Cardiac masses and potential sources of emboli

2016 ◽  
Author(s):  
Nadia Benyounes ◽  
Mauro Pepi ◽  
Roberta Esposito ◽  
Carmen Ginghina ◽  
Ariel Cohen
Keyword(s):  
Imaging Technique ◽  
Pulmonary Arteries ◽  
Clinical Manifestations ◽  
Transoesophageal Echocardiography ◽  
Right Heart ◽  
Postoperative Changes ◽  
The Right ◽  
Ultrasound Artefacts ◽  
Cardiac Masses

Cardiac masses are abnormal structures within or immediately adjacent to the heart. They have to be distinguished from variants of normal cardiac structures, postoperative changes, and ultrasound artefacts. These abnormal masses may be localized in the left or right heart cavities, with different clinical manifestations according to their localization. Among the abnormal cardiac masses (thrombus, vegetations, tumours), tumours are not discussed in this chapter. Echocardiography is the main but not the only imaging technique for the evaluation of cardiac masses, and is largely available. Hence, it is indicated in patients with a systemic embolic event, searching for a cardiac source embolism. When transthoracic echocardiography is negative, transoesophageal echocardiography is indicated, in cryptogenic ischaemic events (no cause found). Right heart masses are mainly responsible for pulmonary embolisms, but may be the cause of a systemic embolus, via the atrial septum. Right heart thrombi rarely form in situ, and are hence more often venous thrombi entrapped in the right heart on their way to the pulmonary arteries. Echocardiography is mandatory in the setting of pulmonary embolism.

scholarly journals EXPRESS: Chronic thromboembolic pulmonary hypertension following pulmonary embolism with a right ventricular thrombus: A report of two cases

2021 ◽  
pp. 204589402110136
Author(s):  
Tailong Zhang ◽  
Weitao Liang ◽  
Longrong Bian ◽  
Zhong Wu
Keyword(s):  
Pulmonary Hypertension ◽  
Right Ventricular ◽  
Chronic Thromboembolic Pulmonary Hypertension ◽  
Imaging Features ◽  
Pulmonary Endarterectomy ◽  
Right Heart ◽  
Thromboembolic Pulmonary Hypertension ◽  
The Right ◽  
Cardiac Masses

Right heart thrombus (RHT) accompanied by chronic thromboembolic pulmonary hypertension (CTEPH) is a rare entity. RHT may develop in the peripheral veins or in situ within the right heart chambers. The diagnosis of RHT is challenging, since its symptoms are typically non-specific and its imaging features resemble those of cardiac masses. Here, we report two cases of RHT with CTEPH that presented as right ventricular masses initially. Both patients underwent simultaneous pulmonary endarterectomy (PEA) and resection of the ventricular thrombi. Thus, when mass-like features are confirmed by imaging, RHT should be suspected in patients with CTEPH, and simultaneous RHT resection is required along with PEA.

scholarly journals The right-sided heart failure

2019 ◽  
Vol 29 (2) ◽  
pp. 135-147
Author(s):  
A. G. Chuchalin
Keyword(s):  
Heart Failure ◽  
Clinical Manifestations ◽  
Clinical Syndrome ◽  
Lv Function ◽  
Right Heart ◽  
Heart Abnormalities ◽  
Lv Volume ◽  
The Right ◽  
And Function ◽  
Heart Physiology

The right-sided heart failure (RSHF) is a complex clinical syndrome including different pathogenic mechanisms and processes resulted from the right ventricle (RV) dysfunction and manifested with signs of heart failure (HF). Recently, there is a growing scientific interest in the right-sided acute and chronic heart abnormalities; this is due to growing knowledge in this field and development of novel diagnostic, therapeutic and pharmacological approaches to treatment of pulmonary hypertension that is a common cause of RSHF. Cardiac embryogenesis, anatomic particularities, difference and interdependence of RV and the left ventricle (LV) are described in the article in order to improve the knowledge on structure and function of both the right heart and the left heart. Discussion on pathophysiology, causes and clinical manifestations of acute RSHF (aRSHF) and chronic RSHF (cRSHF) should consider the right heart physiology. Pharmacological treatment should be targeted to ventricle pre-load, myocardial contractility and RV post-load, correction of pulmonary circulation and LV volume resulting in post-load reduction and improvement in the LV function. Patients with biventricular dysfunction should be treated according to current clinical guidelines on therapy of chronic HF. Vasoactive agents and diuretics have an important role for the treatment of RSHF as this is the basic therapy of pulmonary congestion both in aRSHF and cRSHF. Step-by-step therapeutic algorithm is given in the article.

Percutaneous subclavian catheterization of the right heart and pulmonary arteries

1965 ◽  
Vol 70 (4) ◽  
pp. 481-485 ◽  
Author(s):  
Robert E. Gulde ◽  
L.Russell Malinak ◽  
Faber F. McMullen ◽  
David J. Turell ◽  
Hugh H. Hanson
Keyword(s):  
Pulmonary Arteries ◽  
Right Heart ◽  
The Right

scholarly journals The current situation of Angiostrongylus vasorum in Romania: a national questionnaire-based survey

2021 ◽  
Vol 17 (1) ◽  
Author(s):  
Georgiana Deak ◽  
Eduardo Berriatua ◽  
Andrei Daniel Mihalca
Keyword(s):  
Pulmonary Arteries ◽  
Clinical Manifestations ◽  
Epidemiological Studies ◽  
Domestic Dogs ◽  
Angiostrongylus Vasorum ◽  
Intermediate Hosts ◽  
Red Foxes ◽  
Neurological Signs ◽  
Wide Range ◽  
The Right

Abstract Background Angiostrongylus vasorum (Nematoda, Metastrongyloidea) is a vascular nematode that resides in the pulmonary arteries and the right side of the heart of a wide variety of carnivores, with an indirect life cycle using coprophagic gastropods as intermediate hosts. For domestic dogs, the infection with A. vasorum can be asymptomatic, but more frequently, it is associated with a wide range of clinical manifestations like cardio-respiratory signs, bleedings, neurological signs, and ocular problems which can lead to death when not treated accordingly. Angiostrongylosis was confirmed for the first time in Romania in red foxes (Vulpes vulpes) in 2017 and two years later a seroepidemiologic study was conducted among domestic dogs. However, to this date, no clinical canine angiostrongylosis cases were published in Romania. The aim of the present paper was to evaluate the knowledge about canine angiostrongylosis among veterinarians in Romania and to update the distribution of this disease using a national wide anonymous questionnaire. Results Overall, 147 unique responses were submitted, from 31 out of 42 counties. Twelve veterinarians (8%) from 8 counties (26%) acknowledged diagnosing a case of angiostrongylosis including 5 from the Bucharest and 1 from each of the remaining seven counties. All affected dogs had respiratory distress, 75% suffered cardiopathy, 16% coagulopathies and 8% neurological signs. Case diagnosis was based mostly on larval detection by coprology (67%) and serological antigen detection test (42%). Conclusions Romanian veterinarians are aware of canine angiostrongylosis and a significant number have clinical experience with the disease. Epidemiological studies are now needed to assess its distribution in the country, and further efforts are required to improve understanding of the disease, its diagnostic and treatment methods among veterinarians.

scholarly journals The isobaric pulmonary arterial compliance in pulmonary hypertension

2021 ◽  
pp. 00941-2020
Author(s):  
Denis Chemla ◽  
Emmanuelle Berthelot ◽  
Jason Weatherald ◽  
Edmund M. T. Lau ◽  
Laurent Savale ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Arterial Compliance ◽  
Pulmonary Arteries ◽  
Right Heart ◽  
Right Heart Catheterisation ◽  
Strain Behaviour ◽  
Arterial Load ◽  
Pulmonary Arterial ◽  
Vascular Beds ◽  
The Right

Pulmonary hypertension (PH) is associated with stiffening of pulmonary arteries which increases right ventricular pulsatile loading. High pulmonary artery wedge pressure (PAWP) in postcapillary PH (Pc-PH) further decreases PA compliance (PAC) at a given pulmonary vascular resistance (PVR) compared to precapillary PH, thus responsible for a higher total arterial load. In all other vascular beds, arterial compliance is considered as mainly determined by the distending pressure, due to non-linear stress-strain behaviour of arteries. We tested the applicability, advantages and drawbacks of two comparison methods of PAC depending on the level of mean PA pressure mPAP (isobaric PAC) or PVR.Right heart catheterisation data including PAC (stroke volume/pulse pressure) were obtained in 112Pc-PH (of whom 61 had combined postcapillary and precapillary PH) and 719 idiopathic pulmonary arterial hypertension (iPAH).PAC could be compared over the same mPAP range (25–66 mmHg) in 792/831 patients (95.3%) and over the same PVR range (3–10.7 WU) in only 520/831 patients (62.6%). The main assumption underlying comparisons at a given PVR was not verified as the PVR×PAC product (RC-time) was not constant but on the contrary more variable than mPAP. In the 788/831 (94.8%) patients studied over the same PAC range (0.62–6.5 mL·mmHg−1), PVR and thus total arterial load tended to be higher in iPAH.Our study favours comparing PAC at fixed mPAP level (isobaric PAC) rather than at fixed PVR. A reappraisal of the effects of PAWP on the pulsatile and total arterial load put on the right heart is needed, and this point deserves further studies.

scholarly journals P1449 CMR-driven computational modeling of right ventricular flow dynamics

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
F Capuano ◽  
L Romano ◽  
Y H Loke ◽  
S Dellegrottaglie ◽  
M Notorio ◽  
...  
Keyword(s):  
Blood Flow ◽  
Computational Modeling ◽  
Computational Models ◽  
Pulmonary Arteries ◽  
Flow Patterns ◽  
Imaging Biomarkers ◽  
Patient Specific ◽  
Right Heart ◽  
The Right ◽  
Blood Flow Patterns

Abstract Introduction The analysis of intracardiac blood flow patterns can significantly contribute to improve the understanding and treatment of cardiovascular disease. In contrast to the substantial literature on the left side of the heart, there is currently a significant lack of knowledge about the fluid mechanics of the right heart – pulmonary circulation unit (RH-PCU), both in healthy and diseased conditions. Purpose It is conjectured that computational modeling can be a key element to enhance current imaging techniques and provide quantitative insights into the unique RH-PCU biomechanics. Here we present a novel methodology that allows personalized numerical simulations of right heart flows, through a proper combination of cardiac magnetic resonance (CMR) with computational fluid dynamics (CFD). Methods and results We developed a patient-specific pipeline from medical images to computational models, as depicted in the figure. First, the RV geometry is reconstructed from time-resolved CMR cine images, comprising short-axis and longitudinal slices of the heart, where feature-tracking techniques are used to extract the motion of the RV endocardium contours. A time-continuous description of the moving geometry is obtained through an image-registration algorithm based on diffeomorphic mappings. The moving model of the RV, including the outflow tract and proximal pulmonary arteries, is finally fed to a dedicated CFD solver. The tool is able to provide a detailed description of the velocity and pressure fields inside the right ventricle and proximal pulmonary arteries during all phases of the cardiac cycle. From these fields, global hemodynamic quantities such as vortex properties, kinetic energy, pressure gradients and hemodynamic forces can be computed. Conclusions CMR-driven computational modeling of intra-ventricular flow enables a promising approach for understanding and evaluating the biomechanical environment of the right heart. This high-fidelity framework can be applied to investigate the RV response and adaptation to abnormal pressure and/or volume load conditions. It can also be used to reproduce the virtual flow that would realize in hypothetical conditions, and therefore adds predictive capabilities to modern flow imaging. The analysis may allow to determine an association between blood flow patterns and disease progression, and ultimately lead to derive and validate imaging biomarkers of clinical significance. Abstract P1449 Figure. Pipeline for patient-specific modeling

Positional cyanosis in infants: an unusual presentation of right-sided cardiac masses

2004 ◽  
Vol 14 (1) ◽  
pp. 46-49
Author(s):  
Aviva Levitas ◽  
Gil Gross ◽  
Nili Zucker ◽  
Eli Zalzstein
Keyword(s):  
Surgical Resection ◽  
Tricuspid Valve ◽  
Young Patients ◽  
Unusual Presentation ◽  
Right Heart ◽  
Arterial Desaturation ◽  
The Right ◽  
Cardiac Masses

Positional cyanosis is an uncommon finding in young patients. We report three infants who presented with positional cyanosis due to a pedunculated tumour in the right heart. Arterial desaturation was the result of right-to-left shunting at the level of the oval foramen caused by obstruction and/or insufficiency of the tricuspid valve. The obstruction at the level of the tricuspid valve was variable because of the pedunculated nature of the tumours, which gave them considerable mobility. Hence, the degree of right-to-left shunting was dependent on the position of the patient. In all the patients, surgical resection of the tumours resolved the cyanosis.

scholarly journals The fatal case of an autochthonous heartworm disease in a dog from a non-endemic region of south-eastern Slovakia

2020 ◽  
Vol 57 (2) ◽  
pp. 154-157 ◽  
Author(s):  
M. Miterpáková ◽  
H. Zborovská ◽  
B. Bielik ◽  
M. Halán
Keyword(s):  
Dirofilaria Immitis ◽  
Fatal Case ◽  
Pulmonary Arteries ◽  
Clinical Signs ◽  
Endemic Region ◽  
Right Heart ◽  
South Eastern ◽  
The Past ◽  
Heartworm Disease ◽  
The Right

SummaryDuring the past few years, several localities with increasing Dirofilaria immitis occurrences have been identified in Slovakia; particularly in areas regarded as endemic for Dirofilaria repens up until now. In terms of that, dogs with clinically manifested heartworm disease have been referred to the veterinary ambulances more frequently. We report in this study, two autochthonous cases of D. immitisinfections diagnosed in two seven-year-old siblings of Tibetan Mastiff dogs from the Košice region of south-eastern Slovakia. The course of the disease in both dogs were very different. The female dog did not manifest any unusual findings, however the male dog exhibited severe clinical signs of heartworm disease that lead to his death. The subsequent autopsy revealed adult D. immitis worms in the right heart ventricle and pulmonary arteries.

Cardiac masses in infants and children

1994 ◽  
Vol 4 (4) ◽  
pp. 386-389
Author(s):  
Dante Picarelli ◽  
José Victor Nozar ◽  
Rubén Leone ◽  
Pedro Duhagón ◽  
Carlos Peluffo ◽  
...  
Keyword(s):  
Cardiac Failure ◽  
Postoperative Period ◽  
Left Heart ◽  
Right Heart ◽  
Cross Sectional ◽  
Common Sign ◽  
The Right ◽  
Cardiac Masses ◽  
Late Postoperative Period ◽  
In Infants And Children

SummaryWe discuss the management of 10 children with cardiac masses produced bytumors, thrombus or vegetations. The ages of the patients ranged from five days to nine years, only two being more than five years old. In all cases, the diagnosis was made by cross-sectional and Doppler echocardiography. Themasses were detected in the chambers of the right heart in five patients, in the left heart in four and on both sides in one patient. Five patients had predisposing factors. The clinical features were variable, but cardiac failure was the most common sign. All the patients underwent emergency surgery. Two patients died during the period of hospitalization and two in the late postoperative period. The six surviving patients are now asymptomatic.

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