scholarly journals MORPHOFUNCTIONAL FEATURES OF THE MYOCARDIUM IN ITS DIASTOLIC OVERLOAD

2021 ◽  
Vol 17 (2) ◽  
pp. 39-46
Author(s):  
A.A. Balabai ◽  
A.A. Krikunov ◽  
P.M. Semeniv ◽  
E.V. Rudenko ◽  
V.P. Zakharova
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Left Ventricle ◽  
Blood Volume ◽  
Interstitial Fibrosis ◽  
Mitral Valve Insufficiency ◽  
Diastolic Filling ◽  
Myocardial Oxygen Demand ◽  
Statistical Research ◽  
Valve Insufficiency

Relevance. Adaptation of the heart chambers to their volume overload, which increases with diastolic filling of the left ventricle (LV) or systolic regurgitation in the left atrium (LA) in case of mitral valve insufficiency leads to remodeling of the myocardium of these chambers. Longitudinal hypertrophy of cardiomyocytes (CMCs), realized by building up new sarcomeres at the end of existing myofibrils, is an adaptation mechanism in the early stages, but eventually turns into maladjustment, which leads to heart failure. Hypertrophied CMCs, damaged during decompensation, are replaced by connective tissue due to excessive activation of fibroblasts with deposition of the extracellular matrix, which is also an element of the myocardial remodeling. The progression of heart failure is also associated with a mismatch between blood supply and myocardial oxygen demand, since an increase in the size of the CMCs is accompanied by a rarefaction of the intramural network of microvessels. It is believed that the violation of the ratio of the size of the heart, angiogenesis and cardiac function are the basis for the transition of adaptive compensation of the heart to decompensation with the progression of heart failure. Objective: to study morphological changes in the myocardium of the LV and LA in patients with mitral valve insufficiency. Materials and methods. Macroscopically, the condition of the myocardium was studied on the material of 14 autopsies of patients who died of NdMK insufficiency. History of NdMK – from 3 months. up to 2.4±1.1 years. As a control, the hearts of 3 deaths without cardiopathology were studied. The material for light microscopy was pieces of myocardium from different segments of the left ventricle, as well as from the walls of the left ventricle, obtained during autopsy.Morphological (macroscopic, histological and electron microscopic), morphometric and statistical research methods were used. Results. With LV dilatation associated with chronic mitral valve insufficiency, lengthening of each CMCs provides an increase in the area of ​​the myocardial walls, and, accordingly, the size of the cavity of the corresponding chamber of the heart, which compensates to some extent for the increase in diastolic blood volume in the LV and systolic blood volume in the LA. However, the factor limiting this compensation mechanism is the deficiency of the myocardial microvasculature associated with limited capillary growth. The contradiction between the need for the myocardium to lengthen the CMCs and the inability of capillaries to provide them with oxygen leads to a breakdown in compensation with an increase in fibrotic changes. This is a factor limiting the further increase in the volume of the cavity. Conclusions. Overloading of the myocardium with volume leads to an increase in the length of the CMCs, on average, from 57.3±9.1 µm to 93.7±12.4 µm. The increase in the length of the CMCs is due to the increase in the number of sarcomeres from 43.7±8.4 to 62.5±14.5. The diameter of the CMCs in this case does not increase reliably. Overloading of the heart cavities with volume is often accompanied by desynchronization of the CMCs contraction, which leads to disruption of the integrity of the myocytic "working syncytium" and pronounced interstitial fibrosis.

scholarly journals Mitral Valve Disease in Thyroid Storm

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. A941-A942
Author(s):  
Sandra Rocio Rivera Menjura ◽  
Lia G Moyano Rivas ◽  
Camila Parraguez Gamboa ◽  
Cristobal Balmaceda ◽  
Juan P Peralta ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Invasive Mechanical Ventilation ◽  
Mitral Valve Insufficiency ◽  
Left Ventricular ◽  
Thyroid Storm ◽  
Multiple Infections ◽  
Mitral Insufficiency ◽  
Type I ◽  
Valve Insufficiency

Abstract Introduction: The cardiovascular effects that thyroid gland causes are widely studied. In fact, there is a known correlation between Graves’ Disease and mitral valve damage. We present the case of a patient admitted with thyroid storm and heart failure associated with severe structural damage of the mitral valve papillary muscle. Case Report: 24 year old woman with hyperthyroidism diagnosed 12 years ago, treated irregularly with thiamazole and propranolol, leaving treatment a year ago, presents dyspnea, class III functional capacity, diarrhea and logic dysphagia of a month of evolution. Heart rate over 170 bpm, respiratory rate 48 rpm and blood pressure 143/84 mmHg. Physical exam positive for exophthalmos, grade III goiter, crackles in both lung bases, pretibial myxedema and fulfilling criteria for a thyroid storm (65 points in Burch-Wartofsky Point Scale). First Lab Results: TSH<0.005µU/mL, free T4>7.7ng/dl and TRAB 37.8UI/L. Chest ray: Global cardiomegaly and pulmonary edema. EKG: Narrow complex supraventricular tachycardia. Thyroid ultrasound: Intrathoracic goiter. Transesophageal echocardiogram: Severe mitral insufficiency (Carpentier Type I and IIIB), right cavities and left ventricular enlargement, preserved right ventricular function and severe pulmonary hypertension (PSAP 71-76 mmHg). First treated with thiamazole, hydrocortisone IV, cholestyramine and sedation, falling time after into ventilatory failure and developing delirium, requiring invasive mechanical ventilation. Tested positive for COVID- 19. Starts preparation with Lugol and undergoes Total Thyroidectomy. After surgery develops severe hypocalcemia secondary to transitory hypoparathyroidism. During hospitalization presents multiple infections including pneumonia (Pseudomonas Aeruginosa), lung aspergillosis, bacteriuria (Enteroccocus Faecium) and candiduria (Candida Albicans and Glabrata), each one treated with multiple antibiotics and vasoactive drugs. Once stable, mitral valve replacement is realized, after which, the patient progresses favorably being discharged with programmed ambulatory controls. Conclusion: We report a case of a patient who was presented with positive thyroid storm criteria associated with heart failure and severe mitral valve insufficiency. The case gets complicated as multiple infections take place, including COVID-19. Fortunately, because of the early and aggressive multidisciplinary management, the patient evolved favorably, overcoming the life-threatening conditions she went through. Key Words: Thyroid storm, mitral valve insufficiency, heart failure. Bibliography: Klein I, Danzi S. Thyroid disease and the heart. Circulation. 2007 Oct 9;116(15):1725-35. doi: 10.1161/CIRCULATIONAHA.106.678326. Erratum in: Circulation. 2008 Jan 22;117(3):e18. PMID: 17923583.

scholarly journals Phenomenological Regularities of Assessment of Left Ventricle Function in Mitral Valve Insufficiency

Kardiologiia ◽  
2018 ◽  
Vol 17 (1) ◽  
pp. 32-40
Author(s):  
V. A. Sandrikov ◽  
◽  
T. Y. Kulagina ◽  
V. A. Ivanov ◽  
A. S. Krylov ◽  
...  
Keyword(s):  
Mitral Valve ◽  
Left Ventricle ◽  
Mitral Valve Insufficiency ◽  
Left Ventricle Function ◽  
Valve Insufficiency ◽  
Ventricle Function

scholarly journals Staged Endovascular Repair of Aortic Coarctation followed by Double Valve Surgery

Aorta ◽  
2021 ◽  
Author(s):  
Dimitrios V. Avgerinos ◽  
Rajeev Dayal ◽  
Charles Mack ◽  
Samuel Lang ◽  
Konstantinos S. Mylonas
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Endovascular Repair ◽  
Aortic Coarctation ◽  
Coarctation Of The Aorta ◽  
Mitral Valve Insufficiency ◽  
Valve Surgery ◽  
Valve Repair ◽  
Unique Case ◽  
Valve Insufficiency

AbstractWe present a unique case of late diagnosis of coarctation of the aorta in an adult, presenting with congestive heart failure associated with severe aortic and mitral valve insufficiency. To minimize operative risk, staged endovascular repair of the coarctation was initially performed, followed by aortic valve replacement and mitral valve repair. Six months postoperatively, the 41-year-old patient remains completely asymptomatic.

scholarly journals Surgical treatment of the ischemic heart disease with lowered contractility of left ventricle and mitral valve insufficiency

2020 ◽  
Vol 87 (9-10) ◽  
pp. 22-26
Author(s):  
S. A. Rudenko ◽  
A. V. Rudenko ◽  
Yu. V. Kaschenko ◽  
V. P. Zakharova
Keyword(s):  
Heart Disease ◽  
Mitral Valve ◽  
Left Ventricle ◽  
Ischemic Heart Disease ◽  
Mitral Valve Insufficiency ◽  
Ischemic Heart ◽  
Cardiac Insufficiency ◽  
Mitral Insufficiency ◽  
Valve Insufficiency ◽  
The Impact

Objective. To determine the impact of the mitral valve insufficiency in patients, suffering ischemic heart disease with lowered contractility of left ventricle and methods of its treatment. Materials and methods. During 01.01.2015-31.12.2018 yrs period in the Amosov National Institute of Cardiovascular Surgery there were conducted 2267 consecutive operations of coronary shunting, of them 190 (8.4%) - in patients, suffering the ischemic heart disease with lowered contractility of left ventricle. Reduction of the output fraction of left ventricle down to 35% and lower have served as criterion of inclusion of the patients into the Group. There were 170 (89.5%) men and 20 (10.5%) women. The patients’ age have constituted 29 - 83 yrs old, (61.1 ± 8.9) yrs old at average. Results. In 47.9% of the patients the lowering of the left ventricle contractility after myocardial infarction was followed by occurrence of regurgitation on a mitral valve. At the same time it was noted, that the regurgitation value have had correlated with degree of the left ventricle contractility lowered: in reduction of values of the left ventricle output fracture down to 25% and lower a moderate regurgitation on a mitral valve was registered up to 2 times, a significant one - in 2.5 times, and the pronounced one - in 1.5 times more frequently, than in values of the left ventricle output fracture, exceeding 25%. Occurrence of a mitral insufficiency in 18.7% patients was caused by direct damage of valvular apparatus, while in 81.3% patients the consequences of the heart cavities were present in disorder of contractile function of myocardium. Presence of postinfarction mitral insufficiency enhances the risk of an acute cardiac insufficiency in 1.7 times and necessitates intraoperative correction in values of the regurgitation fraction over 30%. Conclusion. The own data obtained witness, that noncorrected mitral insufficiency in the ischemic heart disease worsens significantly the postoperative period course after performance of coronary shunting, enhancing rate of an acute cardiac, respiratory and renal insufficiency. Thus, taking into account a negative impact of concomitant mitral valve insufficiency on efficacy of surgical interventions in the lowered contractility of left ventricle the need emerges to perform complex reconstructive intervention in patients, suffering ischemic heart disease with lowered contractility of left ventricle.

Analysis of certain blood biochemical parameters in relation to oxidative stress in chronic mitral valve insufficiency of dogs with heart failure

2018 ◽  
Author(s):  
M.S. Indhu ◽  
P.S.L. Sesh ◽  
K. Loganathasamy ◽  
K. Jeyaraja ◽  
K. Padmanath ◽  
...  
Keyword(s):  
Heart Failure ◽  
Free Radicals ◽  
Mitral Valve ◽  
Biochemical Parameters ◽  
Hematological Parameters ◽  
Mitral Valve Insufficiency ◽  
Cardiac Damage ◽  
Blood Biochemical ◽  
Valve Insufficiency ◽  
Healthy Dogs

Chronic mitral valve insufficiency (CMVI) is the most common acquired heart disease in dogs. In heart failure, the cellular oxygenation and metabolism are affected, which leads to the production of free radicals. Free radicals damage DNA, lipid and protein molecules in cells. In the present experiment, blood samples were collected from CMVI dogs with heart failure and were compared with the results obtained from healthy dogs. A significant increase in the levels of xanthine oxidase, AST, LDH and CK and decrease in the activity of catalase were noticed in CMVI dogs when compared to healthy dogs, which revealed overall cardiac and skeletal muscle damage in CMVI dogs. Results of biochemical parameters revealed an increase in urea level and decrease in sodium, potassium, and calcium levels in CMVI dogs as compared to control dogs, all of which indicate cardiac damage in dogs. Study on hematological parameters revealed a significant decrease in Hb, PCV, RBC and platelet counts and an increase in total WBC counts and percentage of neutrophils, decrease in percentage of the lymphocyte and monocyte in CMVI dogs than control. These results indicate secondary phenomenon to heart failure. The present research data indicates the usefulness of these biomarkers in the diagnosis and prognosis of CMVI with heart failure in dogs.

Therapeutic Management of Right Side Congestive Heart Failure in a Dachshund Bitch

2016 ◽  
Vol 12 (2) ◽  
Author(s):  
D. J. Talukdar ◽  
K. Sharma ◽  
H. Bayan ◽  
F. A. Ahmed ◽  
G. Das ◽  
...  
Keyword(s):  
Heart Failure ◽  
Congestive Heart Failure ◽  
Mitral Valve ◽  
Clinical Signs ◽  
Mitral Valve Insufficiency ◽  
Peripheral Region ◽  
Acute Onset ◽  
The Body ◽  
Heartworm Disease ◽  
Valve Insufficiency

Congestive Heart Failure (CHF) is a term that refers to the heart’s inability to pump adequate blood to the body. There are many causes of CHF in dogs viz. mitral valve insufficiency (MVI) or a leaky mitral valve, dilated cardiomyopathy (Haggstrom, 2010) and chronic heartworm disease. Clinical signs vary depending on whether the dog has left- or right-sided heart failure. Right-sided congestive heart failure (RS-CHF) causes poor venous return to the heart, accumulation of fluid in the peritoneum leading to ascites. Fluid also leaks from the veins in the limbs, causing oedema of the peripheral region. In animals, Right-sided congestive heart failure (RS-CHF) has previously been described in dogs (McIntosh and McEntee, 1995), cats and also in ferret (Haggstrom, 2010). The reported canine cases were among young to middle-aged male dogs (Bull mastiff, Siberian husky and dachshund), with acute-onset congestive right-sided heart failure or syncope as the presenting complaints. The present case was diagnosed as right side heart failure in a six years old female Dachshund dog with pleural effusion

scholarly journals Features of structural and geometric remodeling of the heart and changes in the diastolic filling of the heart in patients with chronic heart failure of ischemic genesis with preserved left ventricular ejection fraction

2021 ◽  
Vol 14 (1) ◽  
pp. 93-102
Author(s):  
V. A. Lysenko ◽  
M. S. Potapenko ◽  
V. V. Syvolap
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Left Ventricle ◽  
Diastolic Function ◽  
Ventricular Dysfunction ◽  
Diastolic Pressure ◽  
Left Ventricular ◽  
Diastolic Filling ◽  
Lv Mass ◽  
Diastolic Left Ventricular Dysfunction

Chronic heart failure (CHF) is the most common cardiovascular disease worldwide, estimated at 23 million. With the increase in the growing of the elderly population, the prevalence of hypertension, atrial fibrillation, obesity, diabetes, as well as the improvement of ultrasound diagnostic methods, a further increase in the number of cases of CHF with preserved left ventricular EF. Despite the large number of studies dedicated to analyzing the features of structural and geometric remodeling of the heart, changes in the systolic and diastolic function of the ventricles in patients with CHF, this issue hasn’t been definitively resolved and needs further improvement. The aim of the work – to investigate changes in structural and geometric parameters and diastolic function of the heart in patients with CHF of ischemic origin with preserved LV EF. Materials and methods. The study was included 43 patients (men – n = 19; women – n = 24) for CHF of ischemic origin with preserved LV EF, with sinus rhythm, stage II AB, II-IV FC for NYHA (main group), and 90 patients on coronary heart disease without signs of CHF (men – n = 40 (44.5 %); women – n = 50 (55.5 %)), (comparison group). Groups of patients were comparable in age, sex, height, weight, body surface area. Doppler echocardiographic examination was performed on the device Esaote MyLab Eight (Italy). Results. In patients with CHF preserved LV EF, the indicators prevailed: the size of the LA by 25 % (P = 0.005), the long axis of the LA by 11 % (P = 0.001), the LV EDV index of the LV by 13 % (P = 0.042), the LV mass index by 16 % (P = 0.013) according to the Penn Convention and (P = 0.004) the ASE. Eccentric left ventricular hypertrophy was diagnosed in 56 % of patients. Diastolic left ventricular dysfunction was absent in 2 % of patients with CHF. In 72 % of cases, the type of “relaxation disorder” was established, and in 26 % – “pseudonormal” LV filling profile. In none of the cases was a “restrictive” LV filling profile recorded. The following indicators of left ventricular diastolic function were lower in patients with CHF: e’ of the medial fibrous ring of the mitral valve by 26 % (P = 0.0001) and e’ lateral by 21 % (P = 0.0001), and the A’ the medial fibrous ring of mitral valve by 9 % (P = 0.022), and greater ratios of velocities E/e’ medial by 41 % (P = 0.0001), and E/e’ lateral fibrous ring of the mitral valve by 28 % (P = 0.0001), mean E/e’ by 36 % (P = 0.0001), which indicates a significant increase in end-diastolic pressure in the left ventricle. Conclusions. Structural and geometric remodeling of the heart in patients with CHF with preserved LV EF was characterized by dilatation of the left atrium, a moderate increase in the LV EDV index by 13 % (P = 0.042), a 16 % increase (P = 0.013) in the LV mass index, with the formation eccentric (56 %) and concentric (18 %) LV hypertrophy. Diastolic left ventricular dysfunction was absent in 2 % of patients with CHF. Disorders of diastolic filling of the left ventricle (72 % “relaxation disorder” and 26 % “pseudonormal” type) were occurred due to an increase in end-diastolic pressure in the left ventricle (increase by 41 % (P = 0.0001) ratio E/e’ medial fibrous ring MK), in LA (increase of more than 2 times (P = 0.0001) pulmonary capillary wedge pressure), and was accompanied by the development of postcapillary pulmonary hypertension (increase by 34 % (P = 0.0001) systolic pressure in the pulmonary artery). Despite the preserved LV EF, patients with CHF had significantly lower left and right ventricular contractility (10 % MAPSE med (P = 0.031), 18 % S med (P = 0.001) and 19 % (P = 0.007) RV EF).

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