scholarly journals Postoperative Echocardiographic Reduction of Right Ventricular Function: Is Pericardial Opening Modality the Main Culprit?

2017 ◽  
Vol 2017 ◽  
pp. 1-7 ◽  
Author(s):  
Marco Zanobini ◽  
Matteo Saccocci ◽  
Gloria Tamborini ◽  
Fabrizio Veglia ◽  
Alessandro Di Minno ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Right Ventricular ◽  
Systolic Function ◽  
Right Ventricular Systolic Function ◽  
Main Culprit ◽  
Echocardiographic Parameters ◽  
Group A ◽  
Group B ◽  
Rv Function

Echocardiographic reduction of RV function, measured using TAPSE, is a well described phenomenon after cardiac surgery. The aim of the present study was to investigate the relation between the modality of pericardial opening (lateral versus anterior) and the postoperative right ventricular systolic function by comparing echocardiographic parameters in patients undergoing minimally invasive or traditional mitral valve repair. 34 patients with severe mitral regurgitation due to mitral valve prolapse underwent traditional (sternotomy) operation (Group A) or minimally invasive surgery with right anterolateral thoracotomy (Group B). A postoperative TAPSE fall was found in both groups. Group A experienced a significant postoperative TAPSE fall versus Group B withp<0.0001.

scholarly journals Video-assisted Minimally Invasive Mitral Valve Surgery versus Conventional Mitral Surgery in Rheumatic Patients

2020 ◽  
Author(s):  
Ayman Badawy ◽  
Mohamed Alaa Nady ◽  
Mohamed Ahmed Khalil Salama Ayyad ◽  
Ahmed Elminshawy
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Invasive Approach ◽  
Video Assisted ◽  
Group A ◽  
Group B

Background: Minimally invasive mitral valve surgery became an attractive option because of its cosmetic advantages over the conventional approach. The superiority of the minimally invasive approach regarding other aspects is still debatable. The aim of our study was to determine the potential benefits of minimally invasive mitral valve replacement with intraoperative video assistance over conventional surgery. Methods: This is a single-center prospective cohort study that included 60 patients with rheumatic heart disease who underwent mitral valve replacement. Patients were divided into two groups: group (A) included patients who had conventional sternotomy (n= 30), and group (B) included patients who had video-assisted minimally invasive mitral valve replacement (n= 30). Intraoperative and postoperative outcomes were compared between both groups. Results: Mortality occurred in one patient in the group (A). Cardiopulmonary bypass time was 118.93 ± 29.84 minutes vs. 64.73 ± 19.16 minutes in group B and A respectively (p< 0.001), and ischemic time was 102.27 ± 30.03 minutes vs. 53.67± 18.46 minutes in group B and A respectively (P < 0.001). Ventilation time was 2.77± 2.27 vs. 6.28 ± 4.48 hours in group B and A respectively (p< 0.001) and blood transfusion was 0.50 ± 0.63 vs. 2.83 ± 1.34 units in group B and A respectively (p< 0.001).  ICU stay was 1.73 ± 0.64 days in the group (B) vs. 4.47 ± 0.94 days in group A (p< 0.001). Postoperative bleeding was 353.33 ± 146.77 ml in the group (B) vs. 841.67 ± 302.03 ml in group A (p <0.001). No conversion to full sternotomy was reported in group B. In group (B), two cases (6.6%) required re-exploration for bleeding vs. four cases (13.2%) in group (A) (p=0.67). The hospital stay was 6.13 ± 1.59 days in the group (B) vs. 13.27 ± 7.62 days in group A (p< 0.001). Four cases (13.3%) developed mediastinitis in group A and in the group (B), there was one case of acute right lower limb embolic ischemia. Conclusion: Video-assisted minimally invasive mitral operations could be a safe alternative to conventional sternotomy with the potential of lesser morbidity and earlier hospital discharge.

scholarly journals Standardized subannular repair for type IIIb functional mitral regurgitation in a minimally invasive mitral valve surgery setting†

2019 ◽  
Vol 56 (5) ◽  
pp. 968-975 ◽  
Author(s):  
Jonas Pausch ◽  
Eva Harmel ◽  
Christoph Sinning ◽  
Hermann Reichenspurner ◽  
Evaldas Girdauskas
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Minimally Invasive ◽  
Functional Mitral Regurgitation ◽  
Invasive Approach ◽  
Type Iiib ◽  
Duration Of Surgery ◽  
Group A ◽  
Group B

Abstract OBJECTIVES Subannular repair techniques in addition to undersized ring annuloplasty have been developed to address high mitral regurgitation (MR) recurrence rates after mitral valve repair in type IIIb MR. We compared the results of annuloplasty with simultaneous standardized subannular repair versus isolated annuloplasty, focusing on the periprocedural outcomes of minimally invasive procedures. METHODS A consecutive series of 108 patients with type IIIb functional MR with severe signs of bileaflet tethering underwent an annuloplasty + subannular repair (group A; n = 60) versus isolated annuloplasty (group B; n = 48). The primary end point of this prospective, parallel cohort study was death or recurrent MR >2, 1 year postoperatively. The secondary end points were survival and clinical outcomes, with special regard for the minimally invasively treated subgroups. RESULTS Duration of surgery, cardiopulmonary bypass time and aortic cross-clamp time were comparable between both study groups. Procedural outcomes as well as echocardiographic outcome parameters were similar and independent of access (fully endoscopic versus full sternotomy). At the 12-month follow-up, death or MR >2 occurred in 3.3% (2/60) of patients in group A vs in 20.8% (10/48) of patients in group B (P = 0.037). The overall mortality rate during the follow-up period was 1.7% (1/60) in group A vs 12.5% (6/48) in group B (P = 0.041). CONCLUSIONS Standardized realignment of papillary muscles is feasible and reproducible via a minimally invasive approach, resulting in excellent periprocedural outcomes, and has a clear potential to significantly decrease MR recurrence and improve 1-year outcomes compared to isolated annuloplasty.

scholarly journals P990 Multi-plane echocardiographic analysis of right ventricular function in patients with systemic and subpulmonic physiology

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
A Van Berendoncks ◽  
D J Bowen ◽  
J Mcghie ◽  
J Cuypers ◽  
M Kauling ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Congenital Heart ◽  
Systolic Function ◽  
Daily Practice ◽  
Specific Analysis ◽  
Echocardiographic Parameters ◽  
Apical View ◽  
First Time ◽  
Coronal View ◽  
Rv Function

Abstract Background Right ventricular (RV) function is recognized as a prognostic factor in congenital heart disease (CHD). Accurate echocardiographic parameters to assess systolic function in systemic RV (sRV) lacking. We previously introduced a novel four-view approach with different RV walls visualized in their long axis from one apical view using 2D-multi-plane transthoracic echocardiographic (TTE) (iRotate). Aims To extensively evaluate RV systolic function using iRotate echocardiography in CHD patients with systemic RV compared with a whole spectrum of CHD patients with abnormally loaded subpulmonic RV. Methods and Results Thirty CHD patients with sRV and 112 age, gender and BSA matched patients with abnormally loaded subpulmonic RV were recruited from the outpatient clinic. All subjects underwent complete TTE with evaluation of TAPSE, TDI S’ and peak systolic global longitudinal RV strain (RV-GLS) from the RV walls using the four-view iRotate model. The feasibility of TAPSE and TDI S’ ranged between 94% and 100%. The feasibility of RV-GLS in CHD was 98%, 69%, 87% and 72% respectively in the lateral, anterior, inferior and inferior coronal view walls. All echocardiographic parameters were significantly lower in sRV compared to versus subpulmonic RV cohort (p &lt; 0.001) (Table). Conclusion This study provides for the first time an extensive RV specific analysis of the systemic RV. The feasibility of all RV parameters in the four-view iRotate model is excellent in CHD and represents a reproducible, easily applicable and complete RV assessment in daily practice. Systolic function is significantly reduced in systemic RV compared to subpulmonic RV physiology. Abstract P990 Figure.

Absence of Relationship of Myocardial T2* to Right Ventricular Function In Thalassaemia Major

Blood ◽  
2010 ◽  
Vol 116 (21) ◽  
pp. 5160-5160
Author(s):  
Vassilios Perifanis ◽  
Antonia Kondou ◽  
Aikaterini Teli ◽  
Efthimia Vlachaki ◽  
Marina Economou ◽  
...  
Keyword(s):  
Magnetic Resonance ◽  
Right Ventricular ◽  
Right Ventricular Function ◽  
Lv Function ◽  
Iron Loading ◽  
Thalassaemia Major ◽  
Cardiac Iron ◽  
Group A ◽  
Group B ◽  
Rv Function

Abstract Abstract 5160 Iron-induced cardiac dysfunction is a leading cause of death in transfusion-dependent anemia. Myocardial T2* magnetic resonance imaging (MRI) provides a rapid and reproducible measure of cardiac iron loading and is being increasingly used worldwide for monitoring of transfusion-dependent thalassaemia patients. Recent reports associate myocardial siderosis (T2* <20 ms) with impaired left ventricular (LV) function, as well as with right ventricular (RV) function. As RV dysfunction may play a significant role in heart failure associated with myocardial siderosis the aim of this study was to investigate the relationship between cardiac T2* and RV function in patients treated in a single institution. Methods: A retrospective analysis of 190 well chelated patients with beta-thalassaemia major presenting for their first T2*. MRI scan (examination year 2005) was performed (53.7% male, mean age 26,2±8,3 years). The majority of patients were on Desferrioxamine and 30% were on Deferiprone. Patient's mean ferritin, mean T2* and mean RVEF was 1467±1087 ng/ml, 32,5±15,8ms and 67,9±5,25% respectively. Magnetic resonance images were acquired using a single imager (Philips®, Philips Medical Systems Ltd, Eindhoven, The Netherlands) equipped with a 1.5 Tesla magnet. Each scan included the measurement of heart T2* (mid-septum) together with LV and RV volumes, EF, and mass using previously published techniques. Pearson correlation was used to assess the statistical significance between myocardial T2*, ferritin, RV volumes (End Systolic and End Diastolic), and EF. Results: In 156 patients (Group A) with normal myocardial T2* (>20 ms), the RV ejection fraction (EF) was within the normal range (>55%) in all of them. Mean ferritin, mean T2* and mean RVEF for Group A was 1397±1007ng/ml, 39±11ms and 68,6 ±4,8% respectively. No correlation with feritin was found. In the remaining 34 patients (Group B) with myocardial T2* <20ms, mean ferritin, mean T2* and mean RVEF was 1664±1341ng/ml, 10,8±4,2ms and 64,8±7,35% respectively. Although there was a good correlation between T2* and RVEF for the entire group (A+B) (r=0,312, p=0,001) we did not find a correlation between T2* and RVEF for Group B (r=0,074, p=ns). In the contrary there was a strong correlation between T2* and ferritin for Group B (r=0,382, p=0,0034). There was no other significant correlation between T2* and RESV, REDV for both groups. There was a linear relationship between RV and LVEF for the whole group (r=0,454, p=0,001), for Group A (r=0,269, p=0,015) and more significant for Group B (r=0,720, p=0,001). Conclusions: Myocardial iron deposition by MRI seems not to be associated with RV dysfunction, although it is related to ferritin. The decrease in LV function seen with worsening cardiac iron loading does not necessarily predicts right ventricular dysfunction. The only limitation of our study is that in contrast with other reports the percentage of patients with abnormal T2* was smaller (18%). Larger studies are required to determine the relation of right ventricular function and cardiac iron overload. Disclosures: No relevant conflicts of interest to declare.

Abstract 15733: CD34 + Cell Therapy is Associated With Improved Right Ventricular Function in Heart Failure With Preserved Ejection Fraction

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Sabina Frljak ◽  
Gregor Poglajen ◽  
Gregor Zemljic ◽  
Andraz Cerar ◽  
Francois Haddad ◽  
...  
Keyword(s):  
Heart Failure ◽  
Ejection Fraction ◽  
Cell Therapy ◽  
Right Ventricular ◽  
Cell Transplantation ◽  
Left Ventricular ◽  
Preserved Ejection Fraction ◽  
Group A ◽  
Group B ◽  
Rv Function

Introduction: Right ventricular (RV) dysfunction is an important predictor of adverse prognosis in patients with heart failure with preserved ejection fraction (HFpEF). Hypothesis: We sought to investigate the effects of transendocardial CD34 + cell therapy on RV function in HFpEF patients. Methods: We enrolled 30 patients with HFpEF who underwent transendocardial CD34 + cell transplantation. At baseline, all patients received granulocyte-colony stimulating factor; cells were collected by apheresis and immunomagnetic selection and injected transendocardialy in the left ventricle targeting the areas of local diastolic dysfunction. Patients were followed for 6 months and changes in RV function were assessed by tricuspid annular plane systolic excursion (TAPSE), peak systolic velocity of tricuspid annulus (St), and fractional area change (FAC). Impaired RV function was defined as TAPSE<1.8 cm. Results: At baseline, RV function was impaired in 11 (37%, Group A), and preserved in 19 (63%, Group B) of patients. The groups did not differ in age (64±6 years in Group A vs. 61±11 years in Group B, P=0.37), gender (male: 82% vs. 74%, P=0.61), or left ventricular E/e' (17.7±2.3 vs. 17.3±3.4, P=0.74). Patients in Group A had lower LVEF (55.6±5.1% vs. 61.3±6.5% in Group B, P=0.02), and higher NTproBNP levels (1750±1139 pg/ml vs. 1038±658 pg/ml, P=0.05). At 6 months after cell transplantation we found an overall improvement in all parameters of RV function (TAPSE: +0.21±0.37 cm, P=0.01; St: +0.7±2.1 cm/s, P=0.03; FAC: +8.5±1.9%, P=0.02). However, RV function improvement was significant in Group A (TAPSE: +0.43±0.37 cm, P=0.004; St: +1.4±2.3 cm/s; P=0.01; FAC: +9.8±2.0%, P=0.01), but not in Group B (TAPSE: +0.04±0.27 cm, P=0.65; St: +0.4±1.3 cm/s, P=0.32; FAC: +7.1±3.7%, P=0.08). In both groups we found comparable changes in E/e' (-5.1±3.0 in Group A vs. -5.9±3.2 in Group B, P=0.53), LVEF (1.2±5.7% vs. 1.9±6.5%, P=0.45) and NTproBNP (-462±410 pg/ml vs. -390±398 pg/ml, P=0.64) at 6 months after cell transplantation. Conclusions: Transendocardial CD34 + cell therapy appears to be associated with improvement of right ventricular dysfunction in patients with HFpEF.

Clinical Results of Minimally Invasive Mitral Valve Surgery

2009 ◽  
Vol 4 (6) ◽  
pp. 311-318 ◽  
Author(s):  
Fabio Ius ◽  
Enzo Mazzaro ◽  
Vincenzo Tursi ◽  
Giorgio Guzzi ◽  
Enrico Spagna ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Minimally Invasive ◽  
Heart Association ◽  
Clinical Results ◽  
Mitral Valve Surgery ◽  
Valve Surgery ◽  
Actuarial Survival ◽  
Significant Difference ◽  
Group A ◽  
Group B

Objective This study was carried out with the aim of presenting our experience with minimally invasive mitral surgery and compare the endoaortic clamp with the external aortic clamp (EAC) techniques. Methods Between December 2002 and May 2009, 139 patients (75 men, aged 63 ± 11 years) underwent video-assisted mitral valve surgery through right thoracotomy. Twelve (9%) patients were operated without clamping the aorta, 32 (23%) patients (group A) were operated on by using the endoaortic clamp, and 95 (68%) patients were operated on by using the EAC (group B). There was no significant difference between groups A and B regarding preoperative variables. Results Intraoperative procedure-associated problems were experienced in three group A patients (9.3%, two aortic dissections with conversion to sternotomy; one conversion due to bad exposure) and in two group B patients (2%, one conversion to sternotomy for bleeding and one for ascending aorta hematoma). At a mean follow-up of 32 months, 121 patients (97%) were in New York Heart Association class I–II, with satisfactory echocardiographic results. There was one in-hospital and six late deaths (three noncardiac, two cardiac, and one valve related). Five-year actuarial survival was 88% ± 8%. There were three reoperations, one early (<30 days) after complex mitral valve repair, with a 5-year freedom from reoperation of 97% ± 2%. Postoperative levels of myocardial cytonecrosis enzymes as well as the extracorporeal circulation time were significantly lower in group B patients (P < 0.05). Conclusions Intraoperative procedure-associated complications with endoclamping combined with an apparently better myocardial protection forced us to change our practice to the more simple and economic EAC technique.

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