scholarly journals Mechanical Ventilation. Total Eclipse of the Heart (Editorial)

2021 ◽  
Author(s):  
Giovanni Landoni ◽  
Pasquale Nardelli ◽  
Alberto Zangrillo ◽  
Ludhmila A. Hajjar
Keyword(s):  
Mechanical Ventilation ◽  
Right Ventricle ◽  
Cardiac Function ◽  
Randomized Trials ◽  
Heart Function ◽  
High Peep ◽  
Ventilation Strategy ◽  
Moderate Hypoxia ◽  
The Right ◽  
Careful Assessment

Results from recent large randomized trials investigating the use of high PEEP in patients without ARDS all evidence that high levels may increase mortality due to hypotension and bradycardia. A careful assessment of cardiac function – with particular focus on the right ventricle – should be performed before planning our ventilation strategy in any setting, including COVID-19 and ARDS in general. Mechanical ventilation should be respectful in regards of heart function, and tolerant with moderate hypoxia and hypercapnia, noninvasive (as soon as possible) and synchronized.

Right Ventricle Mass Removal from Tricuspid Valve Apparatus: An Unusual Thromboembolic Complication of Severe Ketoacidosis

2016 ◽  
Vol 19 (2) ◽  
pp. 077
Author(s):  
Ireneusz Haponiuk ◽  
Maciej Chojnicki ◽  
Konrad Paczkowski ◽  
Wojciech Kosiak ◽  
Radosław Jaworski ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Tricuspid Valve ◽  
Mild Hypothermia ◽  
Heart Function ◽  
Thromboembolic Complication ◽  
Surgical Removal ◽  
Unusual Complication ◽  
Type I ◽  
Definitive Therapy ◽  
The Right

The presence of a pathologic mass in the right ventricle (RV) may lead to hemodynamic consequences and to a life-threatening incident of pulmonary embolism. The diagnosis of an unstable thrombus in the right heart chamber usually necessitates intensive treatment to dissolve or remove the pathology. We present a report of an unusual complication of severe ketoacidosis: thrombus in the right ventricle, removed from the tricuspid valve (TV) apparatus. A four-year-old boy was diagnosed with diabetes mellitus (DM) type I de novo. During hospitalization, a 13.9 × 8.4 mm tumor in the RV was found in a routine cardiac ultrasound. The patient was referred for surgical removal of the floating lesion from the RV. The procedure was performed via midline sternotomy with extracorporeal circulation (ECC) and mild hypothermia. Control echocardiography showed complete tumor excision with normal atrioventricular valves and heart function. Surgical removal of the thrombus from the tricuspid valve apparatus was effective, safe, and a definitive therapy for thromboembolic complication of pediatric severe ketoacidosis.<br /><br />

scholarly journals Evaluation of fetal cardiac function in maternal gestational diabetes mellitus by speckle tracking echocardiography

2021 ◽  
Author(s):  
Peina Huang ◽  
Youbin Deng ◽  
Ling Feng ◽  
Yiping Gao ◽  
Xueqing Cheng ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Gestational Diabetes ◽  
Right Ventricle ◽  
Cardiac Function ◽  
Gestational Diabetes Mellitus ◽  
Right Ventricular ◽  
Speckle Tracking ◽  
Speckle Tracking Echocardiography ◽  
Fetal Cardiac Function ◽  
The Right

Abstract The aim of this study was to assess the cardiac function in fetuses of mothers with gestational diabetes mellitus (GDM) by using fetalHQ, a quantitative analysis software for the assessment of fetal cardiac function based on speckle tracking echocardiography. In this prospective cross-sectional study, 49 fetuses exposed to GDM and 50 normal fetuses were enrolled and fetal echocardiography were performed and analyzed. In the GDM group, left ventricular (24 ± 4 vs. 28 ± 4, p < 0.001) and right ventricular global longitudinal strain (23 ± 4 vs. 26 ± 4, p = 0.002) and right ventricular free wall strain (26 ± 6 vs. 29 ± 5, p = 0.006) were significantly lower compared with the control group, whereas there was no significant difference in global spherical index (1.2 ± 0.1 vs. 1.2 ± 0.1, p = 0.425). Additionally, 24-segment transverse fraction shortening of the right ventricle was more impaired than the left and the segments with reduced fraction shortening were mainly located in the mid and apical sections of the right ventricle, and mid section of the left ventricle. In conclusion, fetuses exposed to GDM may have cardiac dysfunction before the onset of cardiac morphologic abnormalities, and the right ventricle is more vulnerable than the left during fetal development.

scholarly journals PPV May Be a Starting Point to Achieve Circulatory Protective Mechanical Ventilation

2021 ◽  
Vol 8 ◽  
Author(s):  
Longxiang Su ◽  
Pan Pan ◽  
Huaiwu He ◽  
Dawei Liu ◽  
Yun Long
Keyword(s):  
Mechanical Ventilation ◽  
Spontaneous Breathing ◽  
Heart Function ◽  
Transpulmonary Pressure ◽  
Right Heart ◽  
Right Heart Function ◽  
Starting Point ◽  
Respiratory Treatment ◽  
The Right ◽  
Right Ventricular Preload

Pulse pressure variation (PPV) is a mandatory index for hemodynamic monitoring during mechanical ventilation. The changes in pleural pressure (Ppl) and transpulmonary pressure (PL) caused by mechanical ventilation are the basis for PPV and lead to the effect of blood flow. If the state of hypovolemia exists, the effect of the increased Ppl during mechanical ventilation on the right ventricular preload will mainly affect the cardiac output, resulting in a positive PPV. However, PL is more influenced by the change in alveolar pressure, which produces an increase in right heart overload, resulting in high PPV. In particular, if spontaneous breathing is strong, the transvascular pressure will be extremely high, which may lead to the promotion of alveolar flooding and increased RV flow. Asynchronous breathing and mediastinal swing may damage the pulmonary circulation and right heart function. Therefore, according to the principle of PPV, a high PPV can be incorporated into the whole respiratory treatment process to monitor the mechanical ventilation cycle damage/protection regardless of the controlled ventilation or spontaneous breathing. Through the monitoring of PPV, the circulation-protective ventilation can be guided at bedside in real time by PPV.

scholarly journals Synergy in the heart: RV systolic function plays a key role in optimizing LV performance during exercise

2020 ◽  
Vol 319 (3) ◽  
pp. H642-H650
Author(s):  
B. Ruijsink ◽  
M. N. Velasco Forte ◽  
P. Duong ◽  
L. Asner ◽  
K. Pushparajah ◽  
...  
Keyword(s):  
Stroke Volume ◽  
Right Ventricle ◽  
Cardiac Function ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Systolic Function ◽  
Left Ventricular ◽  
Cardiac Performance ◽  
Exact Role ◽  
The Right

The right ventricle appears to have an important impact on maintaining systemic cardiac function and delivering stroke volume. However, its exact role in supporting left ventricular function has so far been unclear. This study demonstrates a new mechanism of ventricular interaction that provides mechanistic understanding of the key importance of the right ventricle in driving cardiac performance.

MicroRNA-424(322) as a new marker of disease progression in pulmonary arterial hypertension and its role in right ventricular hypertrophy by targeting SMURF1

2017 ◽  
Vol 114 (1) ◽  
pp. 53-64 ◽  
Author(s):  
Rui Baptista ◽  
Carla Marques ◽  
Steve Catarino ◽  
Francisco J Enguita ◽  
Marina C Costa ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Prognostic Value ◽  
Heart Function ◽  
Inverse Correlation ◽  
Pulmonary Vascular Disease ◽  
Protein Receptor ◽  
Pulmonary Arterial ◽  
Ventricle Hypertrophy ◽  
The Right ◽  
Right Ventricle Hypertrophy

Abstract Aims MicroRNAs (miRNAs) have been implicated in the pathogenesis of pulmonary hypertension (PH), a multifactorial and progressive condition associated with an increased afterload of the right ventricle leading to heart failure and death. The main aim of this study was to correlate the levels of miR-424(322) with the severity and prognosis of PH and with right ventricle hypertrophy progression. Additionally, we intended to evaluate the mechanisms and signalling pathways whereby miR-424(322) secreted by pulmonary arterial endothelial cells (PAECs) impacts cardiomyocytes. Methods and results Using quantitative real-time PCR, we showed that the levels of circulating miR-424(322) are higher in PH patients when compared with healthy subjects. Moreover, we found that miR-424(322) levels correlated with more severe symptoms and haemodynamics. In the subgroup of Eisenmenger syndrome patients, miR-424(322) displayed independent prognostic value. Furthermore, we demonstrated that miR-424(322) targets SMURF1, through which it sustains bone morphogenetic protein receptor 2 signalling. Moreover, we showed that hypoxia induces the secretion of miR-424(322) by PAECs, which after being taken up by cardiomyocytes leads to down-regulation of SMURF1. In the monocrotaline rat model of PH, we found an association between circulating miR-424(322) levels and the stage of right ventricle hypertrophy, as well as an inverse correlation between miR-424(322) and SMURF1 levels in the hypertrophied right ventricle. Conclusions This study shows that miR-424(322) has diagnostic and prognostic value in PH patients, correlating with markers of disease severity. Additionally, miR-424(322) can target proteins with a direct effect on heart function, suggesting that this miRNA can act as a messenger linking pulmonary vascular disease and right ventricle hypertrophy.

scholarly journals Huge right ventricle cardiac fibroma in a child patient

2021 ◽  
Author(s):  
Qiang Fan ◽  
Yunfei Ling ◽  
Qi An
Keyword(s):  
Right Ventricle ◽  
Heart Function ◽  
Pathological Examination ◽  
Borderline Tumor ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Child Patient ◽  
The Right

In this case report, we describe a rare large right ventricular fibroma with sudden chest pain in a 9 year old child. The tumor was successfully surgical removed under cardiopulmonary bypass, but there was only a small remnant of the tumor to avoid rupture of the right ventricle and injury to the tricuspid valve. Pathological examination confirmed that the tumor was fibrous borderline tumor. The patient’s heart function and the size of atrium and ventricles were normal, and there was no tricuspid regurgitation at 3-months follow-up. It was reported that the age less than 17 years old at time of diagnosis are associated with a poor prognosis, the long term outcome for this children patient needs further follow-up.

Transthoracic Right Heart Echocardiography for the Intensivist

2021 ◽  
pp. 088506662110034
Author(s):  
Maxwell A. Hockstein ◽  
Korbin Haycock ◽  
Matthew Wiepking ◽  
Skyler Lentz ◽  
Siddharth Dugar ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Heart Function ◽  
Salient Feature ◽  
Left Ventricular ◽  
Response To Therapy ◽  
Right Heart ◽  
Clinical Scenarios ◽  
The Right ◽  
The Impact ◽  
Rv Function

Background: The impact of critical illness on the right ventricle (RV) can be profound and RV dysfunction is associated with mortality. Intensivists are becoming more facile with bedside echocardiography, however, pedagogy has largely focused on left ventricular function. Here we review measurements of right heart function by way of echocardiographic modalities and list clinical scenarios where the RV dysfunction is a salient feature. Main: RV dysfunction is heterogeneously defined across many domains and its diagnosis is not always clinically apparent. The RV is affected by conditions commonly seen in the ICU such as acute respiratory distress syndrome, pulmonary embolism, RV ischemia, and pulmonary hypertension. Basic ultrasonographic modalities such as 2D imaging, M-mode, tissue Doppler, pulsed-wave Doppler, and continuous Doppler provide clinicians with metrics to assess RV function and response to therapy. Conclusion: The right ventricle is impacted by various critical illnesses with substantial mortality and mortality. Focused bedside echocardiographic exams with attention to the right heart may provide intensivists insight into RV function and provide guidance for patient management.

Abstract 2335: Transposition Of The Great Arteries And Double Outlet Right Ventricle Have Related Early Developmental Origins: Fundamental Insights From In Vivo Imaging

Circulation ◽  
2007 ◽  
Vol 116 (suppl_16) ◽  
Author(s):  
Colin K Phoon ◽  
Ruiping Ji ◽  
Piyali Dhar Chowdhury
Keyword(s):  
Right Ventricle ◽  
Cardiac Function ◽  
Heart Defects ◽  
Left Pulmonary Artery ◽  
Ultrasound Biomicroscopy ◽  
Double Outlet Right Ventricle ◽  
Doppler Imaging ◽  
Truncus Arteriosus ◽  
The Right

Congenital heart defects (CHD) are the most common birth defect. Proper retinoic acid (RA) signaling is required for normal development, and RA excess produces conotruncal CHD such as transposition of the great arteries (TGA) and double outlet right ventricle (DORV). We hypothesized that origins and evolution of TGA and DORV follow specific developmental patterns, definable in vivo by noninvasive ultrasound biomicroscopy (UBM)-Doppler imaging. Timed-pregnant ICR mice were injected with 70 mg/kg IP RA at 8.5 days post-conception (E8.5). Individual embryos were tracked with 40 MHz UBM-Doppler longitudinally on 5 consecutive days (E11.5–15.5: N=34 injected, N=8 uninjected controls). CHD included TGA (24%) and DORV (21%, all with right aorta, left pulmonary artery), as well as ventricular septal defect (VSD, defined at E15.5) and double-inlet left ventricle. External gross examination and histology confirmed ~90% concordance of UBM diagnosis of CHD, here (at E15.5) and in separate experiments (E11.5–15.5, N=111). All E11.5 embryos showed normal cardiac looping, with a normal unseptated heart and outflow tract (OFT) - the truncus arteriosus -arising from the right ventricle/bulbus cordis. Of embryos destined for TGA, 7/8 showed partial septation of the distal truncus into parallel OFT at E12.5; 4 showed DORV at E12.5 before evolving into TGA by E13.5. Of embryos destined for DORV, 6/7 showed partial septation of the distal truncus into parallel OFT at E12.5 as well. Thus, abnormal septation commences in the more distal truncus arteriosus as early as E12.5. In contrast, embryos destined for normal OFT development showed partial OFT septation in spiral (non-parallel) fashion, with complete/near-complete OFT septation and morphology at E13.5. All TGA/DORV embryos displayed normal cardiac function. CONCLUSIONS. TGA and DORV are developmentally related, differing only in complete (TGA) vs. incomplete (DORV) leftward truncal shift. Given normal heart, proximal OFT, and cardiac function, flow streams do not explain TGA/DORV morphogenesis. Corresponding to 4–6 weeks’ human gestation, these first in vivo data support longstanding hypotheses of TGA/DORV embryogenesis, and implicate RA signaling in the pathogenesis of abnormal truncal septation and shift.

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