Unusual Left Ventricular Function and Survival in Peripartum Cardiomyopathy

2000 ◽  
Vol 8 (2) ◽  
pp. 155-157
Author(s):  
Mandeep Bhargava ◽  
Mandeep Singh ◽  
Pujar Venkateshacharya Suresh ◽  
Rajneesh Juneja ◽  
Harinder Kumar Bali ◽  
...  
Keyword(s):  
New York ◽  
Enzyme Inhibitors ◽  
Heart Association ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Left Ventricular ◽  
Functional Class ◽  
Peripartum Cardiomyopathy ◽  
Class Iii ◽  
Converting Enzyme Inhibitors ◽  
New York Heart Association

A 34-year-old woman presented with congestive heart failure 3 months after her third pregnancy. She was stabilized in New York Heart Association functional class II with digoxin and diuretics for 21 years. She was readmitted with worsening symptoms and found to have a regional contraction abnormality. With the addition of angiotensin-converting enzyme inhibitors to her medication, she has been maintained in functional class III for a further 4 years.

Low- and High-renin Heart Failure Phenotypes with Clinical Implications

2018 ◽  
Vol 64 (3) ◽  
pp. 597-608 ◽  
Author(s):  
Noemi Pavo ◽  
Georg Goliasch ◽  
Raphael Wurm ◽  
Johannes Novak ◽  
Guido Strunk ◽  
...  
Keyword(s):  
Heart Failure ◽  
New York ◽  
Enzyme Inhibitors ◽  
Renin Angiotensin System ◽  
Heart Association ◽  
Angiotensin Converting Enzyme Inhibitors ◽  
Therapeutic Interventions ◽  
Converting Enzyme Inhibitors ◽  
Reduced Ejection Fraction ◽  
New York Heart Association

Abstract BACKGROUND Blockade of the renin–angiotensin system (RAS) represents a main strategy in the therapy of heart failure with reduced ejection fraction (HFrEF), but the role of active renin concentration (ARC) for guiding therapy in the presence of an RAS blockade remains to be established. This study assessed angiotensin profiles of HFrEF patients with distinct RAS activations as reflected by ARC. METHODS Two cohorts of stable chronic HFrEF patients on optimal medical treatment (OMT) were enrolled. We assessed ARC and all known circulating angiotensin metabolites, including AngI and AngII, by mass spectrometry to investigate the effect of different therapy modalities. Low- and high-renin HFrEF patients were identified by ARC screening and subsequently characterized by their angiotensin profiles. RESULTS Although different modes of RAS blockade resulted in typical AngII/AngI ratios, concentrations of (AngI+AngII) strongly correlated with ARC [r = 0.95, P < 0.001] independent of therapy mode. Despite RAS blocker treatment with angiotensin-converting enzyme inhibitors (ACE-I) or angiotensin II type 1 receptor blockers (ARB), which anticipated ARC upregulation, about 30% of patients showed lower/normal range ARC values. ARC did not correlate with N-terminal pro-B-type natriuretic peptide (NT-proBNP) concentrations and New York Heart Association (NYHA) stages. Angiotensin concentrations were profoundly diminished for the low-ARC group compared with the high-ARC group: AngI [6.4 ng/L (IQR: 2.1–12.5) vs 537.9 ng/L (IQR: 423.1–728.4), P < 0.001 for ACE-I; and 4.5 ng/L (IQR: 1.4–11.2) vs 203.0 ng/L (IQR: 130.2–247.9), P = 0.003 for ARB] and AngII [<1.4 ng/L (IQR: <1.4–1.5) vs 6.1 ng/L (IQR: 2.0–11.1), P = 0.002 for ACE-I and 4.7 ng/L (IQR: <1.4–12.3) vs 206.4 ng/L (IQR: 142.2–234.4), P < 0.001 for ARB]. CONCLUSIONS In addition to NT-proBNP and NYHA stages, ARC enables classification of HFrEF patients receiving OMT into more distinguished neurohumoral HFrEF phenotypes, offering a rationale for adaptive therapeutic interventions.

An Early Canadian Experience with the Correx Automated Coring and Apical Connector Device for Aortic Valve Bypass

2016 ◽  
Vol 11 (6) ◽  
pp. 434-438
Author(s):  
Hussein A. Al-Amodi ◽  
Christopher L. Tarola ◽  
Hamad F. Alhabib ◽  
Corey Adams ◽  
Linrui Ray Guo ◽  
...  
Keyword(s):  
New York ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Heart Association ◽  
Left Ventricular ◽  
Functional Class ◽  
New York Heart Association ◽  
Apical Connector ◽  
Aortic Valve Bypass

Objective Aortic valve replacement is the standard of care for severe, symptomatic aortic valve stenosis (AS); however, anatomy or preexisting comorbidities may preclude conventional or alternative transcatheter approaches. Aortic valve bypass (AVB) may be performed as a salvage procedure for the relief of symptomatic aortic stenosis in patients who are not suitable candidates for aortic valve replacement. Methods At our institution, seven patients underwent AVB using the Correx automated coring and apical connector system. All patients had severe AS with New York Heart Association functional class 3 symptoms and were not candidates for conventional or transcatheter approaches. Via a left anterolateral thoracotomy to access the descending aorta and left ventricular apex, we used the Correx system (Correx, Waltham, MA USA) to anastomose a valve conduit to the left ventricular apex proximally and the descending aorta distally. Three patients required cardiopulmonary bypass. Results In all seven patients, the automated coring and apical connector was successfully deployed. There were two in-hospital deaths in this series. Immediately postoperatively and at 3 months, there was a significant reduction in mean and peak valve gradients, and all surviving patients performed at New York Heart Association functional class 1. Conclusions Aortic valve bypass seems to be an acceptable alternative for the treatment of severe AS in high-risk patients who are not candidates for aortic valve replacement. The Correx automated system may improve the clinical applicability and surgical repro-ducibility of AVB in appropriately selected patients in which conventional or transcatheter aortic valve replacement is not a feasible options.

Real-Time Three-Dimensional Echocardiographic Study of Left Ventricular Function After Infarct Exclusion Surgery for Ischemic Cardiomyopathy

Circulation ◽  
2000 ◽  
Vol 102 (suppl_3) ◽  
Author(s):  
Jian Xin Qin ◽  
Takahiro Shiota ◽  
Patrick M. McCarthy ◽  
Michael S. Firstenberg ◽  
Neil L. Greenberg ◽  
...  
Keyword(s):  
New York ◽  
Ischemic Cardiomyopathy ◽  
Heart Association ◽  
Left Ventricular ◽  
Functional Class ◽  
Before And After ◽  
Infarct Exclusion ◽  
New York Heart Association ◽  
Lv Volume

Background —Infarct exclusion (IE) surgery, a technique of left ventricular (LV) reconstruction for dyskinetic or akinetic LV segments in patients with ischemic cardiomyopathy, requires accurate volume quantification to determine the impact of surgery due to complicated geometric changes. Methods and Results —Thirty patients who underwent IE (mean age 61±8 years, 73% men) had epicardial real-time 3-dimensional echocardiographic (RT3DE) studies performed before and after IE. RT3DE follow-up was performed transthoracically 42±67 days after surgery in 22 patients. Repeated measures ANOVA was used to compare the values before and after IE surgery and at follow-up. Significant decreases in LV end-diastolic (EDVI) and end-systolic (ESVI) volume indices were apparent immediately after IE and in follow-up (EDVI 99±40, 67±26, and 71±31 mL/m 2 , respectively; ESVI 72±37, 40±21, and 42±22 mL/m 2 , respectively; P <0.05). LV ejection fraction increased significantly and remained higher (0.29±0.11, 0.43±0.13, and 0.42±0.09, respectively, P <0.05). Forward stroke volume in 16 patients with preoperative mitral regurgitation significantly improved after IE and in follow-up (22±12, 53±24, and 58±21 mL, respectively, P <0.005). New York Heart Association functional class at an average 285±144 days of clinical follow-up significantly improved from 3.0±0.8 to 1.8±0.8 ( P <0.0001). Smaller end-diastolic and end-systolic volumes measured with RT3DE immediately after IE were closely related to improvement in New York Heart Association functional class at clinical follow-up (Spearman’s ρ=0.58 and 0.60, respectively). Conclusions —RT3DE can be used to quantitatively assess changes in LV volume and function after complicated LV reconstruction. Decreased LV volume and increased ejection fraction imply a reduction in LV wall stress after IE surgery and are predictive of symptomatic improvement.

Cardiac resynchronization therapy for ischemic myopathy

2016 ◽  
Vol 25 (5) ◽  
pp. 383-385
Author(s):  
Shinichiro Ikeda ◽  
Hideo Yoshida ◽  
Keiji Yunoki ◽  
Kunikazu Hisamochi
Keyword(s):  
New York ◽  
Cardiac Resynchronization Therapy ◽  
Heart Association ◽  
Left Ventricular ◽  
Functional Class ◽  
Cardiac Resynchronization ◽  
Resynchronization Therapy ◽  
Mitral Valve Plasty ◽  
New York Heart Association ◽  
The Right

We performed coronary artery grafting, mitral valve plasty, and tricuspid plasty in a 75-year-old man who had double-vessel coronary disease and moderate mitral and tricuspid insufficiency. Preoperative transthoracic echocardiography revealed an ejection fraction of 34% and dyssynchronous wall motion of the septum and free wall. We placed pacing leads on the right ventricular outlet and posterior left ventricular wall for cardiac resynchronization therapy. The dyssynchrony disappeared postoperatively and the New York Heart Association functional class improved from IV to I.

Cardiac recovery following left ventricular assist device therapy: experience of complete device explantation including ventricular patch plasty

2020 ◽  
Author(s):  
Takayuki Gyoten ◽  
Sebastian V Rojas ◽  
Henrik Fox ◽  
Masatoshi Hata ◽  
Marcus-André Deutsch ◽  
...  
Keyword(s):  
New York ◽  
Ventricular Assist Device ◽  
Heart Association ◽  
Left Ventricular ◽  
Functional Class ◽  
Myocardial Recovery ◽  
Assist Device ◽  
Ventricular Assist ◽  
New York Heart Association ◽  
Patch Plasty

Abstract   OBJECTIVES Myocardial recovery is a rare phenomenon in left ventricular assist device (LVAD) therapy. Surgical LVAD removal is associated with the risk of cardiac failure, and the individual evaluation of sufficient myocardial recovery is crucial. Thus, complete device explantation is not consistently performed to minimize perioperative risk. However, the remaining ventricular assist device components bear significant risks of infection or thrombosis. Therefore, we developed this study to evaluate a complete LVAD explantation protocol. METHODS All patients in our institution who had an LVAD explanted were enrolled in the study. Explant surgery involved removal of the driveline, pump housing, sewing ring and outflow graft. The ventricular wall was reconstructed by double patch plasty. Our analysis focused on surgical and postoperative outcome parameters, including all-cause mortality and major adverse cardiac and cerebrovascular events. RESULTS A total of 12 patients (HVAD, n = 5; HeartMate II, n = 3; HeartMate 3, n = 4) had myocardial recovery and qualified for our LVAD explantation study protocol [median age: 40 years, interquartile range (IQR) 33–52 years; 50% men]. Primary heart failure aetiology: myocarditis (n = 5), dilated cardiomyopathy (n = 4), toxic cardiomyopathy (n = 2) and valvular heart failure (n = 1). The median average duration on LVAD was 10 months (25–75%: IQR 8.5–30 months). The median left ventricular ejection fraction was 15% (IQR 13–18%) at LVAD implantation and 50% (IQR 45–50%) before LVAD explantation (P = 0.0025).The 30-day survival was 100%. The 1-year survival was 91.7%. All patients were discharged after a median 13 days (IQR 10–18 days) postoperatively. No patient had major adverse cardiac and cerebrovascular events. The New York Heart Association functional class remained consistent during the follow-up period (median New York Heart Association functional class: II, IQR II–II class) including preservation of ventricular function. CONCLUSIONS Complete LVAD explantation with ventricular patch plasty is feasible and has consistent long-term results.

scholarly journals EXPRESS: A multicenter retrospective study of patients with pulmonary hypertension transitioned from inhaled to oral treprostinil

2021 ◽  
pp. 204589402199820
Author(s):  
Diane L Zwicke ◽  
Ricardo Restrepo-Jaramillo ◽  
Hassan Alnuaimat ◽  
Kathryn Gordon ◽  
Meredith Broderick ◽  
...  
Keyword(s):  
New York ◽  
Pulmonary Hypertension ◽  
Retrospective Chart Review ◽  
Heart Association ◽  
Oral Formulation ◽  
Functional Class ◽  
World Health ◽  
Class Iii ◽  
New York Heart Association ◽  
Health Organization

Oral treprostinil has recently been shown to delay disease progression in patients with pulmonary arterial hypertension (PAH) in a long-term outcomes study. The potential advantages of an oral formulation have resulted in patients transitioning from inhaled to oral treprostinil. The current study reports a retrospective analysis of patients who transitioned from treatment with inhaled to oral treprostinil. A multicenter retrospective chart review was conducted for 30 patients with pulmonary hypertension that transitioned from inhaled to oral treprostinil. Data were collected from inhaled treprostinil initiation and patients were followed until discontinuation of oral treprostinil or the end of the observation period. Persistence was calculated using Kaplan-Meier estimates. Prior to transition to oral treprostinil, patients had received inhaled treprostinil for a median of 643 (IQR: 322, 991) days and 52% of patients were New York Heart Association (NYHA)/World Health Organization (WHO) Functional Class III. For patients that cross titrated between formulations, the median time to complete the cross titration was 24 (IQR: 1, 57) days. At 16- and 24-weeks post transition, oral treprostinil persistence was 86% and 76%, respectively. Persistence was 59% at 52 weeks post transition. Clinical stability for the majority of patients at first follow-up post transition was suggested based on available NYHA/WHO Functional Classification. Transitions from inhaled to oral treprostinil appeared safe and tolerable in the short-term. Additional prospective studies are needed to fully evaluate the safety and efficacy of transitions from inhaled to oral treprostinil.

scholarly journals Effectiveness of Artificial Neochordae Implantation in Tricuspid Valve Repair

2019 ◽  
Vol 46 (2) ◽  
pp. 100-106
Author(s):  
Salih Salihi ◽  
H. Tarik Kiziltan ◽  
Ahmad Huraibat ◽  
Askin Ali Korkmaz ◽  
Ibrahim Kara ◽  
...  
Keyword(s):  
New York ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Heart Association ◽  
Functional Class ◽  
Tricuspid Valve Repair ◽  
Class Iii ◽  
Valve Repair ◽  
New York Heart Association

Various techniques for treating tricuspid regurgitation have been described; however, because of scarce data about the long-term outcomes of different repairs, the optimal technique has not been established. We evaluated the effectiveness and durability of artificial neochordae implantation in the treatment of tricuspid regurgitation. From 2009 through 2014, 507 patients underwent tricuspid valve repair at our institution. Of those, 48 patients implanted with artificial neochordae were included in our study. The median age of the participants was 62 years (range, 4–77 yr) and 50% were women. Thirty patients (63%) were in New York Heart Association functional class III, and 11 (23%) were in class II. The cause of tricuspid regurgitation was functional in 33 patients (69%) and rheumatic in 15 (31%). In 46 patients, neochordae implantation was performed in addition to Kay annuloplasty (n=13) or ring annuloplasty (n=33). Forty-two patients were discharged from the hospital with absent or mild tricuspid regurgitation. The mean follow-up period was 44.3 ± 20.2 months. Follow-up echocardiograms revealed that tricuspid regurgitation was absent, minimal, or mild in 38 patients (80.8%), moderate in 7, and severe in 2. Our results indicate that the use of artificial neochordae implantation as an adjunct procedure to annuloplasty leads to effective and durable repair in comparison with conventional techniques for treating tricuspid regurgitation.

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