scholarly journals Right heart dilatation in a fetus with an abnormal foramen ovale valve: an indicator of interatrial communication restriction

2017 ◽  
Author(s):  
Wenjia Lei ◽  
Miao Fan ◽  
Meilian Wang ◽  
Yu Wang ◽  
Wei Sun ◽  
...  
Keyword(s):  
Congenital Heart ◽  
Inferior Vena ◽  
Vena Cava ◽  
Opening Angle ◽  
Foramen Ovale ◽  
Normal Range ◽  
Right Heart ◽  
Interatrial Communication ◽  
Channel Outlet ◽  
Orifice Opening

Aims: Foramen ovale (FO) valve with a shape or motion abnormality is frequently detected during routine obstetric ultrasonic examinations. However, the hemodynamics mechanism of this entity remains unclear. The purpose of the study is to determine the relevance of interatrial communication restriction and resultant morphological modifications.Materials and methods: We reviewed the echocardiographic records of fetuses with isolated abnormal FO valve evaluated between January of 2010 and december of 2016. The size (DFO) of the FO orifice, opening angle (α) of the FO valve, and dimensions of cardiac chambers, FO channel outlet (DOUT) and inferior vena cava (DIVC) were measured. We evaluated their (DFO, DOUT, α) relationships to the diameters of RA and DIVC. Five hundred and seventy normal fetuses were selected to establish the normal range of the DOUT/DIVC ratio so as to provide a criterion for restriction.Results: An abnormal FO valve was identified in 89 fetuses without congenital heart disease, with restriction noted in 62 fetuses (45 fetuses with RA dilatation, 12 fetuses with RA and RV dilatation, and 5 fetuses with no RA dilatation). There were no significant correlations between RA/LA and DFO/DIVC, RA/ LA and α. RA/LA was negatively correlated with DOUT/DIVC (R2=0.97, p<0.01).Conclusions: For a fetus with an abnormal FO valve, right heart dilatation could be considered as an indicator of interatrial communication restriction, which could be assessed by evaluating the FO channel outlet. The degree of right atrium dilatation indicates the severity of the restriction.

scholarly journals Isolated Marked Inferior Vena Cava Dilatation: Unusual Presentation or Underrecognized Common Phenomenon?

2018 ◽  
Vol 2018 ◽  
pp. 1-3 ◽  
Author(s):  
Sneha R. Gadi ◽  
Benjamin K. Ruth ◽  
Alan Johnson ◽  
Sula Mazimba ◽  
Younghoon Kwon
Keyword(s):  
Inferior Vena Cava ◽  
Inferior Vena ◽  
Vena Cava ◽  
Unusual Presentation ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Atrial Pressure ◽  
Common Phenomenon ◽  
Right Heart

Inferior vena cava (IVC) diameter and respirophasic variation are commonly used echocardiographic indices to estimate right atrial pressure. While dilatation of the IVC and reduced collapsibility have traditionally been associated with elevated right heart filling pressures, the significance of isolated IVC dilatation in the absence of raised filling pressures remains poorly understood. We present a case of an asymptomatic 28-year-old male incidentally found to have IVC dilatation, reduced inspiratory collapse, and normal right heart pressures.

Role of right heart receptors in the control of renin, vasopressin, and cortisol secretion in dogs

1992 ◽  
Vol 263 (5) ◽  
pp. R1071-R1077 ◽  
Author(s):  
D. H. Carr ◽  
D. B. Jennings ◽  
T. N. Thrasher ◽  
L. C. Keil ◽  
D. J. Ramsay
Keyword(s):  
Inferior Vena ◽  
Vena Cava ◽  
Plasma Renin ◽  
Atrial Pressure ◽  
Right Atrial ◽  
Right Heart ◽  
Hormonal Responses ◽  
The Right ◽  
Maximal Reduction

We have reported that increased left heart pressure inhibits increases in plasma renin activity (PRA), arginine vasopressin (AVP), and cortisol during arterial hypotension. The goal of this study was to determine whether increases in right heart pressure also inhibited hormonal responses to hypotension. Seven dogs were chronically instrumented with inflatable cuffs around the ascending aorta (AA), the pulmonary artery (PA), and the thoracic inferior vena cava (IVC), as well as with catheters in both atria, the abdominal aorta, and vena cava. The IVC, the PA, and the AA cuffs were inflated on different days to cause step reductions in mean arterial pressure (MAP) of 5, 10, 20, and 30% below control MAP. Graded constriction of the AA caused large increases in left atrial pressure and plasma atrial natriuretic peptide (ANP), but had no effect on plasma AVP or cortisol and caused only a small increase in PRA at the maximal reduction of MAP. Constriction of the IVC reduced both atrial pressures and plasma ANP, but stimulated increases in PRA, AVP, and cortisol. Constriction of the PA increased right atrial pressure and plasma ANP and caused increases in plasma AVP and cortisol that were similar to responses during IVC constriction, but the PRA response was only half (P < 0.05). These results indicate that increasing pressure on the right side of the heart can attenuate the PRA response to hypotension, and suggest that the inhibition is mediated by the rise in plasma ANP.

scholarly journals A rare case of paradoxical pulmonary embolism in spontaneous aortocaval fistula

2021 ◽  
pp. 20200183
Author(s):  
Valentina Vespro ◽  
Stefano Fusco ◽  
Anna Maria Ierardi ◽  
Viviana Grassi ◽  
Ilenia D’Alessio ◽  
...  
Keyword(s):  
Pulmonary Embolism ◽  
Inferior Vena ◽  
Rare Complication ◽  
Vena Cava ◽  
Paradoxical Embolism ◽  
Aortocaval Fistula ◽  
Shortness Of Breath ◽  
Right Heart ◽  
Abdominal Ct ◽  
Abdominal Aortic

Aortocaval fistula (ACF) is a rare complication of abdominal aortic aneurysm (AAA), occurring in less than 1% of all AAAs. Paradoxical embolism can rarely be associated with ACF, pulmonary embolism may originate from dislodgment of thrombotic material from the AAA in the inferior vena cava (IVC) through the ACF. We report a case of a patient admitted to the emergency department with abdominal pain and shortness of breath who immediately underwent thoraco-abdominal CT. Imaging allowed a prompt pre-operative diagnosis of an ACF between an AAA and the IVC, also identifying CT signs of right heart overload and the presence of a paradoxical pulmonary embolism.

Partial Anomalous Venous Return (PAVR)

2010 ◽  
pp. 208-211
Author(s):  
Edward C. Rosenow
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Inferior Vena Cava ◽  
Congenital Heart ◽  
Inferior Vena ◽  
Venous Return ◽  
Vena Cava ◽  
Lower Lobe

• A third of cases are associated with congenital heart disease • Only a third of cases have anomalous vein of right lower lobe that looks like a scimitar (widens as it gets closer to inferior vena cava)

scholarly journals Platypnea-orthodeoxia syndrome after open prostatectomy and cystolithotomy: Coincidence or unknown pathophysiology?

2020 ◽  
Vol 8 ◽  
pp. 2050313X2090459
Author(s):  
Ismael P Flores ◽  
Alexandre T Maciel
Keyword(s):  
Case Report ◽  
Patent Foramen Ovale ◽  
Inferior Vena ◽  
Vena Cava ◽  
Sitting Position ◽  
Foramen Ovale ◽  
Open Prostatectomy ◽  
Anatomical Changes ◽  
Upper Abdominal ◽  
Cardiac Shunt

A few cases of platypnea-orthodeoxia syndrome have been described in the literature, some of them after thoracic or upper abdominal surgeries. In most cases, hypoxemia in the upright or sitting position, which is the main clinical symptom for this uncommon diagnosis, is usually related to a dynamic right to left cardiac shunt induced by anatomical changes in the relative position between the inferior vena cava and the atria in the presence of a patent foramen ovale. In this case report, we describe a situation in which platypnea-orthodeoxia syndrome developed acutely before surgery but that became severely exacerbated after an open urologic surgery without a clear acute anatomical change that could be responsible for triggering the syndrome. This case might suggest that the pathophysiology of acute platypnea-orthodeoxia syndrome is not completely elucidated and that other possible triggers for acute clinical manifestation in addition to acute anatomical thoracic changes must be explored.

scholarly journals 1099 Constrictive pericarditis:a challenge in Cardiology

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
C Kairis ◽  
C Stefanidis ◽  
B Saxpekidis ◽  
C Petridis ◽  
L Mosialos ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Pulmonary Artery ◽  
Inferior Vena Cava ◽  
Right Ventricle ◽  
Cardiac Catheterization ◽  
Constrictive Pericarditis ◽  
Inferior Vena ◽  
Vena Cava ◽  
Permanent Pacemaker ◽  
Right Heart

Abstract Funding Acknowledgements none A 50-year old woman had complained about dyspnea and leg swelling despite taking furosemide 80 mgr per day. Her past medical history had included radiation therapy for Hodgkin"s lymphoma, prosthetic heart valves (mechanical MV, AV- INR = 3,2) and permanent pacemaker. Also her coronary vessels were normal. On clinical examination she was non-febrile, the arterial pressure was 120/80mmHg,there was atrial fibrillation at 70 pulses/min at rest and oxygen saturation was 96%. The chest x-ray finding was left pleural effusion. The patient also had ascites. Kidney function was normal without proteinuria. The diagnostic paracentesis and biochemical analysis of ascitic fluid was indicative of transudative fluid.Cytologic analysis was negative for malignancy. Moreover,needle biopsy specimen was subjected to histopathology,which was negative for malignancy. Echocardiography had revealed normal size and function of left ventricle ( LV = 46mm-EF = 60%). The mechanical valves had normal function, without paravalvular leak or masses. Also right ventricle was normal. The pulmonary artery pressure measured by echocardiography was in the normal range (RVSP = 35mmHg), but the inferior vena cava was dilated.There were also dilated hepatic veins and hepatic vein flow reversal.There was variation&gt; 25% in triscupid inflow with respiration. TEE had confirmed the findings of transthoracic echo with regard of prosthetic valves. CT of chest and abdomen findings were no pathologic lymphadenopathy,no pulmonary embolism and absence of tumor compressing inferior vena cava. Chest CT scan had demonstrated pericardium thickening,indicative of constrictive pericarditis. CMR was not performed because of permanent pacemaker. The final step in diagnostic algorithm was cardiac catheterization: a)the pulmonary artery systolic pressure measured during right heart catheterization was 35mmHg. b)dip & plateau’ pattern or ‘square root sign of right ventricle, i.e. pattern of accentuated early dip in diastolic pressure, followed by plateauing in mid-late diastole. c)prominent y wave of right atrium- absent x wave because of AF. d)left ventriculography was not performed because of mechanical aortic valve. At the end constrictive pericarditis was confirmed by the surgical report. According to ESC guidelines a diagnosis of constrictive pericarditis is based on the association of signs and symptoms of right heart failure and impaired diastolic filling due to pericardial constriction by one or more imaging methods, including echocardiography, CT, CMR, and cardiac catheterization. However,the most important step is the suspicion of constrictive pericarditis, especially in patients with history of radiation therapy and heart surgery. Abstract 1099 Figure.

Venoarterial shunting from inferior vena cava to left atrium in atrial septal defects with normal right heart pressures

1967 ◽  
Vol 19 (2) ◽  
pp. 293-300 ◽  
Author(s):  
William L. Winters ◽  
Felix Cortes ◽  
Michael McDonouch ◽  
Ralph R. Tyson ◽  
Howard Baier ◽  
...  
Keyword(s):  
Inferior Vena Cava ◽  
Left Atrium ◽  
Inferior Vena ◽  
Vena Cava ◽  
Right Heart ◽  
Septal Defects ◽  
Atrial Septal Defects

P2473Non-invasive assessment of central venous pressure in heart failure: comparing three-dimensional echocardiography and Swan-Ganz catheter

2019 ◽  
Vol 40 (Supplement_1) ◽  
Author(s):  
T Szymczyk ◽  
L J Paluszkiewicz ◽  
A Costard-Jaeckle ◽  
V Rudolph ◽  
J F Gummert ◽  
...  
Keyword(s):  
Heart Failure ◽  
Inferior Vena ◽  
Venous Pressure ◽  
Three Dimensional ◽  
Vena Cava ◽  
Right Heart Catheterization ◽  
Heart Catheterization ◽  
Right Heart ◽  
Cross Sectional ◽  
Dimensional Echocardiography

Abstract Background Assessing hemodynamics, in particular central venous pressure (CVP) is essential in heart failure diagnostics, leading individual therapy. Hereby, invasive measurement through Swan-Ganz right heart catheterization (RHC) is considered gold standard for patient evaluation, but catheterization implies risks of invasiveness including bleeding, infection, vessel and nerve injury, as well as patient discomfort. Non-invasive methods are warranted, but no alternative technique is validated yet. Two-dimensional echocardiography (2DE) is believed to be uncertain in this approach as vena cava often shows ellipse-shapes. Therefore, this study sought to investigate standardized and breathing corrected three-dimensional inferior vena cava echocardiography (3DE) to directly compare CVP with right heart catheterization. Methods and results We prospectively included 100 consecutive heart failure patients in this study (mean age 53±12 years, body mass index 27±5, New York Heart Association functional class 2.3±0.6, left ventricular ejection fraction 34.1±12.8%, brain natriuretic peptide 658.13±974.03, 76% male), all underwent Swan-Ganz right-heart catheterization and immediately both 2DE and 3DE (Philips EPIQ 7G) of inferior vena cava. From two-dimensional data the diameter of IVC was measured perpendicularly in long and short-axis. From 3DE data a cross-sectional image of IVC was reconstructed for both vertical and horizontal diameters of IVC as well as the area of IVC. Established 2DE images revealed mean vena cava sizes of 15.9±5.9 mm, while standardized cross-sectional breathing corrected 3DE images showed diameters of 19.8±7.8 mm in longitudinal axis and 15.74±7.8 in short axis. RHC mean CVP was 9.00±5.4 mmHg and correlation of CVP and 2DE measurements failed adequate correlation (2DE 95% CI 0.19–1.61; r=0.25; p=0.312). However, 3DE axis ratio assessment correlated well with invasive CVP and showed reproducible results (3DE 95% CI 0.26–0.69; r=0.89; p<0.01). This resulted for a CVP cut point of 10 mmHg in a 89% true negative and 50% true positive correct detection. Conclusions Standardized 3DE correlates well with invasive CVP while established 2DE usual care assessment does not show reliable CVP correlation. 3DE CVP assessment may represent a more feasible and easily applicable method for CVP measurement, including absence for risks of right heart catheterization. Further studies are ongoing to validate these findings in the future.

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