Abstract 14595: The Clinical Impact of Portal Vein Pulsatility on the Prognosis of Hospitalized Acute Heart Failure Patients

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Naoya Kuwahara ◽  
Tomoyuki Honjo ◽  
Kenji Kaihotsu ◽  
Kohei Kamemura ◽  
Kazuhiko Nakayama ◽  
...  
Keyword(s):  
Heart Failure ◽  
Portal Vein ◽  
Prognostic Marker ◽  
Primary Endpoint ◽  
Right Heart Failure ◽  
Right Atrial ◽  
Portal System ◽  
Prognostic Analysis ◽  
Minimal Velocity ◽  
Hepatic Portal

Introduction: Heart failure (HF) especially right-heart failure causes hepatic portal system congestion. The Portal vein (PV) pulsatility can be influenced by right atrial pressure (RAP). However, the association between PV pulsatility and the condition of HF remains unclear. Hypothesis: In this study, we aim to evaluate usefulness of PV pulsatility as a prognostic marker as well as a therapeutic indicator for hospitalized acute HF patients. Methods: We enrolled 54 patients with acute HF and 17 patients without HF served as controls. PV flow velocity was measured by ultrasonography at admission and discharge phase. PV pulsatility ratio (PVPR) was calculated by dividing minimal velocity by peak velocity. The primary endpoint for prognostic analysis was cardiac death and unexpected re-hospitalization for recurrent HF. The observation period was one year from first hospitalization for HF. Results: On admission, PVPR was significantly higher in controls compared to acute HF patients (0.91±0.08 vs. 0.71±0.04, p&lt0.01).PVPR did not change during the hospitalization in controls (admission 0.91±0.08 vs discharge 0.93±0.06, p=0.31). However, in acute HF patients, PVPR was significantly elevated after the improvement of HF (admission 0.71±0.04 vs discharge 0.82±0.02, p&lt0.05) due to the increase in minimal velocity (admission 12.6±4.5 cm/s vs. discharge 14.6±4.6 cm/sec, p&lt0.05), indicating the decrease in RAP. To elucidate the association between PVPR and primary endpoint, the patients were divided into three groups according to the tertile of PVPR at discharge (PVPR-Q1:0.92&ltPVPR&lt1, PVPR-Q2: 0.73&ltPVPR&lt0.92, PVPR-Q3:PVPR&lt0.73). Kaplan-Meier analysis found that the patients with higher PV pulsatility at discharge had significantly higher event rate among the groups (Figure). Conclusions: PVPR at discharge would reflect the condition of HF. It also can be a novel prognostic marker for hospitalized acute HF patients.

Cardiac and Pericardial Echinococcosis: Report of 15 Cases

2007 ◽  
Vol 15 (4) ◽  
pp. 278-279 ◽  
Author(s):  
Vakeli Murat ◽  
Zhongxi Qian ◽  
Shuiyuan Guo ◽  
Jun Qiao
Keyword(s):  
Heart Failure ◽  
Developing Countries ◽  
Cardiopulmonary Bypass ◽  
Right Heart Failure ◽  
Right Atrial ◽  
Serologic Test ◽  
Right Heart ◽  
Late Death ◽  
The Right

Between 1978 and 2002, 15 patients (mean age, 23.0 ± 8.5 years) with cardiac and pericardial echinococcosis were treated surgically. The cysts were located in the right atrium in 3 patients, on the anterior myocardium in 7, and pericardially in 5. The 3 patients with right atrial cysts were operated on using cardiopulmonary bypass. There were 4 recurrences requiring re-operation after a mean of 12 months. All other patients received mebendazole treatment and exhibited no recurrence during follow-up. One late death due to chronic right heart failure occurred after 10 months of follow-up. The serologic test is an effective method of diagnosis in undeveloped and developing countries.

scholarly journals Giant right atrial aneurysm presenting as right heart failure

2012 ◽  
Vol 64 (2) ◽  
pp. 200-202 ◽  
Author(s):  
V.S. Narain ◽  
Aniket Puri ◽  
R. Sethi ◽  
Pallavi Aga ◽  
Suresh Behera ◽  
...  
Keyword(s):  
Heart Failure ◽  
Right Heart Failure ◽  
Right Atrial ◽  
Right Heart ◽  
Right Atrial Aneurysm

Tricuspid valve relocation with endomyocardial fibrosis removal for Löeffler’s endocarditis

2019 ◽  
Vol 56 (3) ◽  
pp. 622-624
Author(s):  
Tohru Asai ◽  
Fumihiro Miyashita ◽  
Hiromitsu Nota ◽  
Piers N Vigers
Keyword(s):  
Heart Failure ◽  
Right Ventricle ◽  
Right Atrium ◽  
Hypereosinophilic Syndrome ◽  
Right Heart Failure ◽  
Right Atrial ◽  
Endomyocardial Fibrosis ◽  
Right Heart ◽  
Atrial Enlargement ◽  
The Right

Abstract Löffler endocarditis with hypereosinophilic syndrome is rare but can cause critical ventricular obliteration by endomyocardial fibrosis. A 52-year-old woman experienced severe right heart failure with extreme shrinkage of her right ventricle, severe tricuspid regurgitation and marked right atrial enlargement. Preoperative tests showed identical pressures in the right atrium and pulmonary artery. Endocardial stripping was done, and to enlarge the right ventricle, we relocated the anterior and posterior tricuspid leaflets cephalad, up the right atrium wall, to ‘ventricularize’ a portion of the right atrium, with autologous pericardial augmentation of the tricuspid leaflets. An annuloplasty ring was added to reinforce the relocated tricuspid attachment. Right heart pressures normalized postoperatively. The patient recovered uneventfully. She has received corticosteroid therapy continuously and has shown no recurrence of heart failure in the 5 years since surgery.

Doppler-Based Renal Venous Stasis Index as a New Prognostic Marker in Right Heart Failure

2018 ◽  
Author(s):  
Faeq Husain-Syed ◽  
Horst-Walter Birk ◽  
Claudio Ronco ◽  
Tanja Schörmann ◽  
Khodr Tello ◽  
...  
Keyword(s):  
Heart Failure ◽  
Prognostic Marker ◽  
Right Heart Failure ◽  
Venous Stasis ◽  
Right Heart

Prognostic value and usefulness of Pulmonary Artery Pulsatility index (PAPi) in evaluation of heart transplant candidates

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
M Bellettini ◽  
S Pidello ◽  
G Gallone ◽  
S Frea ◽  
M Masetti ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Artery ◽  
Primary Endpoint ◽  
Pulmonary Circulation ◽  
Pulsatility Index ◽  
Prognostic Value ◽  
Cox Regression ◽  
Right Atrial ◽  
Heart Catheterization ◽  
Rv Function

Abstract Background Heart transplantation (HTx) is considered the best available treatment for patients with end stage heart failure. Candidate evaluation with right heart catheterization (RHC) is fundamental in order to exclude pulmonary hypertension with irreversible high pulmonary vascular resistance (PVR), which is associated with elevated post-HTx mortality. PVR, rather than directly measured, is derived by cardiac output and pulmonary artery pressures, which are strictly dependent on right ventricular (RV) function. The pulmonary artery pulsatility index (PAPi) is a hemodynamic parameter integrating the information of RV function and of pulmonary circulation, which could be useful in pre-HTx evaluation. Purpose We designed this study to evaluate the potential predictive influence of pre-HTx PAPi on post-HTx survival and to assess whether this index could add useful information in the pre-HTx evaluation of patients with advanced heart failure. Methods Consecutive adult HTx recipient at two medium-large tranplant centers between 2000 and 2017 with available data on pre-HTx RHC were retrospectively included. PAPi was calculated as the ratio of pulmonary artery pulse pressure to right atrial pressure. PAPi values in the lowest quartile were defined as reduced (PAPi<1.67). The primary endpoint was all-cause mortality at 1-year post-HTx. The association of reduced PAPi with the primary endpoint was evaluated. Cox regression was used to adjust for clinical and hemodynamic variables. Analyses stratified by PVR status (≥3 WU vs. <3 WU) were also performed. Results Among 655 HTx recipients (female 20,8%, age 53±11 years), median pre-HTx PAPi was 3.0 (interquartile range 1.67–5.32). Patients in the lowest versus the remaining PAPi quartiles had significantly reduced 1-year survival (78.0% vs 87.2%, p=0.006), also after adjusting for age, estimated glomerular filtration rate, total bilirubin, high PVR and urgent transplantation (adj-hazard ratio: 0.64; 95% confidence interval 0.51–0.82). When stratifying patients by estimated PVR status, reduced PAPi was associated with worse 1-year survival among patients with normal PVR (78.3% vs. 88.3% p=0.011), but not in those with increased PVR (78.0% vs. 82.6%, p=0.36) (Figure 1). Conclusions Pre-HTx PAPi, integrating information of RV function and pulmonary circulation, provides incremental prognostic value over traditional clinical and hemodynamic parameters among HTx recipient. The prognostic value appears important among patients with normal estimated PVR, possibly due to an underestimation of PVR in patients with impaired RV function. The integration of PAPi in the pre-HTx evaluation may lead to better patient selection and post-HTx survival. Figure 1. 1 year survival stratified by PVR status Funding Acknowledgement Type of funding source: None

scholarly journals Massively dilated right atrium masquerading as a mediastinal tumor

2011 ◽  
Vol 1 (1) ◽  
pp. 20
Author(s):  
Thomas Schroeter ◽  
Nicolas Doll ◽  
Sreekumar Subramanian ◽  
Friedrich W. Mohr ◽  
Michael A. Borger
Keyword(s):  
Heart Failure ◽  
Tricuspid Valve ◽  
Right Atrium ◽  
Mediastinal Tumor ◽  
Right Heart Failure ◽  
Right Atrial ◽  
Right Heart ◽  
Tricuspid Valve Insufficiency ◽  
Valve Insufficiency ◽  
The Right

Severe tricuspid valve insufficiency causes right atrial dilatation, venous congestion, and reduced atrial contractility, and may eventually lead to right heart failure. We report a case of a patient with severe tricuspid valve insufficiency, right heart failure, and a massively dilated right atrium. The enormously dilated atrium compressed the right lung, resulting in a radiographic appearance of a mediastinal tumor. Tricuspid valve repair and reduction of the right atrium was performed. Follow up examination revealed improvement of liver function, reduced peripheral edema and improved New York Heart Association (NYHA) class. The reduction of the atrial size and repair of the tricuspid valve resulted in a restoration of the conduit and reservoir function of the right atrium. Given the chronicity of the disease process and the long-standing atrial fibrillation, there is no impact of this operation on right atrial contraction. In combination with the reconstruction of the tricuspid valve, the reduction atrioplasty will reduce the risk of thrombembolic events and preserve the right ventricular function.

scholarly journals Hepatic and portal vein Dopplers in the clinical management of patients with right-sided heart failure: two case reports

2019 ◽  
Vol 11 (1) ◽  
Author(s):  
Matthew Jefkins ◽  
Barry Chan
Keyword(s):  
Heart Failure ◽  
Portal Vein ◽  
Case Reports ◽  
Systolic Dysfunction ◽  
Right Heart Failure ◽  
Venous Hypertension ◽  
Assessment Tools ◽  
Point Of Care Ultrasound ◽  
Right Heart ◽  
Vasopressor Support

Abstract Background Patients with right heart failure pose significant volume management challenges for hemodynamic optimization. We present two cases in which point of care ultrasound (POCUS) of the hepatic and portal veins contributed to the venous hypertension assessment and decongestive strategy for patients with right-sided heart failure. Case presentation Patient A was 91 years old with known pulmonary hypertension and right ventricular systolic dysfunction who presented in septic shock requiring vasopressor support. Hepatic and portal vein Dopplers were consistent with right heart failure and significant venous congestion, therefore, diuresis was initiated which resulted in portal flow normalization, renal recovery, and cessation of vasopressor support. Patient B was 82 years old with severe idiopathic pulmonary fibrosis on home oxygen who presented in decompensated right heart failure. Despite aggressive diuresis, a negative fluid balance was not achieved. The patient continued to deteriorate and prior to their death portal vein, Doppler showed significant flow reversal. Conclusion Hepatic and portal vein Doppler ultrasounds are venous hypertension assessment tools that can be readily used at the bedside by clinicians trained in POCUS that may contribute holistically to the hemodynamic profiling for patients with right heart failure and direct therapeutic interventions.

scholarly journals An atypical assessment of Ebstein’s anomaly in an 86-year-old man

2015 ◽  
Vol 76 (2) ◽  
Author(s):  
Antonello D’Andrea ◽  
Giancarlo Scognamiglio ◽  
Franco Giordano ◽  
Sergio Cuomo ◽  
Maria Giovanna Russo ◽  
...  
Keyword(s):  
Heart Failure ◽  
Natural History ◽  
Supraventricular Tachycardia ◽  
Right Heart Failure ◽  
Right Atrial ◽  
Ebstein’S Anomaly ◽  
Congenital Disease ◽  
Right Heart ◽  
Ebstein's Anomaly ◽  
History Of

We present the echocardiographic analysis of an 86- year-old man affected by Ebstein’s anomaly. In the natural history of this congenital disease only 5% of patients survive beyond the fifth decade. The patient presented severe right atrial dilatation and right heart failure, and he was referred to our institution for supraventricular tachycardia.

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