Two-Dimensional Transthoracic Echocardiographic Demonstration of Reduction in Fibrin Content in Purulent Pericarditis Following Intrapericardial Fibrinolytic Agent Administration

We describe an adult patient who presented with purulent pericarditis in whom two-dimensional transthoracic echocardiography demonstrated a marked decrease in the area of the right ventricular wall together with the overlying fibrin following intrapericardial administration of a fibrinolytic agent. Documentation of this decrease by measurements performed and illustrated on two-dimensional images have not been reported previously in an adult patient with purulent pericarditis, to the best of our knowledge.

Unusual Needle Migration into the Heart of a Pediatric Patient

Sharp-object penetration into the chest is rare and may lead to life-threatening complications, hence the significance of early detection and removal. We present an uncommon case of the accidental penetration of a sewing needle into the chest of a 5-year-old girl, with the needle traveling from the entrance site to the right ventricle through the lung tissue. Due to the possibility of cardiovascular accidents, the patient was transferred to a special ward. For positioning and correct actions, TTE and CT scan of the chest with and without contrast were performed and the presence of a tangential needle with the right ventricular wall and inside the pericardium was reported. The patient was taken to the operating room, and after exploring, a 2 cm needle was inserted into the right ventricle and removed. The patient was discharged after 5 days.

The cardiac STAT3 intercalated disc specific expression in tail suspension rat

Background: The cardiovascular system is significantly agitated by loss of gravity. In microgravity, the body fluids shift toward the thoracic cavity, induced the heart becomes more spherical. This further increased the cardiac preload with an increasing of transmural central venous pressure, affects the right heart ventricles to tolerating the enhanced preload on the right ventricular wall. Method: In this study we investigated the rat right ventricle remodeling in simulating persistent microgravity by using tail-suspension model, examined the remolding of the heart and the specific STAT3 expression in right heart myocardium. Result: The results indicated that microgravity induced heart remodeling included a significant increasing of the ventricular weight in the left. However, the right ventricle was not increased significantly in the microgravity simulation rats. The histological study demonstrated that the outstanding development on right ventricular wall which included the gap junction remodeling and STAT3 signaling protein specific accumulation in the right ventricles. Conclusion: The results existed that the right cardiac ventricle has a distinctive remodeling process during microgravity simulation which was not the muscular hypertrophy and relative weight increasing, but manifested the STAT3 accumulation and the electrical gap junction remodeling. The effect of microgravity induced right ventricle remodeling and the STAT3 specific accumulation can be used for multi-purpose research. Key words: Microgravity simulation; Right ventricle remodeling; Intercalated disc

The clinical significance and prognostic value of right ventricular wall tension in moderate or severe tricuspid regurgitation

Background: We aim to explore the determinants of right ventricular wall tension (RV WT [RV base-to-apex length multiplied by systolic pulmonary artery pressure] and association with all-cause mortality in patients with moderate-to-severe tricuspid regurgitation. Materials & methods: Of total, 180 patients (71 ± 15years, 54% females) were included. An increased RV WT was defined as >3300 mmHgxmm. Results: Patients with increased RV WT (n = 85, 47%) were more likely to be male and taller than patients with normal RV WT. In a multivariable-adjusted model, increased RV WT was associated with a 2.6-fold higher risk of all-cause mortality (HR: 2.59, 95% CI: 1.65–4.06). Conclusion: In patients with significant tricuspid regurgitation, an increased RV WT was common, and associated with a 2.6-fold higher risk of all-cause mortality. Male sex was the only independent determinant.

Prevalence and characteristics of mitral valve prolapse in military young adults in Taiwan of the CHIEF Heart Study

The prevalence of mitral valve prolapse (MVP) among middle- and older-aged individuals is estimated to be 2–4% in Western countries. However, few studies have been conducted among Asian individuals and young adults. This study included a sample of 2442 consecutive military adults aged 18–39 years in Hualien, Taiwan. MVP was defined as displacement of the anterior or posterior leaflet of the mitral valve to the mid portion of the annular hinge point > 2 mm in the parasternal long-axis view of echocardiography. Cardiac chamber size and wall thickness were measured based on the latest criteria of the American Society of Echocardiography. The clinical features of participants with MVP and those without MVP were compared using a two-sample t test, and the cardiac structures were compared using analysis of covariance with adjustment for body surface area (BSA). Eighty-two participants were diagnosed with MVP, and the prevalence was 3.36% in the overall population. Compared with those without MVP, participants with MVP had a lower body mass index (kg/m2) (24.89 ± 3.70 vs. 23.91 ± 3.45, p = 0.02) and higher prevalence of somatic symptoms related to exercise (11.0% vs. 4.9%, p = 0.02) and systolic click in auscultation (18.3% vs. 0.6%, p < 0.01). In addition, participants with MVP had greater left ventricular mass (gm) and smaller right ventricular wall thickness (mm) and dimensions (mm) indexed by BSA than those without MVP (149.12 ± 35.76 vs. 155.38 ± 36.26; 4.66 ± 0.63 vs. 4.40 ± 0.68; 26.57 ± 3.99 vs. 25.41 ± 4.35, respectively, all p-values < 0.01). In conclusion, the prevalence and clinical features of MVP in military young adults in Taiwan were in line with those in Western countries. Whether the novel MVP phenotype found in this study has any pathological meaning needs further investigation.

The role of echocardiography in predicting technical problems and complications of transvenous leads extractions procedures

Introduction Transesophageal echocardiography (TEE) is a useful tool in preoperative observation of patients undergoing transvenous leads extraction (TLE) due to complications associated with implanted devices. Echocardiographic phenomena may determine the safety of the procedure. Methods and results Data from 936 transesophageal examinations (TEE) performed at a high volume center in patients awaiting TLE from 2015 to 2019 were assessed. TEE revealed a total of 1156 phenomena associated with the implanted leads in 697 (64.85%) patients, including: asymptomatic masses on endocardial leads (AMEL) (58.65%), vegetations (12,73%), fibrous tissue binding the lead to the vein or heart wall (33.76%), lead-to-lead binding sites (18.38%), excess lead loops (19.34%), intramural penetration of the lead tip (16.13%), lead-dependent tricuspid dysfunction (LDTD) (6.41%). Risk factors for technical difficulties during TLE in multivatiate analysis were: fibrous tissue binding the lead to atrial wall (OR=1.738; p<0.05), to right ventricular wall (OR=2.167; p<0.001), lead-to-lead binding sites (OR=1.628; p<0.01) and excess lead loops (OR=1.488; p<0.05). Lead-to-lead binding sites increased probability of major complications (OR=3.034; p<0.05). Presence of fibrous tissue binding the lead to the superior vena cava (OR=0.296; p<0.05), right atrial wall (OR=323; p<0.05) and right ventricular wall (OR=0.297; p<0.05) reduced the probability of complete procedural success, whereas fibrous tissue binding the lead to the tricuspid apparatus decreased the probability of clinical success (OR=0.307; p<0.05), Conclusions: Careful preoperative TEE evaluation of the consequences of extended lead implant duration (enhanced fibrotic response) increases the probability of predicting the level of difficulty of TLE procedures, their efficacy and risk of major complications.