Echogenic cardiac mass in the left atrium and associated supraventricular tachycardia in a neonate

Introduction. Primary cardiac tumors in children are rare and the majority of them are diagnosed before the age of one year. They are mainly rhabdomyomas and have a tendency to regress. The incidence of arrhythmias is not well-defined, depending on the size and location of tumors. Case outline. The authors report a female neonate with ongoing fetal supraventricular tachycardia (SVT). Delivery by urgent cesarean section was performed with neither fetal echocardiography nor fetal antiarrhythmic drug intervention. Electrocardiogram confirmed tachycardia with narrow QRS complex at a rate of 260 beats/min. converting to sinus rhythm after a third dose of intravenous bolus injection of adenosine-5?-triphosphate. But the rhythm reverted to SVT showing refractory supraventricular reentrant tachycardia. Echocardiography performed after conversion to sinus rhythm showed an echogenic, well circumscribed mass in the left atrium, fixed to the primum atrial septum without other structural defects. SVT was treated by a bolus of amiodarone followed by an intravenous infusion. Long-term management with oral amiodarone and beta blocker had a good response. During the one-year follow-up echocardiograms were performed every month showing complete regression of cardiac mass, and there has been no recurrence of tachycardia since neonatal period. Conclusion. Tumor regression and a good long-term outcome in our patient suggest that it was probably a small but unfavorably positioned rhabdomyoma, associated with fetal and perinatal SVT. Prognosis and outcome of the disease depends on timely diagnosis and prompt and adequate treatment of associated life-threatening arrhythmias.

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Long-Term Outcomes of Patients with Hydrocephalus Secondary to Tectal Plate Glioma versus Idiopathic Aqueductal Stenosis: Results from a Single Center

Pediatric Neurosurgery ◽

10.1159/000515516 ◽

2021 ◽

pp. 1-11

Author(s):

Hamid Reza Niknejad ◽

Melissa Frederickx ◽

Emiel Salaets ◽

Jurgen Lemiere ◽

Lieven Lagae ◽

...

Keyword(s):

Aqueductal Stenosis ◽

Maximum Diameter ◽

Benign Tumors ◽

Term Outcome ◽

Adequate Treatment ◽

Long Term Outcome ◽

Tectal Plate ◽

The Mean

Introduction: Tectal plate gliomas (TPG) constitute a distinct entity of benign tumors of the brain stem which show an indolent clinical course. Adequate treatment of secondary hydrocephalus is undoubtedly a major factor in the outcome. However, little is known about to what degree the tumor itself determines the long-term outcome of these patients. Methods: We retrospectively analyzed and compared the clinical and radiological data of 16 pediatric TPG patients with data of 12 pediatric idiopathic aqueductal stenosis (IAS) patients treated in our center from 1988 to 2018. For both groups, we assessed the long-term outcome in terms of hydrocephalus management, and for the TPG group, we assessed tumor growth during follow-up. In a separate prospective part of the study, we performed a neuropsychological evaluation in a subgroup of patients using a standardized testing battery, covering intelligence, learning, memory, executive functions, and an inventory on depression. Results: In the TPG group, the mean clinical and radiological follow-up was 84 and 70 months, respectively. On average, the maximum diameter of the tumor increased by 11% (p = 0.031) and the estimated tumor volume with 35% (p = 0.026) on radiological follow-up. The fronto-occipital horn ratio (FOHR) decreased by 23% on average after treatment. In the IAS group, the mean clinical and radiological follow-up was 117 and 85 months, respectively. In this group, the FOHR decreased by 21% on average. Neurocognitive testing revealed significant higher scores in the TPG group on global intelligence (TPG = 109, IAS = 85.5, U = 3, p < 0.01, z = −2.71), performance (TPG= 100, IAS = 85, U = 7, p = 0.03, z = −2.2), and verbal intelligence (TPG = 122, IAS = 91.5, U = 2, p < 0.00, z = −2.87) as well as working memory (TPG = 109.5, IAS = 77, U = 0.5, p = 0.01, z = −2.46). Conclusion: Our results suggest that the long-term outcome in TPG patients is acceptable and that cognition is substantially better preserved than in patients with IAS. This puts the idea of a significant contribution of the tumoral mass to disease outcome on the long term in question. Adequate and prompt management of hydrocephalus is the most important factor in long-term cognitive outcome.

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Long-term outcome after percutaneous closure of persistent left superior caval vein draining into the left atrium: a contrast-enhanced CT study

Cardiology in the Young ◽

10.1017/s1047951117000737 ◽

2017 ◽

Vol 27 (8) ◽

pp. 1550-1556 ◽

Cited By ~ 1

Author(s):

Davide Marini ◽

Matteo Castagno ◽

Michele Millesimo ◽

Francesca Ferroni ◽

Gaetana Ferraro ◽

...

Keyword(s):

Left Atrium ◽

Percutaneous Closure ◽

Caval Vein ◽

Term Outcome ◽

Long Term Outcome ◽

Superior Caval Vein ◽

Contrast Enhanced Ct ◽

Contrast Enhanced ◽

Enhanced Ct

AbstractBackgroundData regarding long-term outcome after percutaneous closure of left superior caval vein draining into the left atrium are lacking. The aim of the present study was to report the long-term follow-up by using contrast-enhanced CT.MethodsIn all, three patients underwent percutaneous closure of left superior caval vein draining into the left atrium between 2005 and 2015. All of them were evaluated clinically and underwent contrast-enhanced CT.ResultsIn one patient, the Amplatzer® Septal Occluder was used. In two patients, the Amplatzer® Vascular Plug type-1 was preferred: the device size/LSVC diameter ratio was 1.7 in the child and 1.2 in the adult. There were no early-onset or long-term onset complications. CT was performed 1, 2, and 10 years after the procedure, respectively. Complete occlusion of the vessel was documented in all. After 10 years since the procedure, CT revealed a persistent trivial residual shunt through the accessory hemiazygos vein in one patient, in whom the device was implanted above its drainage into the left superior caval vein. When an Amplatzer® Vascular Plug type-1 is oversized compared with the venous vessel diameter, it immediately assumes a dog-bone shape that disappears early to regain its shape memory and nominal size.ConclusionsPercutaneous occlusion of left superior caval vein draining into the left atrium has excellent early and long-term outcomes. The optimal implantation of the device is below the drainage of the accessory hemiazygos vein, when present. The device might be oversized compared with the left superior caval vein diameter according to the age of the patient.

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An update of the long-term outcome of patients with nonspecific pleurisy at medical thoracoscopy

BMC Pulmonary Medicine ◽

10.1186/s12890-021-01596-2 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Yan-Xia Yu ◽

Yuan Yang ◽

Yan-Bing Wu ◽

Xiao-Juan Wang ◽

Li-Li Xu ◽

...

Keyword(s):

Pleural Effusion ◽

Malignant Disease ◽

Long Term Outcomes ◽

Benign Diseases ◽

Term Outcome ◽

Long Term Outcome ◽

Medical Thoracoscopy ◽

One Year

Abstract Background Medical thoracoscopy (MT) is recommended in patients with undiagnosed exudative pleural effusion and offers a degree of diagnostic sensitivity for pleural malignancy. However, not all patients who undergo MT receive an exact diagnosis. Our previous investigation from 2014 summarized the long-term outcomes of these patients with nonspecific pleurisy (NSP); now, we offer updated data with the goal of refining our conclusions. Methods Between July 2005 and August 2018, MT with pleural biopsies were performed in a total of 1,254 patients with undiagnosed pleural effusions. One hundred fifty-four patients diagnosed with NSP with available follow-up data were included in the present study, and their medical records were reviewed. Results A total of 154 patients were included in this study with a mean follow-up duration of 61.5 ± 43.7 months (range: 1–180 months). No specific diagnosis was established in 67 (43.5%) of the patients. Nineteen patients (12.3%) were subsequently diagnosed with pleural malignancies. Sixty-eight patients (44.2%) were diagnosed with benign diseases. Findings of pleural nodules or plaques during MT and the recurrence of pleural effusion were associated with malignant disease. Conclusions Although most NSP patients received a diagnosis of a benign disease, malignant disease was still a possibility, especially in those patients with nodules or plaques as noted on the MT and a recurrence of pleural effusion. One year of clinical follow-up for NSP patients is likely sufficient. These updated results further confirm our previous study’s conclusions.

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Abstract 18649: Long-term Outcome and the Mechanisms of Pulmonary Antrum Radial-linear Ablation in Patients With Paroxysmal Atrial Fibrillation

Circulation ◽

10.1161/circ.132.suppl_3.18649 ◽

2015 ◽

Vol 132 (suppl_3) ◽

Author(s):

Xue Zhao ◽

Jianqiang Hu ◽

Yan Huang ◽

Yawei Xu ◽

Yanzhou Zhang ◽

...

Keyword(s):

Atrial Fibrillation ◽

Paroxysmal Atrial Fibrillation ◽

Holter Monitoring ◽

Pericardial Tamponade ◽

Term Outcome ◽

Long Term Outcome ◽

Long Term Follow Up ◽

One Year

Objectives: The aim of this study was to determine the mechanisms and effectiveness of pulmonary antrum radial-linear (PAR) ablation in comparison with pulmonary vein isolation (PVI) in patients with paroxysmal atrial fibrillation (AF) after a long-term follow-up. Background: The one-year follow up data suggested that PAR ablation appeared to have a better outcome over the conventional PVI for paroxysmal AF. Methods: The enrollment occurred between March, 2011, and August, 2011, with the last follow-up in May, 2014. A total of 133 patients with documented paroxysmal AF were enrolled from 5 centers and randomized to PAR group or PVI group. Event ECG recorder and Holter monitoring were conductedduring the follow-up for all patients. Results: The average procedure time was 151±23 min in PAR group and 178±43 min in PVI group ( P <0.001). The average fluoroscopy time was 21±7 min in PAR group and 27±11 min in PVI group ( P= 0.002). AF triggering foci were eliminated in 59 patients (89.4%) in PAR group, whereas, only 4 patients (6.0%) in PVI group (P<0.001).At median 36 (37-35) months of follow-up after single ablation procedure, 43 of 66 patients in PAR group (65%) and 28 of 67 patients in PVI group (42%) had no recurrence of AF off antiarrhythmic drug (AAD) (P=0.007); and 47 of 66 patients in PAR group (71%) and 32 of 67 patients in PVI group (48%) had no recurrence of AF with AAD (P=0.006). At the last follow-up, the burden of AF was significantly lower in PAR group than in PVI group (0.9% ± 2.3% vs 4.9% ± 9.9%;90th percentile, 5.5% vs 19.6%; P=0.008). No major adverse event (death, stroke, PV stenosis) was observed in all the patients except one case of pericardial tamponade. Conclusions: PAR ablation is a simple, safe, and effective strategy for the treatment of paroxysmal AF with better long-term outcome than PVI. PAR ablation might exhibit the beneficial effect on AF management through multiple mechanisms. Registration: ChiCTR-TRC-11001191

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The volume of left atrium measured by multi-detector computed tomography can predict of long term outcome in catheter ablation of atrial fibrillation

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeab111.011 ◽

2021 ◽

Vol 22 (Supplement_3) ◽

Author(s):

YR Kim

Keyword(s):

Computed Tomography ◽

Atrial Fibrillation ◽

Catheter Ablation ◽

Left Atrium ◽

Volume Estimation ◽

Term Outcome ◽

Long Term Outcome ◽

Group 2 ◽

Group 1

Abstract Funding Acknowledgements Type of funding sources: None. Background This study aimed to identify the volume left atrium (LA) and left atrial appendage (LAA) calculated by multidetector computed tomography (MDCT) is related to the long term out come of radiofrequency catheter ablation (RFCA) for atrial fibrillation(AF). Methods We analyzed data from 99 consecutive patients who referred for RFCA due to drug-refractory symptomatic AF (age 56 ± 10 years; 74% men; 64% paroxysmal AF). Prior to the procedure, all patients underwent ECG-gated 128 channels MDCT scan for assessment for pulmonary vein anatomy, LA and LAA volume estimation, and electro-anatomical mapping integration. Results The volume of LA and LAA calculated by CT was 142.6 ± 32.2 mL and 14.7 ± 6.0 mL, respectively. LA volume was smaller in paroxysmal AF(PAF) than persistent AF(PeAF) (133.9 ± 29.3 mL vs. 158.0 ± 31.4 mL, p < 0.0001) but LAA volume was not significantly different between PAF and PeAF(13.9 ± 5.0 mL vs. 16.3 ± 7.3 mL, p = 0.09). Patients were classified into 2 groups by the LA volume of 160mL; group 1 (LA volume < 160mL,n = 73) and group 2 (LA volume ≥160mL, n = 26). After a mean follow up 12.6 ± 5.3 months, 78.8% of the patients maintained sinus rhythm after the index ablation. AF free survival was significantly greater in group 1 than group 2 (84.9% vs. 61.5% p = 0.017). No relationship was found between LAA volume and the outcome of RFCA. Multivariate analysis showed that the LA volume >160mL was an independent predictor of arrhythmia-free after ablation (Hazard ration 2.55, 95% confidential interval 1.02-6.35, p = 0.045) Conclusion Higher LA volume is independent risk factor for AF recurrence after RFCA but not LAA volume. The LA volume quickly assessed by MDCT could be a good predictor of long term recurrence after AF ablation.

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P6361Prognostic value of discharge heart rate in acute heart failure patients: more relevant in atrial fibrillation?

European Heart Journal ◽

10.1093/eurheartj/ehz746.0957 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

R Vidal-Perez ◽

R Agra-Bermejo ◽

D Pascual-Figal ◽

F Gude Sampedro ◽

C Abou Jokh ◽

...

Keyword(s):

Heart Failure ◽

Atrial Fibrillation ◽

Heart Rate ◽

Sinus Rhythm ◽

Acute Heart Failure ◽

Left Ventricular Ejection ◽

Long Term Outcomes ◽

All Cause Mortality ◽

One Year

Abstract Background The prognostic impact of heart rate (HR) in acute heart failure (AHF) patients is not well known especially in atrial fibrillation (AF) patients. Purpose The aim of the study was to evaluate the impact of admission HR, discharge HR, HR difference (HRD) (admission- discharge) in AHF patients with sinus rhythm (SR) or AF on long- term outcomes. Methods We included 1398 patients consecutively admitted with AHF between October 2013 and December 2014 from a national multicentric, prospective registry. Logistic regression models were used to estimate the association between admission HR, discharge HR and HR difference and one- year all-cause mortality and HF readmission. Results The mean age of the study population was 72±12 years. Of these, 594 (42.4%) were female, 655 (77.8%) were hypertensive and 655 (46.8%) had diabetes. Among all included patients, 745 (53.2%) had sinus rhythm and 653 (46.7%) had atrial fibrillation. Only discharge HR was associated with one-year all-cause mortality (Relative risk (RR)= 1.182, confidence interval (CI) 95% 1.024–1.366, p=0.022) in SR. In AF patients discharge HR was associated with one-year all-cause mortality (RR= 1.276, CI 95% 1.115–1.459, p≤0.001). We did not observe a prognostic effect of admission HR or HRD on long-term outcomes in both groups. This relationship is not dependent on left ventricular ejection fraction (Figure 1) Effect of post-discharge heart rate Conclusions In AHF patients lower discharge HR, neither the admission nor the difference, is associated with better long-term outcomes especially in AF patients Acknowledgement/Funding Heart Failure Program of the Red de Investigaciόn Cardiovascular del Instituto de Salud Carlos III, Madrid, Spain (RD12/0042) and the Fondo Europeo de

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One Year follow-up of Patients with Rhinitis Medicamentosa after Vasoconstrictor Withdrawal

American Journal of Rhinology ◽

10.2500/105065897781446865 ◽

1997 ◽

Vol 11 (1) ◽

pp. 67-72 ◽

Cited By ~ 5

Author(s):

Peter M. Graf ◽

Hans Hallén

Keyword(s):

Nasal Spray ◽

Nasal Mucosa ◽

Adequate Treatment ◽

Nasal Stuffiness ◽

Symptom Scores ◽

Nasal Hyperreactivity ◽

One Year ◽

Rhinitis Medicamentosa

The aim of the study was to systematically follow-up 10 patients with rhinitis medicamentosa for at least 1 year after vasoconstrictor withdrawal. During withdrawal of the decongestants the patients used budesonide nasal spray, 400 μg/day, for 6 weeks. The thickness of the nasal mucosa, the decongestive effect of oxymetazoline, and the histamine sensitivity were measured with rhinostereometry during the period. The thickness of the nasal mucosa and the symptom scores of nasal stuffiness were reduced considerably 6 and 12 months after vasoconstrictor withdrawal. The histamine sensitivity reflecting nasal hyperreactivity was still increased after 6 months, but not after 1 year. The decongestive effect of oxymetazoline increased after 6 months, indicating reversible tolerance. We conclude that when given adequate treatment and information about nose-drop overuse, all patients were able to stop using the vasoconstrictors and no one relapsed into a daily long-term overuse of vasoconstrictors during the 1-year follow-up period.

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Left Atrial Reverse Remodeling Following Valve Surgery for Chronic Degenerative Mitral Regurgitation in Patients with Preoperative Sinus Rhythm: Effects on Long-Term Outcome

Journal of Cardiac Surgery ◽

10.1111/jocs.12215 ◽

2013 ◽

Vol 28 (6) ◽

pp. 619-626 ◽

Cited By ~ 4

Author(s):

Snejana Hyllén ◽

Shahab Nozohoor ◽

Carl Meurling ◽

Per Wierup ◽

Johan Sjögren

Keyword(s):

Mitral Regurgitation ◽

Sinus Rhythm ◽

Left Atrial ◽

Valve Surgery ◽

Reverse Remodeling ◽

Term Outcome ◽

Long Term Outcome ◽

Atrial Reverse Remodeling

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Long-Term Outcome Following B-Cell Depletion Therapy with Rituximab In Children and Adults with Immune Thrombocytopenia (ITP)

Blood ◽

10.1182/blood.v116.21.72.72 ◽

2010 ◽

Vol 116 (21) ◽

pp. 72-72 ◽

Cited By ~ 1

Author(s):

Vivek L. Patel ◽

Matthieu Mahévas ◽

Roberto Stasi ◽

Susanna Cunningham-Rundles ◽

Bertrand Godeau ◽

...

Keyword(s):

Board Of Directors ◽

Research Funding ◽

Response Rate ◽

Initial Response ◽

Response Rates ◽

Advisory Committees ◽

Term Outcome ◽

Long Term Outcome ◽

One Year

Abstract Abstract 72 Background: Studies of B-cell depletion using Rituximab in adults with ITP report responses lasting at least one year in almost all of the 30–40% of patients with complete responses (CR: platelet count >150 × 109/l) and also a small fraction of patients with partial responses (PR: platelet count 50–150 × 109/l). However data describing patients with ITP who are relapse-free and off-treatment beyond 1–2 years from initial Rituximab are almost entirely anecdotal and comparable response data are even less available for children. This study assessed the duration of unmaintained platelet response following rituximab treatment in 72 adults and 66 children with ITP, all of whom had had at least an initial response to rituximab. Long-term outcome was estimated from these data. Methods: Seventeen published studies including 486 patients, 376 adults and 110 children, were used to obtain the initial response rates to standard-dose rituximab treatment (375mg/m2 weekly for 4 weeks) in adults and children. Only 1 included study did not use the standard dose of rituximab. The Godeau study (Blood, 2008) was used to estimate the one-year response rate in adults with ITP. Only those adults whose responses persisted at least one year had follow up assessed whereas children who demonstrated even ephemeral responses were included. Only verified counts were used in this IRB-approved multicenter study. Results: 138 subjects with CR's or PR's after rituximab were included. All patients had starting platelet counts <30×109/l and 131 (95%) had ITP of > 6 months duration. Thirty-three (24%) had undergone splenectomy. Using the data from prior publications to obtain the initial response rates, children had a 56% initial response rate to rituximab treatment and adults had a 57% rate. Taking initial responders and then using the Godeau data for adults and Kaplan-Meier analysis of our data for children, 38% one-year response rates were obtained for both children and adults treated with rituximab. Both age groups also showed remarkable similarity at two years with 30% relapse-free response rates. However, all of the 26 eligible children maintained their response beyond two years whereas adults continued to relapse. Therefore the five-year response rate was 30% for children and only 21% for adults. Sex, duration of ITP, and age among adults did not affect long-term outcome. The rate of relapse was almost identical for splenectomized patients and non-splenectomized ones but the splenectomized patients appeared to relapse sooner (Figure). Patients with CR's (55 of the 72 adults with responses lasting at least one year were CR's) had better long-term outcomes than did patients with PR's even more than one year from initial treatment. B-cells returned significantly sooner to higher levels in subjects who relapsed compared to those whose responses were ongoing. No clinical long-term toxicity was observed but 2 patients were identified to have mild hypogammaglobulinemia > 30 months from initial treatment. Conclusions: In summary, only approximately 1 in 5 adults treated with rituximab will have an at least five-year relapse-free response rate which is disappointingly low; children have only a slightly higher five-year relapse-free response rate. A pilot study to improve outcomes using either R-CVP or double dose rituximab was unsuccessful (Hasan, Am J Hematol,2009) Current efforts to improve long-term response rates have focused on the combination of high dose dexamethasone and rituximab (or even by providing maintenance treatment with rituximab). A better understanding of the mechanism of effect of rituximab in patients with ITP might allow an improved treatment strategy to be developed. Fortunately, the toxicity of rituximab treatment in patients with uncomplicated ITP appears to be low; however, yearly testing for immunoglobulins for a minimum of five years might be appropriate. Disclosures: Neufeld: Novartis. Inc: Research Funding. Shenoy:Novartis Oncology: Honoraria. Bussel:Amgen: Equity Ownership, Membership on an entity's Board of Directors or advisory committees, Research Funding; Cangene: Research Funding; GlaxoSmithKline: Equity Ownership, Membership on an entity's Board of Directors or advisory committees, Research Funding; Genzyme: Research Funding; Immunomedics: Research Funding; Ligand: Membership on an entity's Board of Directors or advisory committees, Research Funding; Eisai Inc: Membership on an entity's Board of Directors or advisory committees, Research Funding; Shionogi: Membership on an entity's Board of Directors or advisory committees, Research Funding; Sysmex: Membership on an entity's Board of Directors or advisory committees, Research Funding; Portola: Consultancy.

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