scholarly journals Right atrium and cryptogenic ischaemic stroke in the young: a case–control study

Open Heart ◽  
2021 ◽  
Vol 8 (1) ◽  
pp. e001596
Author(s):  
Pauli Pöyhönen ◽  
Jouni Kuusisto ◽  
Jani Pirinen ◽  
Heli Räty ◽  
Lauri Lehmonen ◽  
...  
Keyword(s):  
Young Adults ◽  
Right Atrium ◽  
Cryptogenic Stroke ◽  
Transoesophageal Echocardiography ◽  
Right Atrial ◽  
Anatomical Landmarks ◽  
Crista Terminalis ◽  
Maximal Volume ◽  
Minimal Volume ◽  
Right Atrial Appendage

BackgroundRecent studies suggest left atrial (LA) dysfunction in cryptogenic stroke. We studied the dynamics of right atrium (RA) and right atrial appendage (RAA) in young adults with cryptogenic stroke. We hypothesised that bi-atrial dysfunction and blood stagnation might contribute to thrombosis formation in patients with patent foramen ovale (PFO), as deep venous thrombosis is detected only in the minority of patients.MethodsThirty patients (aged 18–49) with a first-ever cryptogenic stroke and 30 age-matched and sex-matched stroke-free controls underwent cardiac magnetic resonance (CMR) imaging. An approach to estimate the RAA volume was developed, using crista terminalis and pectinate muscles as anatomical landmarks. Atrial expansion indices were calculated as (maximal volume – minimal volume) ×100%/minimal volume. Total pulmonary to systemic blood flow ratio (Qp/Qs) was based on phase contrast CMR. Right-to-left shunt (RLS) was evaluated with transoesophageal echocardiography in 29 patients and transcranial Doppler in 30 controls, moderate-to-severe RLS considered as clinically significant.ResultsWe found that RA and RAA volumes were similar between patients and controls. Also, RA expansion index was similar, but RAA (95.6%±21.6% vs 108.7%±25.8%, p=0.026) and LA (126.2%±28% vs 144.9%±36.3%, p=0.023) expansion indices were lower in patients compared with controls. Seven (24%) of 29 patients had an RLS compared with 1 (3%) of 30 controls (p=0.012). Among 59 study subjects, RLS was associated with lower RA (81.9%±15.9% vs 98.5%±29.5%, p=0.030), RAA (84.7%±18% vs 105.6%±24.1%, p=0.022), LA (109.8%±18.6% vs 140.1%±33.7%, p=0.017) and LAA (median 102.9% (IQR 65.6%–121.7%) vs 229.1% (151.8%–337.5%], p=0.002) expansion indices and lower Qp/Qs ratio (0.91±0.06 vs 0.98±0.07, p=0.027).ConclusionsThis study suggests bi-atrial dysfunction in young adults with cryptogenic stroke, associated with moderate-to-severe RLS. Dysfunction of the atria and atrial appendages may be an additional mechanism for PFO-related stroke.Trial registration numberNCT01934725.

scholarly journals Transthoracic Right Atrial Cannulation for Total Parenteral Nutrition — Case Report

1981 ◽  
Vol 9 (1) ◽  
pp. 53-57 ◽  
Author(s):  
L. Hayden ◽  
G. Ramsey Stewart ◽  
D. C. Johnson ◽  
M. McD. Fisher
Keyword(s):  
Parenteral Nutrition ◽  
Total Parenteral Nutrition ◽  
Right Atrium ◽  
Venous Catheter ◽  
Right Atrial ◽  
X Ray ◽  
Right Thoracotomy ◽  
Right Atrial Appendage ◽  
The Right ◽  
Nutrition Programme

A man with severe peripheral vascular disease and requiring total parenteral nutrition because of short bowel syndrome was referred because a central venous catheter could not be inserted by conventional techniques. A right thoracotomy was performed and a Hickman catheter inserted via the right atrial appendage into the right atrium. This catheter was used for a total of seven months for total parenteral nutrition. For the last two months of this time, the patient was maintained at home on a Home Parenteral Nutrition Programme. After four months of total parenteral nutrition the patient developed recurrent fevers and the catheter was found to have migrated from the right atrium into the pulmonary artery. The catheter was resited under x-ray control and used for a further three months until the recurrence of fever and dyspnoea heralded the onset of septic pulmonary emboli resulting in his death.

Assessing the Relationship Between Right Atrial Stiffness and Chamber Pressure to Quantitatively Define Myocardial Tensile Properties

2017 ◽  
Author(s):  
Alexander R. Mattson ◽  
Michael D. Eggen ◽  
Vladimir Grubac ◽  
Paul A. Iaizzo
Keyword(s):  
Right Atrium ◽  
Right Atrial ◽  
Chamber Pressure ◽  
Detailed Knowledge ◽  
Cardiac Device ◽  
Clinical Procedures ◽  
Tensile Forces ◽  
Pacemaker Leads ◽  
Right Atrial Appendage ◽  
The Right

Developing a successful cardiac device requires detailed knowledge of cardiac mechanical properties. For example, tissue failure characteristics and compliance feed into design criteria for many pacemaker leads (Zhao et al., 2011). In the right atrium, tensile forces are exerted on the right atrial appendage in multiple clinical procedures. In a traditional lead implant, mechanical manipulations with a stylet aid a clinician in assessing lead fixation, with a seldom used “tug” test providing additional input. Atrial lead dislodgement remains one of the top complications for bradycardia pacing leads (Chahuan et al., 1994), in part because there is no standard mechanical assessment at implant to verify fixation. Thus, a deeper understanding of forces exerted on the atrium during implant, is fundamental to understanding the problem. Further characterization of the biomechanics relevant to atrial device implants will provide valuable design input for fixation tests and help drive research toward new atrial fixation mechanisms. This study aims to better define the relationships between right atrial stiffness and the chamber pressures within the right atrium, so to characterize the link between tensile displacement within the right atrium, and the force exerted on an implanted device in a functional heart. These experiments quantitatively define the fixation force of a fixed cardiac device with a given pulled displacement; i.e. displacing the device a given distance will effectively ensure the experimentally derived fixation force.

scholarly journals P1474 Right or left; which sided the infective endocarditis is?

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A A Baskurt ◽  
E Ozpelit ◽  
Z Kumral ◽  
B Akdeniz
Keyword(s):  
Infective Endocarditis ◽  
Aortic Root ◽  
Right Atrium ◽  
Heart Surgery ◽  
Open Heart Surgery ◽  
Transoesophageal Echocardiography ◽  
Right Atrial ◽  
Replacement Surgery ◽  
Reactive Protein ◽  
The Right

Abstract ABSTRACT Treatment and management of infective endocarditis (IE) depends on the side of involvement. Involvement of both sides of heart is rarely encountered. We describe one case of both sided infective endocarditis caused by staphylococcus auerus. In this case, the vegetation is thought to be on the right side of the heart at first examination by transthrorasic echocardiography (TTE). However; when examined more carefully with transoesophageal echocardiography (TEE), nothing was as it seemed. CASE PRESENTATİON A 86-year-old woman, who underwent mechanic aortic valve replacement surgery 11 years before, was admitted to emergency room with fever, dispnea and cough. Physical examination showed a temperature of 38.6. Electrocardiography showed a atrial fibrillation of 112 beats/min. Laboratory tests revealed an elevated C reactive protein of 211 mg/l. The patient was empirically treated with intravenous piperacillin-tazobactam and teicoplanin, by the recommendation of infection disease unit. Staphylococcus aureus grew in both bottles of blood cultures. A TTE showed severe tricuspid regurgitation with vegetation, mild aortic regurgitation and moderate mitral regurgitation with no clear vegetation. We decided perform TEE and realised the vegetation in the right atrium was originated from the right atrial wall not from the tricuspid valve. Then we also noticed a thickening in the walls of aortic root with systolic expansion. This finding was consistent with paraaortic abscess formation. The 3D TEE examination helped us to understand the origin of the vegetation in the right atrium. Because the wall of the right atrium which the vegetation arised from was in direct continuity with the infected aortic root. We conclude that the paraortic abscess was spread to the right atrium by neighborhood. After one week of IV antibiotics treatment, the patient undergone open heart surgery. The surgical inspection confirmed the echocardiographic diagnosis. DISCUSSION Echocardiography helps us in diagnosis, determination of side of involvement, and complications of infective endocarditis. Usually the endocarditis invole only one side of the heart: left or right. We have found only four cases of double-sided endocarditis in literature. Our case is the first one , in which we describe a direct extension of aortic root abscess to the right atrium. Abstract P1474 figure 1

scholarly journals Morphology and Position of the Right Atrioventricular Valve in Relation to Right Atrial Structures

Diagnostics ◽  
2021 ◽  
Vol 11 (6) ◽  
pp. 960
Author(s):  
Jakub Hołda ◽  
Katarzyna Słodowska ◽  
Karolina Malinowska ◽  
Marcin Strona ◽  
Małgorzata Mazur ◽  
...  
Keyword(s):  
Right Atrium ◽  
Variable Structure ◽  
Atrial Appendage ◽  
Right Atrial ◽  
Variable Component ◽  
Atrioventricular Valve ◽  
Stable Point ◽  
Complex Anatomy ◽  
Right Atrial Appendage ◽  
The Right

The right atrioventricular valve (RAV) is an important anatomical structure that prevents blood backflow from the right ventricle to the right atrium. The complex anatomy of the RAV has lowered the success rate of surgical and transcatheter procedures performed within the area. The aim of this study was to describe the morphology of the RAV and determine its spatial position in relation to selected structures of the right atrium. We examined 200 randomly selected human adult hearts. All leaflets and commissures were identified and measured. The position of the RAV was defined. Notably, 3-leaflet configurations were present in 67.0% of cases, whereas 4-leaflet configurations were present in 33.0%. Septal and mural leaflets were both significantly shorter and higher in 4-leaflet than in 3-leaflet RAVs. Significant domination of the muro-septal commissure in 3-leflet valves was noted. The supero-septal commissure was the most stable point within RAV circumference. In 3-leaflet valves, the muro-septal commissure was placed within the cavo-tricuspid isthmus area in 52.2% of cases, followed by the right atrial appendage vestibule region (20.9%). In 4-leaflet RAVs, the infero-septal commissure was located predominantly in the cavo-tricuspid isthmus area and infero-mural commissure was always located within the right atrial appendage vestibule region. The RAV is a highly variable structure. The supero-septal part of the RAV is the least variable component, whereas the infero-mural is the most variable. The number of detected RAV leaflets significantly influences the relative position of individual valve components in relation to right atrial structures.

Antegrade Cardioplegia Decannulation Made Simple With the Cor-Knot System: Technique and Tips After 20 Consecutive and Controlled Patients

2020 ◽  
Vol 15 (5) ◽  
pp. 494-496
Author(s):  
Aristotelis Panos ◽  
Kyriakos Mpellos ◽  
Sylvio Vlad ◽  
Patrick O. Myers
Keyword(s):  
Minimally Invasive ◽  
Right Atrium ◽  
Right Atrial ◽  
Video Assisted ◽  
Cannulation Site ◽  
System Technique ◽  
Prolene Suture ◽  
Right Atrial Appendage ◽  
The Right

Closing the cardioplegia cannulation site can be challenging in minimally invasive video-assisted cardiac surgery. The Cor-Knot system is used to tie down valve sutures within the heart efficiently, although erosions to neighboring structures are reported. We hypothesized that a modification of the Cor-Knot system could enable safe hemostasis of the cardioplegia aortic root site and avoid erosions of the aorta or right atrium. This is a single-arm prospective study including 20 consecutive patients operated through a video-assisted method at our clinic between January 2019 and February 2019. At the end of the procedure, the suture was passed through a Cor-Knot device and crimped on a band of Teflon-felt. The two tips of the Teflon-felt toward the right atrium were put together and tightened with a 5/0 Prolene suture in order to protect the sharp ends of the device. Hemostasis was achieved using the technique in all 20 patients, with no requirement for further suture placement to ensure hemostasis of the cardioplegia cannulation site. The device was protected from the right atrial appendage and there was no bleeding. At 6-month follow-up, no patients required a reoperation for aortic or right atrial erosion. The Cor-Knot system was used off-label to close the cardioplegia cannulation site in minimally invasive surgery. This appears safe and effective in our initial 20-patient experience.

scholarly journals Sensing and pacing with floating electrodes in the right atrium and right atrial appendage

1987 ◽  
Vol 9 (2) ◽  
pp. 308-315 ◽  
Author(s):  
André E. Aubert ◽  
Bruce N. Goldreyer ◽  
Milford G. Wyman ◽  
Hugo Ector ◽  
Bart G. Denys ◽  
...  
Keyword(s):  
Right Atrium ◽  
Atrial Appendage ◽  
Right Atrial ◽  
Right Atrial Appendage ◽  
The Right

scholarly journals Prominent Eustachian Valve Mimicking Thrombus in Right Atrium Diagnosed with Computed Tomography in a Patient with Atrial Fibrillation

2020 ◽  
pp. 1-2
Author(s):  
Ibrahim SARI ◽  
Gülsüm Bingöl ◽  
Ibrahim SARI ◽  
Muharrem Nasıfov ◽  
Özge Özden Tok ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Right Atrium ◽  
Left Atrial Appendage ◽  
Thrombus Formation ◽  
Correct Diagnosis ◽  
Atrial Appendage ◽  
Right Atrial ◽  
Eustachian Valve ◽  
Right Atrial Appendage ◽  
The Right

A 51-year-old man presented with paroxsysmal atrial fibrillation (AF). Transthoracic echocardiography revealed mass of 2.3x0.6 cm adjacent to the superior part of the right atrium (RA) compatible with thrombus. Although thrombus formation in the setting of AF is more common in left atrial appendage and left atrium it can also be seen in right atrial appendage and RA. We performed cardiac computerized tomography (CCT) in order to clarify the nature of mass in RA and exclude coronary stenosis. CCT showed prominent eustachian valve measuring 3.2 cm which was not clear on echocardiography. This case underscores the importance of complementary cardiovascular imaging to facilitate the correct diagnosis.

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