Neuromonitoring During Cardiac Surgery in a Patient with Ventriculo-Caval Shunt Migration: Case Report

Ventricular shunting is a well-recognised and commonly practiced method of reducing increased intracranial pressure in patients with neurologic pathology. There are possible complications related to shunt implantation, where the rarest is intracardiac migration of the distal shunt catheter. We present a case where the distal catheter migrated into the right ventricle, causing extrasystoles and was complicated with acute right ventricle failure during the endovascular shunt evacuation procedure.

Transcatheter aortic valve implantation in patient with mechanical circulation support complicated with postoperative right ventricle failure

В статье представлен клинический случай транскатетерной имплантации аортального клапана (ТИАК) пациенту 71 года с критическим аортальным стенозом в стадии систолической дисфункции с развитием истинного кардиогенного шока. Операция была выполнена в условиях продолжающейся внутриаортальной баллонной контрпульсации. Несмотря на технический успех ТИАК, пациент скончался в раннем послеоперационном периоде при явлениях острой правожелудочковой недостаточности. Авторами проводится анализ особенностей лечения пациента и причин, повлиявших на неблагоприятный исход, а также обсуждается влияние патологии правого желудочка на результаты транс катетерной коррекции аортального стеноза. Clinical case of transcatheter aortic valve implantation (TAVI) in 71 years old male with decompensated critical aortic stenosis in the setting of cardiogenic shock is presented in the paper. The procedure was performed under use of continuous intra-aortic balloon pump. Despite of technical success of TAVI the patient passed away early after procedure with clinical signs of right ventricle failure. The authors analyze the treatment strategy in the context of unfavorable outcome as well as the impact of right ventricle disease on results of TAVI

Echocardiographic estimation of right ventricular wall tension: haemodynamic comparison and long-term follow-up

Prognosis in pulmonary hypertension is strictly linked to right ventricle failure, which results from uncoupling between right ventricle function and its afterload. This study sought to describe how to estimate with echocardiography right ventricular wall tension, its correlation with right ventricle haemodynamics and its prognostic role. A total of 190 patients without overt right ventricle failure but with suspected pulmonary hypertension on a previous echocardiogram underwent right heart catheterization and nearly-simultaneous echocardiography. Right ventricular wall tension was estimated according to Laplace’s law as right ventricle length × tricuspid regurgitation peak gradient and it was correlated with right ventricle haemodynamic profile; its potential prognostic impact was tested along with canonical right ventricle function parameters. Right ventricular wall tension correlated significantly with invasive estimation of right ventricle end-diastolic pressure (R: 0.343, p < 0.001) and with several other haemodynamic variables, such as mean pulmonary artery pressure, pulmonary artery compliance, transpulmonary gradient, pulmonary vascular resistance, right atrial pressure and right ventricle stroke work index (all p < 0.001). At a mean follow-up of five years and three months, only right ventricular wall tension was associated to all-cause mortality ( p = 0.036), while tricuspid annular plane systolic excursion ( p = 0.536), right ventricle fractional area change ( p = 0.383), right ventricle fractional area change ( p = 0.076), tricuspid regurgitation peak gradient ( p = 0.107) and tricuspid annular plane systolic excursion/tricuspid regurgitation peak gradient ( p = 0.181) could not. We identified a novel bedside echocardiographic predictor of altered right ventricle haemodynamics, which is precociously altered in patients without overt right ventricle failure and is associated to all-cause mortality at a long-term follow-up. Further studies are needed to confirm its role in pulmonary hypertension patients.