for the purpose of identifying early AE predictors. Results Among all left atrium parameters, LA strain was most prognostic for AE between groups (AE group vs. non-AE group): LA diameter (3,7cm vs. 3,5cm, p = 0,03), LA maximal volume index (27 ml/m2 vs. 24,5 ml/m2, p = 0,03), LAS (30% vs.37%, p &lt; 0,0001) Statistically significant differences in systolic and diastolic LV function between AE and non-AE groups were: ejection fraction (p &lt; 0.0001), stroke volume index (p &lt; 0.0001), fractional shortening (p &lt; 0.0001), cardiac index (p &lt; 0.0001), LV systolic work (p &lt; 0,0001), WMSI- wall motion score index (p &lt; 0,0001), average LV peak systolic longitudinal global strain- LGSav (p &lt; 0,001), mitral inflow peak early velocity/average mitral annular peak early velocity- E/e"av (p &lt; 0,001). After adjustment for all echocardiographic parameters, LA strain (OR 0,91 95% CI, p = 0,04), WMSI ≥ 2 (OR 6.1 95% CI, p &lt; 0.001), average peak systolic left ventricle LGS (OR = 15.1 95% CI, p &lt; 0.0001) and cardiac index (OR 2.6 95% CI, p = 0.01) were independently associated with adverse outcomes. Conclusion Routine left atrium strain is very prognostic parameter of high-risk STEMI patients for adverse events and could possibly be considered as an important component of the new predictive score system for MACE and mortality of STEMI patients in the near future.

Risk of venous thromboembolism following surgical treatment of superficial venous incompetence

VASA ◽  
2017 ◽  
Vol 46 (6) ◽  
pp. 484-489 ◽  
Author(s):  
Tom Barker ◽  
Felicity Evison ◽  
Ruth Benson ◽  
Alok Tiwari
Keyword(s):  
Venous Thromboembolism ◽  
Varicose Vein ◽  
Lower Incidence ◽  
Varicose Veins ◽  
Secondary Data ◽  
Foam Sclerotherapy ◽  
Increased Risk ◽  
Significant Difference ◽  
Chi Squared ◽  
One Year

Abstract. Background: The invasive management of varicose veins has a known risk of post-operative deep venous thrombosis and subsequent pulmonary embolism. The aim of this study was to evaluate absolute and relative risk of venous thromboembolism (VTE) following commonly used varicose vein procedures. Patients and methods: A retrospective analysis of secondary data using Hospital Episode Statistics database was performed for all varicose vein procedures performed between 2003 and 2013 and all readmissions for VTE in the same patients within 30 days, 90 days, and one year. Comparison of the incidence of VTEs between procedures was performed using a Pearson’s Chi-squared test. Results: In total, 261,169 varicose vein procedures were performed during the period studied. There were 686 VTEs recorded at 30 days (0.26 % incidence), 884 at 90 days (0.34 % incidence), and 1,246 at one year (0.48 % incidence). The VTE incidence for different procedures was between 0.15–0.35 % at 30 days, 0.26–0.50 % at 90 days, and 0.46–0.58 % at one year. At 30 days there was a significantly lower incidence of VTEs for foam sclerotherapy compared to other procedures (p = 0.01). There was no difference in VTE incidence between procedures at 90 days (p = 0.13) or one year (p = 0.16). Conclusions: Patients undergoing varicose vein procedures have a small but appreciable increased risk of VTE compared to the general population, with the effect persisting at one year. Foam sclerotherapy had a lower incidence of VTE compared to other procedures at 30 days, but this effect did not persist at 90 days or at one year. There was no other significant difference in the incidence of VTE between open, endovenous, and foam sclerotherapy treatments.

Levels of Prothrombin Fragment F1+2 in Patients with Hyperhomocysteinemia and a History of Venous Thromboembolism

1997 ◽  
Vol 78 (05) ◽  
pp. 1327-1331 ◽  
Author(s):  
Paul A Kyrle ◽  
Andreas Stümpflen ◽  
Mirko Hirschl ◽  
Christine Bialonczyk ◽  
Kurt Herkner ◽  
...  
Keyword(s):  
Venous Thromboembolism ◽  
Thrombin Generation ◽  
Oral Anticoagulant Therapy ◽  
Oral Anticoagulants ◽  
Control Group ◽  
Prothrombin Fragment ◽  
Hemostatic System ◽  
Significant Difference ◽  
System Activation ◽  
One Year

SummaryIncreased thrombin generation occurs in many individuals with inherited defects in the antithrombin or protein C anticoagulant pathways and is also seen in patients with thrombosis without a defined clotting abnormality. Hyperhomocysteinemia (H-HC) is an important risk factor of venous thromboembolism (VTE). We prospectively followed 48 patients with H-HC (median age 62 years, range 26-83; 18 males) and 183 patients (median age 50 years, range 18-85; 83 males) without H-HC for a period of up to one year. Prothrombin fragment Fl+2 (Fl+2) was determined in the patient’s plasma as a measure of thrombin generation during and at several time points after discontinuation of secondary thromboprophylaxis with oral anticoagulants. While on anticoagulants, patients with H-HC had significantly higher Fl+2 levels than patients without H-HC (mean 0.52 ± 0.49 nmol/1, median 0.4, range 0.2-2.8, versus 0.36 ± 0.2 nmol/1, median 0.3, range 0.1-2.1; p = 0.02). Three weeks and 3,6,9 and 12 months after discontinuation of oral anticoagulants, up to 20% of the patients with H-HC and 5 to 6% without H-HC had higher Fl+2 levels than a corresponding age- and sex-matched control group. 16% of the patients with H-HC and 4% of the patients without H-HC had either Fl+2 levels above the upper limit of normal controls at least at 2 occasions or (an) elevated Fl+2 level(s) followed by recurrent VTE. No statistical significant difference in the Fl+2 levels was seen between patients with and without H-HC. We conclude that a permanent hemostatic system activation is detectable in a proportion of patients with H-HC after discontinuation of oral anticoagulant therapy following VTE. Furthermore, secondary thromboprophylaxis with conventional doses of oral anticoagulants may not be sufficient to suppress hemostatic system activation in patients with H-HC.

Comparative Study between Endoscopic Aided Septoplasty with Two Handed Technique using Endoholder and Conventional Septoplasty

2020 ◽  
Vol 16 (3) ◽  
Author(s):  
Apar Pokharel ◽  
Naganawalachullu Jaya Prakash Mayya ◽  
Nabin Gautam
Keyword(s):  
Comparative Study ◽  
Nasal Septum ◽  
Deviated Nasal Septum ◽  
Endoscopic Septoplasty ◽  
Septal Surgery ◽  
Significant Difference ◽  
Common Causes ◽  
Prospective Comparative Study ◽  
Evolutionary Step ◽  
One Year

Introduction: Deviated nasal septum is one of the most common causes for the nasal obstruction. The objective of this study is to compare the surgical outcomes in patients undergoing conventional septoplasty and endoscopic septoplasty in the management of deviated nasal septum. Methods:  Prospective comparative study was conducted on 60 patients who presented to the Department of ENT, College of Medical sciences, during a period of one year. The severity of the symptoms was subjectively assessed using NOSE score and objectively assessed using modified Gertner plate. Results: There was significant improvement in functional outcome like NOSE Score and area over the Gertner plate among patients who underwent endoscopic septoplasty. Significant difference in incidence of post-operative nasal synechae and haemorrhage was seen in conventional group compared to endoscopic group. Conclusions: Endoscopic surgery is an evolutionary step towards solving the problems related to deviated nasal septum. It is safe, effective and conservative, alternative to conventional septal surgery.

EVALUTING THE EFFECTS OF EARLY INTERVENTION PROGRAM FOR CHILDREN WITH DEVELOPMENTAL DISABILITIES IN COMMUNITY

2011 ◽  
pp. 70-76
Author(s):  
Keyword(s):  
Social Cognition ◽  
Early Intervention ◽  
Developmental Delay ◽  
Intervention Program ◽  
Language Skills ◽  
Early Intervention Program ◽  
Self Help ◽  
Home Based ◽  
Significant Difference ◽  
One Year

Objectives: To evualate the effects of early intervention program after one year for 33 disabled children in Hue city in 2010. Objects and Methods: Conduct with practical work and assessment on developing levels at different skills of the children with developmental delay under 6 years old who are the objects of the program. Results: With the Portage checklist used as a tool for implementing the intervention at the community and assessing developing skills on Social, Cognition, Motor, Self-help and Language skills for children with developmental delay, there still exists significant difference (p ≤ 0.05) at developing level of all areas in the first assessment (January, 2010) and the second assessment (December, 2010) after 12 months. In comparison among skills of different types of disabilities, there is significant difference of p ≤ 0.05 of social, cognition and language skills in the first assessment and of social, cognition, motor and language skills in the second assessment. Conclusion: Home-based Early Intervention Program for children with developmental delay has achieved lots of progress in improving development skills of the children and enhancing the parents’ abilities in supporting their children at home.

Renal Phosphate Handling in Antiretroviral-naïve HIV-infected Patients

2020 ◽  
Vol 20 ◽  
Author(s):  
Tewogbade Adeoye Adedeji ◽  
Simeon Adelani. Adebisi ◽  
Nife Olamide Adedeji ◽  
Olusola Akanni Jeje ◽  
Rotimi Samuel Owolabi
Keyword(s):  
Hiv Infection ◽  
Plasma Phosphate ◽  
Cross Sectional ◽  
Phosphate Retention ◽  
Significant Difference ◽  
Immunodeficiency Virus ◽  
Life Threatening ◽  
Moderate Chronic Kidney Disease ◽  
One Year ◽  
Sectional Analysis

Background: Human immunodeficiency virus (HIV) infection impairs renal function, thereby affecting renal phosphate metabolism. Objectives: We prospectively estimated the prevalence of phosphate abnormalities (mild, moderate to life-threatening hypophosphataemia, and hyperphosphataemia) before initiating antiretroviral therapy (ART). Methods: A cross-sectional analysis was performed on 170 consecutive newly diagnosed ART-naïve, HIV-infected patients attending our HIV/AIDS clinics over a period of one year. Fifty (50) screened HIV-negative blood donors were used for comparison (controls). Blood and urine were collected simultaneously for phosphate and creatinine assay to estimate fractional phosphate excretion (FEPi %) and glomerular filtration rate (eGFR). Results: eGFR showed significant difference between patients’ and controls’ medians (47.89ml/min/1.73m2 versus 60ml/min/1.73m2, p <0.001); which denotes a moderate chronic kidney disease in the patients. Of the 170 patients, 78 (45.9%) had normal plasma phosphate (0.6-1.4 mmol/L); 85 (50%) had hyperphosphataemia. Grades 1, 2 and 3 hypophosphataemia was observed in 3 (1.8%), 3 (1.8%), and 1(0.5%) patient(s) respectively. None had grade 4 hypophosphataemia. Overall, the patients had significantly higher median of plasma phosphate than the controls, 1.4 mmol/L (IQR: 1.0 – 2.2) versus 1.1 mmol/L (IQR: 0.3 – 1.6), p <0.001, implying hyperphosphataemia in the patients; significantly lower median urine phosphate than the controls, 1.5 mmol/L (IQR: 0.7 -2.1) versus 8.4 mmol/L (IQR: 3.4 – 16), p <0.001), justifying the hyperphosphataemia is from phosphate retention; but a non-significantly lower median FEPi% than the controls, 0.96 % (IQR: 0.3 -2.2) versus 1.4% (IQR: 1.2 -1.6), p > 0.05. Predictors of FEPi% were age (Odds ratio, OR 0.9, p = 0.009); weight (OR 2.0, p < 0.001); CD4+ cells count predicted urine phosphate among males (p = 0.029). Conclusion: HIV infection likely induces renal insufficiency with reduced renal phosphate clearance. Thus, hyperphosphataemia is highly prevalent, and there is mild to moderate hypophosphataemia but its life-threatening form (grade 4) is rare among ART-naïve HIV patients.

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