scholarly journals Stiff “Left Atrial” syndrome post-mustard procedure

2021 ◽  
Vol 6 (3) ◽  
pp. 069-073
Author(s):  
Cowgill Joshua A ◽  
Moran Adrian M
Keyword(s):  
Pulmonary Hypertension ◽  
Left Atrial ◽  
Clinical Course ◽  
Venous Blood ◽  
Underlying Mechanism ◽  
Late Complications ◽  
Imaging Data ◽  
Atrial Switch ◽  
Great Vessels ◽  
Mustard Procedure

Objectives: We describe the clinical course and management of two patients with post-capillary pulmonary hypertension due to diffuse pulmonary venous baffle calcification decades post-Mustard procedure. Background: From the late 1950s to the early 1990s, the definitive surgical repair for children with D-transposition of the great vessels (D-TGA) was an atrial switch procedure (either Senning or Mustard operation) which utilizes atrial-level baffles to shunt pulmonary venous blood to the morphologic right (systemic) ventricle and caval blood to the morphologic left (sub-pulmonary) ventricle. From a hemodynamic standpoint, baffle leaks and stenoses as well as precapillary pulmonary hypertension have all been described as both early and late complications [1]. Recently, delayed post-capillary pulmonary hypertension (in the absence of discrete baffle obstruction) decades post-atrial switch has also been described [2]. The underlying pathophysiology for this postcapillary pulmonary hypertension is unclear but is theorized to involve impaired diastology referable to the pulmonary venous baffle. Methods/Results: Using hemodynamic and imaging data, we describe two patients with extensive pulmonary venous baffle calcification and resultant pulmonary hypertension from the so-called “stiff left atrial (LA) syndrome.” This problem can be difficult to treat medically and is not amenable to catheter-based interventions. We hypothesize that this is an underlying mechanism for pulmonary hypertension in at least some post-Mustard and Senning patients. Conclusion: We describe the treatments and clinical course for each of these patients, and in particular describe how the surgical revision of the pulmonary venous baffle in one case led to the complete resolution of symptoms.

Adrenal component to pulmonary hypertension caused by nicotine administration in the dog

1980 ◽  
Vol 49 (1) ◽  
pp. 66-72 ◽  
Author(s):  
M. B. Maron ◽  
D. A. Rickaby ◽  
C. A. Dawson
Keyword(s):  
Pulmonary Hypertension ◽  
Arterial Pressure ◽  
Left Atrial ◽  
Venous Return ◽  
Venous Blood ◽  
Main Pulmonary Artery ◽  
Mixed Venous Blood ◽  
Lung Lobe ◽  
Nicotine Administration ◽  
Lower Lung

In this study, we investigated the possibility that the adrenal gland contributes to nicotine-induced pulmonary hypertension using a canine left lower lung lobe (LLL) preparation that was pump-perfused with mixed venous blood at constant flow and outflow pressure. Main pulmonary artery, left atrial, and LLL arterial pressures were monitored to assess the responses of the animal's intact right lung and isolated LLL. With the adrenal venous return intact, injection of 10-26 micrograms/kg nicotine into the left ventricle or ascending aorta resulted in a 42% increase in LLL arterial pressure and a 70% increase in the pulmonary arterial-left atrial pressure gradient (Ppa-Pla). When the adrenal venous return was interrupted, the increases in LLL arterial pressure and Ppa-Pla were reduced to 6 and 10%, respectively. The LLL response could be eliminated by alpha-adrenergic receptor blockade, suggesting that adrenal catecholamines may contribute to the pulmonary hypertension induced by nicotine infusion.

THE CLINICAL COURSE OF MYOCARDIAL INFARCTION PECULIARITIES IN MEN UNDER 60 YEARS OLD WITH PULMONARY HYPERTENSION

2020 ◽  
pp. 64-68
Author(s):  
Gordienko A.V. ◽  
Men’shikova A.N. ◽  
Sotnikov A.V.
Keyword(s):  
Myocardial Infarction ◽  
Heart Failure ◽  
Pulmonary Hypertension ◽  
Clinical Course ◽  
Comparative Assessment ◽  
Study Group ◽  
Routine Examination ◽  
Group Iii ◽  
Appropriate Treatment ◽  
Level Group

Relevance. Pulmonary hypertension (PH) negatively affects the prognosis of myocardial infarction (MI). Aim. To evaluate MI clinical features (CF) in men under 60 years old (y.o.) with PH, arising during MI to improve pre-vention and outcomes. Material and methods. The study included men 19-60 y.o. with MI and various dynamics of mean pulmonary artery pressure (MPAP), determined by echocardiography (A. Kitabatake) in first 48 hours (1) and completion of third week (2). Patients were divided into four groups: studied (I) included 67 patients (mean age 50.4±7.1 y.o) with PH (MPAP2 25 and more mm Hg) and normal of MPAP1 level. Group II included patients with a normal MPAP in both phases of study (70; 52.1±6.6 y.o); group III – with elevated MPAP at both study points (149; 51.2±5.5 y.o) and IV – with in-creased MPAP1 and normal MPAP2 (61, 50.5±6.8 y.o). A comparative assessment of the MI CF frequency in selected groups were performed. Results. The study group occupied intermediate place frequency in medical history presence: coronary heart disease (I: 59.5; II: 61.4; III: 63.6 and IV: 48.9%; p = 0.04), chronic heart failure (CHF) (35.7 ; 34.1; 51.1 and 24.5%, respec-tively; p=0.001), repeated (45.2; 42.0; 47.3 and 29.8%) and early recurrent (3.6; 3.4 ; 6.0 and 3.2%; pIII-IV=0.006) MI, Q-MI (44.0; 35.2; 58.7 and 56.4; p=0.001), anginal MI phenotype (75.0; 74.7; 54.3 and 77.7%; p˂0.0001) and acute HF (ACF) (45,2; 36,8; 50,5 и 48,9%; р=0,002). No pulmonary edema was detected in it (p˂0.0001). Conclusions. Men under 60 y.o. with PH resulting from MI occupy an intermediate place in frequency of complica-tions, ACF and CHF in first 56 days of MI during routine examination compared with other MPAP dynamics patients. This confirms the need for additional verification of PH genesis for the appropriate treatment.

The effect of pulmonary hypertension on left atrial mechanical functions in chronic obstructive lung disease

2004 ◽  
Vol 97 (2) ◽  
pp. 187-192 ◽  
Author(s):  
Mahmut Acikel ◽  
Mustafa Yilmaz ◽  
Yekta Gurlertop ◽  
Hasan Kaynar ◽  
Engin Bozkurt ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Lung Disease ◽  
Left Atrial ◽  
Obstructive Lung Disease ◽  
Chronic Obstructive Lung Disease ◽  
Chronic Obstructive

Late laryngo-tracheal cartilage necrosis with external fistula 44 years after radiotherapy

2003 ◽  
Vol 117 (8) ◽  
pp. 658-659 ◽  
Author(s):  
Yoshitaka Takiguchi ◽  
Hiro-Oki Okamura ◽  
Ken Kitamura ◽  
Seiji Kishimoto
Keyword(s):  
Clinical Course ◽  
Subcutaneous Tissue ◽  
Bacterial Colonization ◽  
Histological Study ◽  
Inflammatory Cells ◽  
Late Complications ◽  
Laryngeal Oedema ◽  
Anterior Neck ◽  
Tracheal Cartilage ◽  
Cutaneous Flap

Major late complications, following radiotherapy of head and neck carcinomas, such as laryngeal oedema, perichondritis and chondronecrosis usually occur between three and 12 months after treatment. However, the present case displayed necrosis of the laryngo-tracheal cartilage and ulceration of anterior neck skin with a tracheal fistula 44 years after irradiation. The reasons for the long interval between irradiation and late complications may be explained by long-standing hypovascularity and/or infection of the irradiated area. Histological study revealed chondronecrosis without inflammatory cells in the laryngo-tracheal cartilage and bacterial colonization of subcutaneous tissue. Necrotic tissue was removed and tracheostomy was performed. The fistula was almost completely closed using a delto-pectoral cutaneous flap and the clinical course of patient has been good. This paper demonstrates the possibility of laryngo-tracheal necrosis in cases that had received radiation as long ago as 44 years.

Problems in the diagnosis of discordant atrioventricular with concordant ventriculo-arterial connections: anatomical considerations, surgical management, and long-term outcome

2015 ◽  
Vol 26 (1) ◽  
pp. 127-138 ◽  
Author(s):  
Daniela Laux ◽  
Lucile Houyel ◽  
Fanny Bajolle ◽  
Francesca Raimondi ◽  
Younes Boudjemline ◽  
...  
Keyword(s):  
Surgical Management ◽  
Heart Defects ◽  
Pacemaker Implantation ◽  
Heterotaxy Syndrome ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Atrial Switch ◽  
Great Vessels

AbstractBackgroundDiscordant atrioventricular with concordant ventriculo-arterial connections is a rare cardiac defect. When isolated, the haemodynamics resemble transposition of the great arteries. In complex heart defects such as heterotaxy, haemodynamics guide the surgical approach.ObjectiveTo report a series of eight patients with discordant atrioventricular and concordant ventriculo-arterial connections focussing on anatomical and diagnostic difficulties, surgical management, and follow-up.MethodsA retrospective review was carried out from 1983 to 2013. Anatomical description was based on segmental analysis. Emphasis was placed on the venoatrial connections.ResultsSegmental arrangement was {I, D, S} in six patients, all with spiralling great vessels. There were two patients with parallel great vessels of whom one had {S, L, D} and the other had {S, L, A} arrangement. Of eight patients, five had heterotaxy syndrome. Median age at repair surgery was 1.4 years (with a range from 1.1 months to 8.1 years). The repair surgery finally performed was the atrial switch procedure in seven out of eight patients. The main post-operative complications were two cases of baffle obstruction and one sick sinus syndrome needing pacemaker implantation. There were two early post-operative deaths and six late survivors. Median follow-up was 4.2 years (with a range from 3.9 to 26.7 years) with good functional status in all survivors.DiscussionDiagnosing discordant atrioventricular with concordant ventriculo-arterial connections remains challenging. There are ongoing controversies about the definition of atrial morphology and heterotaxy syndrome animating the anatomic discussion of these complex heart defects. Haemodynamically, the atrial switch procedure is the surgical method of choice with an encouraging long-term follow-up despite rhythm disturbances and baffle obstruction.

scholarly journals Right atrial to left atrial volume index ratio is associated with increased mortality in patients with pulmonary hypertension

2018 ◽  
Vol 35 (11) ◽  
pp. 1729-1735 ◽  
Author(s):  
Manu M. Mysore ◽  
Kenneth C. Bilchick ◽  
Priscilla Ababio ◽  
Benjamin K. Ruth ◽  
William C. Harding ◽  
...  
Keyword(s):  
Pulmonary Hypertension ◽  
Left Atrial ◽  
Left Atrial Volume ◽  
Right Atrial ◽  
Volume Index ◽  
Atrial Volume ◽  
Left Atrial Volume Index ◽  
Index Ratio

Left atrial dissection: Pathogenesis, clinical course, and transesophageal echocardiographic recognition

2001 ◽  
Vol 14 (8) ◽  
pp. 813-820 ◽  
Author(s):  
Pastora Gallego ◽  
José M. Oliver ◽  
Ana González ◽  
Francisco J. Domínguez ◽  
Angel Sanchez-Recalde ◽  
...  
Keyword(s):  
Left Atrial ◽  
Clinical Course ◽  
Left Atrial Dissection

Left Atrial Pacing Following Mustard's Correction of Transposition of the Great Vessels

CHEST Journal ◽  
1982 ◽  
Vol 81 (3) ◽  
pp. 374-376 ◽  
Author(s):  
Daniel G. Knauf ◽  
John H. Selby ◽  
James A. Alexander
Keyword(s):  
Left Atrial ◽  
Atrial Pacing ◽  
Great Vessels

scholarly journals Chronic subdural hematomas: challenges and solutions. Part I. Clinical variants and diagnosis

2021 ◽  
Vol 2 (2) ◽  
pp. 21-27
Author(s):  
Leonid B. Likhterman ◽  
◽  
Aleksandr D. Kravchuk ◽  
Vladimir A. Okhlopkov ◽  
◽  
...  
Keyword(s):  
Brain Imaging ◽  
Intracranial Hemorrhage ◽  
Subdural Hematoma ◽  
Clinical Course ◽  
Chronic Subdural Hematoma ◽  
Imaging Data ◽  
Clinical Variants ◽  
Brain Compression ◽  
Brain Imaging Data ◽  
Ct And Mri

Chronic subdural hematoma (cSDH) is a multifactorial extensive intracranial hemorrhage, causing the local and/or general brain compression. Hematoma has a delimiting capsule, which defines all pathophysiological features, clinical course and treatment tactics. The paper reports contemporary views on ethiology and clinical course of cSDH. Emphasis is placed on the diagnosis. Based on the analysis of 558 verified cSDH observations, the phasal course and brain imaging data are reported. CT and MRI signs of cSDH are defined.

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