Risk Factors of Pregnancy Outcome in Patients with Pulmonary Hypertension

OBJECTIVE: The purpose of this study is to explore the factors affecting the pregnancy outcome of patients with pulmonary hypertension, and to design a digital model predicting the pregnancy outcome of patients and judge whether patients have the conditions to continue pregnancy. METHODS: The clinical data of patients with pregnancy complicated with pulmonary hypertension hospitalized in Guangdong Provincial People's Hospital from January 1, 2014 to December 31, 2020 were retrospectively analyzed. The severity of pulmonary hypertension, the structural and functional indexes measured by echocardiography were compared, and the effects on maternal and neonatal outcomes were analyzed. RESULTS: A total of 158 patients met the inclusion and exclusion criteria. The results showed that tricuspid regurgitation velocity (P<0.001), right ventricular diameter (P<0.05), right atrial diameter (P<0.05), pulmonary artery diameter (P<0.001) and cardiac function classification (P<0.001) were risk factors for maternal outcomes; Tricuspid regurgitation velocity (P<0.001) and structural changes of right heart were risk factors for neonatal outcomes. By multivariate logistic regression analysis, tricuspid regurgitation velocity (P<0.001), cardiac function (P<0.05) and superior inferior diameter of right atrium (P<0.05) were significant risk factors for maternal outcomes, while tricuspid regurgitation velocity (P<0.001) and superior inferior diameter of right atrium (P<0.05) were significant risk factors for neonatal outcomes. Using significant risk factors, a risk score system was established to predict the pregnancy outcome. CONCLUSION: in this study, we analyzed the clinical data of patients with pregnancy complicated with pulmonary hypertension in our hospital in recent years, and found that the changes of right heart structure (the acceleration of tricuspid regurgitation velocity, and the increase of right atrium, right ventricular diameter, right ventricular outflow tract anteroposterior diameter and main pulmonary artery diameter), are influencing factors of pregnancy outcomes in patients with pulmonary hypertension. In addition, we preliminarily designed a risk score through multi factor analysis, which is helpful to predict the possible outcome of puerperium and neonatal outcomes of patients, and to provide some reference for clinicians and patients to make decisions on whether to continue pregnancy in clinical practice.

PUTH Grading System for Urinary Tumor With Supradiaphragmatic Tumor Thrombus: Different Surgical Techniques for Different Tumor Characteristics

PurposeTo explore the different treatment strategies for urinary tumors with Mayo IV thrombus.Materials and MethodsWe retrospectively analyzed the patients with Mayo IV thrombus in Peking University Third Hospital from January 2014 to April 2021. We used the Peking University Third Hospital (PUTH) grading system to classify urinary tumors with supradiaphragmatic thrombus. PUTH-A referred to the filled thrombus whose tip just reached above the diaphragm, or the thrombus entering the right atrium (&lt; 2cm). PUTH-B referred to the filled thrombus entering the right atrium (&gt; 2cm), or the thrombus invading the wall of the inferior pericardial vena cava. Detailed techniques were described for various scenarios. Clinicopathological data and perioperative outcomes were reported. Group difference statistical analysis was performed.ResultsA total of 26 cases of urinary tumors with supradiaphragmatic IVC thrombus (Mayo grade IV) underwent treatment were enrolled in this study. 19 patients in the PUTH-A group received the open approach without sternotomy and cardiopulmonary bypass. Seven patients in the PUTH-B group received open thoracotomy assisted by cardiopulmonary bypass. No intraoperative death occurred. After 56 months of follow-up, 46.2% (12 of 26) patients died of all causes. Estimated 1-year, 2-year, and 3-year overall survival were 72.0% (95% CI, 54.4%-89.6%), 58.2% (95% CI, 38.0%-78.4%), and 52.4% (95% CI, 31.2%-73.6%), respectively.ConclusionsWe introduced the PUTH grading system for the characteristics of urinary tumors with supradiaphragmatic tumor thrombus, and selected different surgical techniques according to different classifications. This grading system was relatively feasible and effective.

Paradoxical Malignant Embolism, Brief Review

During gestation period the oxygenated maternal blood is transferred to the embryo via the placenta and umbilical cord into the right atrium. It is further transferred through an interatrial shunt to the left atrium, the Foramen Ovale, and distributed to the embryonic body. The foramen is closed after the birth, but remains occasionally patent, permitting embolization through a right to left shunt. This is transferring thrombi, fat, cement and bony spikes, air, and occasionally malignant tissue. This brief review is on the malignant embolization.

Technique for detecting an electrical connection between the right atrium and right pulmonary venous carina

Introduction: There is increasing evidence of the epicardial connection between the right-sided pulmonary vein (PV) carina and right atrium interrupts right-sided PV isolation after circumferential PV ablation in patients with atrial fibrillation. In such cases, carina ablation is often required. This study aimed to assess the utility of the right atrial posterior wall (RAPW) pacing in the detection of the right-sided epicardial connection (EC), evaluate the requirement for additional carina ablation after circumferential pulmonary vein (PV) ablation depending on the presence of EC, and investigate the clinical characteristics including the amount of epicardial adipose tissue (EAT) in patients with ECs. Methods and Results: Forty-one patients scheduled for PV isolation were enrolled. Before ablation, activation mapping of the LA was prospectively performed during pacing from the RAPW. EC was observed in 12 patients (EC group, 29%), whereas no EC was observed in the remaining 29 patients (non-EC group, 71%). For PV isolation, carina ablation was required in addition to circumferential ablation in 7 patients (58%) in the EC group, compared to 2 patients (7%) in the non-EC group (p < 0.003). Periatrial and intercaval EAT volumes were significantly lower (12.8 ± 6.2 vs. 23.1 ± 13.9 ml/m , p < 0.02, and 1.1 ± 0.8 vs. 2.2 ± 1.6 ml/m , p< 0.02, respectively) and the patients were younger (66.5 ± 6.6 vs. 72.4 ± 8.3 years, p < 0.03) in the EC group than in the non-EC group. Conclusions: RAPW pacing revealed EC between the RA and right PV carina in nearly a quarter of the patients.

Surgical management of biatrial myxoma: case report

<p>Heart tumours account for approximately 0.2 % of all tumours: of these, approximately 75 % of all primary heart tumours are benign and 50 % of them are myxomas. Further, myxomas make up 0.0017 % of the general population of patients with cardiovascular disease. Biatrial myxomas, i.e. tumours in both the left and right atria, can be in the form of a ‘butterfly’ or a ‘dumbbell’, and account for &lt; 1 % of all cardiac myxomas. Here we describe the successful surgical management of a rare case of a large biatrial myxoma and concomitant atrioventricular valve insufficiency. Briefly, 2D transthoracic echocardiography findings included an end-diastolic volume of 90 ml, an end-systolic volume of 40 ml and a left ventricular ejection fraction of 55 % (according to Simpson). The fibrous ring of the mitral valve measured 36 mm with a regurgitation degree of 2 while the fibrous ring of the tricuspid valve was 42 mm in size and the regurgitation grade was 3. Lesion size in the cavity of the left and right atrium were 73 × 38 mm and 80 × 42 mm, respectively. These neoplasia were surgically removed under peripheral cardiopulmonary bypass, hypothermia and cold cardioplegia (Custodiol). The myxomas were accessed through the right atrium, according to Giradon and were resected without defragmentation. Next, mitral valve plasty using a soft support ring and annuloplasty of the tricuspid valve were performed according to de Vega. The duration of artificial circulation was 150 minutes and that of myocardial ischaemia was 100 minutes. The patient was extubated 11 hours after surgery, spent 22 hours in the intensive care unit and was discharged on the 14th day after surgery. Surgical resection of biatrial myxomas before the development of serious irreversible or life-threatening complications can provide rapid symptomatic relief in congestive heart failure.</p><p>Received 30 May 2021. Revised 22 August 2021. Accepted 23 August 2021.</p><p><strong>Funding: </strong>The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Contribution of the authors<br /> </strong>Literature review: T.A. Simonyan<br /> Drafting the article: T.A. Simonyan, I.M. Tsiskaridze<br /> Critical revision of the article: T.A. Simonyan, I.Yu. Farulova, E.A. Babajanyan<br /> Surgical treatment: I.I. Scopin, I.M. Tsiskaridze<br /> Final approval of the version to be published: T.A. Simonyan, I.I. Scopin, I.M. Tsiskaridze, I.Yu. Farulova, E.A. Babajanyan</p>

Local Recurrence of Primary Cardiac Leiomyosarcoma After Resection: A Rare Case

Introduction: Leiomyosarcoma (LMS) is a fatal tumor, though primary cardiac is very rarely encountered. In this report, we evaluated the surgical and medical management of primary cardiac LMS, which is a sporadic tumor.Case Presentation: A 60-year-old female patient was examined for pulmonary edema after penicillin allergy in May 2019, while transthoracic echocardiography (ECHO) revealed an appearance compatible with a 5x3.5 cm mass in the right atrium. In addition, transesophageal ECHO showed a 7x4.6 cm foreground mass compatible with a myxoma in the right atrium (RA). The patient was then operated on emergency. Besides, an adjuvant ifosfamide-mesna-doxorubicine (IMA) protocol was planned to be given to the patient after local radiotherapy.Conclusions: In this report presented, we made RT and chemotherapy treatment plans in the case of recurrence without R0 surgery. Recurrence rates of up to 50% can occur in LMS, and systemic chemotherapy can be applied after relapse