Prognostic Factors for Late Ventricular Arrhythmias after Repair of Tetralogy of Fallot

1997 ◽  
Vol 5 (1) ◽  
pp. 20-24
Author(s):  
Fumikazu Nomura ◽  
Seiichiro Ikawa ◽  
Keishi Kadoba ◽  
Masataka Mitsuno ◽  
Yoshiki Sawa ◽  
...  
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Ventricular Arrhythmias ◽  
Right Atrial ◽  
Age At Surgery ◽  
Group A ◽  
Group B ◽  
The Right

During a median follow-up period of 9 years (ranging from 9 months to 25 years), 24-hour ambulatory electrocardiographic studies were undertaken in 155 patients after repair of tetralogy of Fallot. The patients were divided into two groups. Group A consisted of 76 patients in whom the right ventricular approach was used and group B comprised 79 patients whose repair was through the right atrium. A transannular patch was employed in all patients in group A and in none of the patients in group B. Age at surgery was between 1 and 37 years (median age 4.8 years). During follow-up, 37 patients (48.6%) in group A had significant ventricular arrhythmias (Lown grade 2 or higher) and 13 patients (15.4%) in group B had significant ventricular arrhythmias. A close relationship was observed between age at surgery and Lown grade (R2 = 0.374, p < 0.001) and between follow-up duration and Lown grade (R2 = 0.514, p < 0.001), especially when the two groups were analyzed separately (R2 = 0.502, 0.476, p < 0.001). In contrast, no significant relationship was observed between the ratio of right ventricular to left ventricular pressure and Lown grade or between right ventricular systolic pressure and Lown grade. Discriminant analysis revealed risk factors associated with postoperative ventricular arrhythmias are follow-up duration (partial F = 3.22, p < 0.01), right ventricular to pulmonary artery pressure gradient (partial F = 3.35, p < 0.01), and operative method (partial F = 2.4, p < 0.05). Despite antiarrhythmic therapy, 11 of 22 late postoperative deaths occurred suddenly, presumably from ventricular arrhythmias. In this series of patients, the right atrial and pulmonary artery approach significantly reduced the risk of life-threatening ventricular arrhythmias after repair of tetralogy of Fallot.

Right heart pressures and blood-gas tensions in ponies during exercise and laryngeal hemiplegia

1986 ◽  
Vol 251 (1) ◽  
pp. H121-H126 ◽  
Author(s):  
M. Manohar
Keyword(s):  
Heart Rate ◽  
Pulmonary Artery ◽  
Pleural Pressure ◽  
Right Atrial ◽  
Stride Frequency ◽  
Group A ◽  
Alveolar Hypoxia ◽  
Severe Exercise ◽  
Group B ◽  
The Right

Right atrial, right ventricular, and pulmonary artery pressures, along with change in pleural pressure, were determined with catheter-tipped micromanometers in two groups of ponies at rest, as well as during moderate (trot; heart rate = 180 beats . min-1) and severe (gallop; heart rate = 220 beats . min-1) exercise performed on a treadmill. Group A (n = 8) ponies served as controls, and group B ponies (n = 6) had laryngeal hemiplegia (LH) induced by sectioning the left recurrent laryngeal nerve 20-29 days before the study. It was observed that LH ponies could not gallop for more than 45-90 s. With both levels of exertion, pressures in the right atrium, right ventricle, and pulmonary artery increased very significantly in normal ponies. The change in pleural pressure of galloping ponies was 30.4 +/- 2.9 cmH2O, and the respiratory (and stride) frequency was 138 +/- 4 breaths . min-1. During severe exercise in normal ponies, the systolic, mean, and diastolic pressures in the pulmonary artery were 107 +/- 7, 63.5 +/- 4.2, and 46 +/- 4 mmHg, despite the fact that no alveolar hypoxia could be detected. In LH ponies pulmonary artery pressures rose to levels observed in normal ponies, but during galloping, the change in pleural pressure (delta Ppl) (92 +/- 6 cmH2O) was three times that in normal ponies, and there was no synchronization of respiratory (86 +/- 6 breaths . min-1) frequency to stride frequency (142 +/- 3 strides . min-1). Despite these respiratory adjustments (decreased frequency and increased delta Ppl), arterial PO2 decreased and arterial PCO2 increased in galloping LH ponies.(ABSTRACT TRUNCATED AT 250 WORDS)

DeVega versus ring annuloplasty in severe functional tricuspid insufficiency and their impact on the right ventricle

2019 ◽  
Vol 1 (4) ◽  
pp. 133-139
Author(s):  
Yasser Hamdy ◽  
Mohammed Mahmoud Mostafa ◽  
Ahmed Elminshawy
Keyword(s):  
Right Ventricular ◽  
Tricuspid Valve ◽  
Tricuspid Regurgitation ◽  
Early Postoperative Period ◽  
Tricuspid Valve Repair ◽  
Ring Annuloplasty ◽  
Significant Difference ◽  
Group A ◽  
Group B ◽  
The Right

Background: Functional tricuspid valve regurgitation secondary to left-sided valve disease is common. DeVega repair is simple, but residual regurgitation with subsequent impairment of the right ventricular function is a concern. This study aims to compare tricuspid valve repair using DeVega vs. ring annuloplasty and their impact on the right ventricle in the early postoperative period and after six months. Methods: This is a prospective cohort study of 51 patients with rheumatic heart disease who underwent tricuspid valve repair for secondary severe tricuspid regurgitation. Patients were divided into two groups: group A; DeVega repair (n=34) and group B; ring annuloplasty repair (n=17). Patients were assessed clinically and by echocardiography before discharge and after six months for the degree of tricuspid regurgitation, right ventricular diameter and tricuspid annular plane systolic excursion (TAPSE). Results: Preoperative echocardiographic assessment showed no difference in left ventricular end-systolic diameter, end-diastolic diameter, ejection fraction and right ventricular diameter, however; group A had significantly better preoperative right ventricular function measured by TAPSE (1.96 ± 0.27 vs1.75 ± 0.31 cm; p=0.02). Group B had significantly longer cardiopulmonary bypass time (127.65 ± 13.56 vs. 111.74 ± 18.74 minutes; p= 0.003) and ischemic time (99.06 ± 11.80 vs. 87.15 ± 16.01 minutes; p= 0.009). Pre-discharge, there was no statistically significant difference in the degree of tricuspid regurgitation, but the right ventricular diameter was significantly lower in group B (2.66 ± 0.41 and 2.40 ± 0.48 cm; p=0.049). After six months of follow up, the degree of tricuspid regurgitation (p= 0.029) and the right ventricular diameter were significantly lower in the ring annuloplasty group (2.56 ± 0.39 and 2.29 ± 0.44 cm; p=0.029). Although there was a statistically significant difference in preoperative TAPSE, this difference disappeared after six months. Conclusion: Both DeVega and ring annuloplasty techniques were effective in the early postoperative period, ring annuloplasty was associated with lesser residual regurgitation and better right ventricular remodeling in severe functional tricuspid regurgitation than DeVega procedure after 6-months of follow up.

scholarly journals Prolonged Sinus Pauses upon Termination of Paroxysmal Atrial Fibrillation: Abnormal Right Atrial Electrophysiologic and Electroanatomic Findings

2017 ◽  
Vol 44 (2) ◽  
pp. 107-114 ◽  
Author(s):  
Zhengyu Bao ◽  
Hongwu Chen ◽  
Bing Yang ◽  
Michael Shehata ◽  
Weizhu Ju ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Node ◽  
P Wave ◽  
Right Atrial ◽  
Control Group ◽  
Paroxysmal Supraventricular Tachycardia ◽  
Group A ◽  
Group B ◽  
Activation Times ◽  
The Right

The efficacy of pulmonary vein antral isolation for patients with prolonged sinus pauses (PSP) on termination of atrial fibrillation has been reported. We studied the right atrial (RA) electrophysiologic and electroanatomic characteristics in such patients. Forty patients underwent electroanatomic mapping of the RA: 13 had PSP (group A), 13 had no PSP (group B), and 14 had paroxysmal supraventricular tachycardia (control group C). Group A had longer P-wave durations in lead II than did groups B and C (115.5 ± 15.4 vs 99.5 ± 10.9 vs 96.5 ± 10.4 ms; P=0.001), and RA activation times (106.8 ± 13.8 vs 99 ± 8.7 vs 94.5 ± 9.1 s; P=0.02). Group A's PP intervals were longer during adenosine triphosphate testing before ablation (4.6 ± 2.3 vs 1.7 ± 0.6 vs 1.5 ± 1 s; P &lt;0.001) and after ablation (4.7 ± 2.5 vs 2.2 ± 1.4 vs 1.6 ± 0.8 s; P &lt;0.001), and group A had more complex electrograms (11.4% ± 5.4% vs 9.3% ± 1.6% vs 5.8% ± 1.6%; P &lt;0.001). Compared with group C, group A had significantly longer corrected sinus node recovery times at a 400-ms pacing cycle length after ablation, larger RA volumes (100.1 ± 23.1 vs 83 ± 22.1 mL; P=0.04), and lower conduction velocities in the high posterior (0.87 ± 0.13 vs 1.02 ± 0.21 mm/ms; P=0.02) and high lateral RA (0.89 ± 0.2 vs 1.1 ± 0.35 mm/ms; P=0.04). We found that patients with PSP upon termination of atrial fibrillation have RA electrophysiologic and electroanatomic abnormalities that warrant post-ablation monitoring.

A stabilization period of 5 minutes is adequate when measuring pulmonary artery pressures after turning

1993 ◽  
Vol 2 (6) ◽  
pp. 474-477 ◽  
Author(s):  
PA Shinners ◽  
MO Pease
Keyword(s):  
Pulmonary Artery ◽  
Pulmonary Artery Pressure ◽  
Supine Position ◽  
Surgical Intensive Care Unit ◽  
Pressure Measurements ◽  
Artery Pressure ◽  
Group A ◽  
Group B ◽  
The Right ◽  
Stabilization Period

OBJECTIVE: To compare hemodynamic measurements made before turning and at 5 and 30 minutes after turning, and to determine whether the stabilization period affects the difference between supine and side-lying pulmonary artery pressures. METHODS: This study was performed in the cardiothoracic surgical intensive care unit of a midwestern university hospital. The 31 postoperative open-heart surgical patients, 26 men and 5 women aged 41 to 76 years (64 +/- 9.3, mean +/- SD) with pulmonary artery catheters in place, were divided into two groups to compare supine to side-lying pressures and the time intervals between the position changes. The supine-first subjects (Group A) were placed in the supine position for baseline measurements and turned to either the right or left side-lying position for the 5- and 30-minute pulmonary artery pressure measurements. The side-first subjects (Group B) were placed in either the right or left side-lying position for baseline measurements and then in the supine position for the 5- and 30-minute pulmonary artery pressure measurements. RESULTS: Pulmonary artery pressures, heart rate and arterial pressure were not significantly different at 5 and 30 minutes. Supine pulmonary artery pressures in Group A were not significantly different from supine pressures in Group B. Side-lying pulmonary artery pressures in Group A were not significantly different from side-lying pressures in Group B. Side-lying vs supine pulmonary artery pressures were significantly different in both Group A and Group B. CONCLUSION: The current practice of turning and settling the patient, zeroing the transducer and proceeding to make the pulmonary artery pressure readings appears to be valid. The stabilization period after turning does not explain the differences found between side-lying and supine pulmonary artery pressures.

Histologic Evaluation of Stapled Right Atrial Appendages with Fabric Buttressing

2010 ◽  
Vol 5 (5) ◽  
pp. 359-363
Author(s):  
Hideyuki Fumoto ◽  
A. Marc Gillinov ◽  
D. Geoffrey Vince ◽  
Masatoshi Akiyama ◽  
Diyar Saeed ◽  
...  
Keyword(s):  
Doppler Echocardiography ◽  
Fibrous Tissue ◽  
Atrial Appendage ◽  
Right Atrial ◽  
Histologic Evaluation ◽  
Group A ◽  
Right Atrial Appendage ◽  
Group B ◽  
The Right ◽  
Group D

Objective The aim of this study was to histologically evaluate the importance of using buttressing materials in stapling the atrial appendages. Methods We stapled the right atrial appendage with a commercial apparatus in 11 mongrel dogs. To evaluate the efficiency of using a buttressing material as an adjunct to stapling, we conducted 30-day studies without (group A: n = 2) or with buttressing material (group B: n = 3) and 90-day studies without (group C: n = 3) or with buttressing material (group D: n = 3) and thereafter made assessments using Doppler echocardiography and performed histologic analyses on all stapled appendages. Results During surgery, blood oozing from the stapling sites was observed in four of five cases of groups A and C; with buttressing, there was no oozing in groups B and D. In groups A and B, we observed the myocardium of the appendage being focally replaced with fibrous tissue. Myocardium in group C was infiltrated diffusely with loose fibrous tissue and in group D had been almost completely replaced with fibrous tissue. Conclusions The buttressing material was useful not only in preventing oozing but also likely promoting the growth of fibrous tissue in the right atrial appendage.

Prognostic value of non-ischemic ring-like left ventricular scar pattern in patients with apparently idiopathic ventricular arrhythmias: a CMR imaging study

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
G Nucifora ◽  
D Muser ◽  
S Castro ◽  
R Casado Arroyo ◽  
D Benhayon ◽  
...  
Keyword(s):  
Ventricular Arrhythmias ◽  
Prognostic Significance ◽  
Imaging Study ◽  
Left Ventricular ◽  
High Rate ◽  
Life Threatening ◽  
History Of ◽  
Group A ◽  
Group B

Abstract Background The presence of left ventricular (LV) late gadolinium enhancement (LGE) at cardiac magnetic resonance (CMR) has been correlated to life-threatening arrhythmic events in patients with apparently idiopathic ventricular arrhythmias (VAs). Aim of the present study was to investigate the prognostic significance of a specific LV-LGE phenotype characterized by a subepicardial/midmyocardial “ring-like” pattern of fibrosis. Methods Out of a total of 518 consecutive patients with apparently idiopathic VAs who underwent CMR study, 79 (15%) had evidence of LV-LGE. Of these, 23 (4%) patients had LV LGE with ring-like pattern, defined as subepicardial or midmyocardial LGE involving at least 3 contiguous segments in the same slice (group A), while 56 (11%) patients had LV LGE with no ring-like pattern (group B). The remaining 439 patients had no LGE (group C). The end-point of the study was a composite SCD, resuscitated cardiac arrest and nonfatal episodes of ventricular fibrillation or documented sustained ventricular tachycardia. Results Group A patients were more frequently males compared to groups B and C (96% vs. 79% vs. 52%; p&lt;0.01) and had more frequently a family history of SCD and/or cardiomyopathy (30% vs. 11% vs. 5%; p&lt;0.01). All patients in Group A showed VAs with a predominant RBBB morphology vs. 38 (68%) patients in Group B and 65 (15%) in Group C (p&lt;0.01). During a follow-up of 63±39 months, the composite outcome occurred in 13 patients (57%) in Group A vs. 11 (20%) in Group B and 2 (1%) in Group C (p&lt;0.01). Conclusion In patients with apparently idiopathic VAs, a nonischemic LV-LGE with a ring-like pattern at CMR is associated with a high rate of malignant arrhythmic events during follow-up. Funding Acknowledgement Type of funding source: None

scholarly journals Surgical repair of tetralogy of Fallot using autologous right atrial appendages: short- to mid-term results

2020 ◽  
Author(s):  
Ahmadali Amirghofran ◽  
Fatemeh Edraki ◽  
Mohammadreza Edraki ◽  
Gholamhossein Ajami ◽  
Hamid Amoozgar ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Pulmonary Stenosis ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Right Atrial ◽  
The Mean ◽  
Mid Term Results ◽  
Tetralogy Of Fallot Repair

Abstract OBJECTIVES The prevention of pulmonary insufficiency (PI) is a crucial part of the tetralogy of Fallot repair. Many techniques have been introduced to construct valves from different materials for the right ventricular outflow tract, including the most commonly constructed monocusp valves. We are introducing a new bicuspid valve made intraoperatively using the autologous right atrial appendage (RAA) to prevent PI in these patients. METHODS The RAA valve was constructed and used in 21 patients with tetralogy of Fallot. The effective preservation of the native valve was impossible in all patients because of either a severe valve deformity or a small annulus. The RAA valve was created after ventricular septal defect closure and right ventricular outflow tract myectomy and was covered with a bovine transannular pericardial patch. The perioperative data were evaluated, and the echocardiography results were assessed immediately after operations and in follow-up with a median of 10.5 months. The data were retrospectively compared with 10 other patients with similar demographic data but with only transannular patches. RESULTS The mean age of the patients was 13.3 months. No mortality or related morbidity occurred after repair using the RAA valve. The PI severity early after the operation was trivial or no PI in 18 patients, and mild PI was observed in 3 patients, which progressed to moderate PI in one of them in the mean 12-month follow-up period. Fifteen patients had mild or no pulmonary stenosis, while moderate pulmonary stenosis was observed in 6 others. Compared with the other 10 patients with only transannular patches, the RAA valve patients had prolonged operative and clamping times, but no difference in postoperative course and shorter hospital stays. The degree of PI was, of course, significantly less in the RAA valve patients, but pulmonary stenosis was the same. CONCLUSIONS The RAA valve construction is a safe and effective technique to prevent PI after the tetralogy of Fallot repair, at least in terms of short- and mid-term results. A longer follow-up period is needed to confirm if this new valve can eliminate or significantly delay the need for pulmonary valve replacement in these patients.

Afferent sympathetic nerve fibers with mechanoreceptors in the right heart

1975 ◽  
Vol 228 (1) ◽  
pp. 223-230 ◽  
Author(s):  
Y Uchida
Keyword(s):  
Pulmonary Artery ◽  
Right Ventricular ◽  
Sympathetic Nerve ◽  
Nerve Fibers ◽  
Right Atrial ◽  
Right Heart ◽  
Unmyelinated Fibers ◽  
Myelinated Fibers ◽  
Sympathetic Nerve Fibers ◽  
The Right

Mechanosensitivity of afferent sympathetic nerve fibers from the right heart and the pulmonary artery has been examined. Action potentials of the afferent fibers that responded to tapping the right heart and the pulmonary artery were derived from upper thoracic communicating rami of both sides of anesthetized dogs. The fibers were composed of myelinated Adelta fibers and unmyelinated fibers. The receptive fields of both groups of fibers were located widely in the right heart and the pulmonary artery. Myelinated fibers ceased to fire quickly whereas unmyelinated fibers continued to fire after withdrawl of a brief mechanical stimulus. In the myelinated group, the pressure threshold was 3-50, 6-58, and 3-10 mmHg for right ventricular, pulmonary and right atrial threshold was 15-58, 22-34, and 4-8 mmHg for right ventricular, pulmonary, and right atrial fibers, respectively. Spontaneous discharge of myelinated fibers was synchronous with each rise and/or fall in intracardiac or pulmonary pressure whereas that of unmyelinated fibers was irregular and independent. A rise in pressure produced by pulmonary embolization or occlusion caused an augumented discharge whereas a fall caused by caval vein occulsion eliminated the discharge. The results indicate the existence of both myelinated and unmyelinated fibers with mechanoreceptors in the right heart and the pulmonary artery.

Sign in / Sign up

Export Citation Format

Share Document