Cardiac Function in Brain Death, Usage of Advanced Hemodynamic Monitoring

Background: This study used advanced hemodynamic monitoring along with simultaneous echocardiography to assess donated heart function of brain death patients using advanced hemodynamic monitoring and its efficacy in organ donation. Methods: Forty-eight brain death patients who were candidates of heart donation on the basis of primary standard investigations were selected with purposive and convenient sampling methods. They were investigated with advanced hemodynamic monitoring after echocardiography and primary assessments and the gleaned data were recorded. Results: Echocardiography showed that LVS (left ventricle size) and LVF (left ventricle function) were normal in %100 and %87.5 of patients, respectively. LVEF (left ventricle ejection fraction) was <%50 in %12.5 and >%50 in %87.5 of patients. SVR was smaller than 1200 at the beginning of the study that reached %54.4 at the end of the study. CI (cardiac index) was < 2.4 in %16.7 of the patients at the onset of the study that reached %25 at the end. Reduction of CI and SVR in patients with EF <%50 was significantly higher than that in patients with EF>%50. Conclusion: Given the extensive pathological changes in the cardiovascular system exerted by brain death, advanced hemodynamic monitoring, if performed continually, can greatly aid in managing inotropic drugs in these patients, decision-making for managing intravascular volume, creating hemodynamic stability, and finally, preventing deterioration of function of the donated heart and loss of a donated organ.

546 Antegrade in-stent CTO recanalization

Methods and results A 64-year-old man with prior PCI and stent of proximal LAD due to an anterior ST-elevation myocardial infarction (STEMI) presented with exertional angina (CCS III), despite optimal medical therapy (OMT). The echocardiogram showed a dilatated left ventricle with anterior and apical akinesia and a severely reduced left ventricle ejection fraction. Coronarography was performed and a chronic total occlusion was found at the proximal edge of the stent previously implanted in the proximal LAD, with a thin tapered entry (J-CTO score 1). Moderate angiographic disease was present in the circumflex (LCX) and in the right coronary artery (RCA). Interventional collaterals were absent. Dobutamine stress echocardiogram was performed to unmask myocardial viability. Indeed, during intravenous Dobutamine administration, we registered an increase in the left ventricle function, whereas only apex remained still akinetic. Accordingly, the patient underwent LAD CTO PCI using a 7 Fr EBU 4.0 guiding catheter, via right femoral artery access. The RCA ostium was engaged with a 6 Fr Judkins right 4.0 guiding catheter, via right radial artery access. Antegrade wire escalation technique was attempted. Due to scarce support, a 7 Fr Guidion guiding catheter extension and a Corsair microcatheter were placed in the proximal LAD. Antegrade crossing was very difficult due to intrastent high plaque burden. The occlusion was crossed with an Asahi Conquest Pro 9 guidewire. Subsequently, an Asahi Gaia third guidewire was advanced through the intrastent segment and then in the distal part of LAD. The advance of microcatheter was challenging but successfully achieved taking advantage of the low profile, high torqueability and trackability of the Asahi Corsair Pro microcatheter. Microcatheter tip injection confirmed the correct position in the vessel’s true lumen. An Asahi Grand Slam guidewire was placed in the distal LAD to provide extra support for delivery of interventional devices. The lesion was pre-dilated with progressively larger balloon, starting from a 1.1 mm diameter semi-compliant over-the-wire balloon (OTW). Two stents were implanted with a minimal overlap at the distal edge of the proximal stent (Resolute Onyx 3.0 × 38 mm and 2.5 × 24 mm). The result was improved with stents high-pressure post-dilatation and with selective intracoronary adenosine and nitroglycerin administration with final Thrombolysis in Myocardial Infarction (TIMI) grade 3 flow. The total amount of contrast media used was 210 ml. The total procedure time was with 125 min with 45 min of fluoroscopy. No complications occurred. Conclusions CTO PCI still represents one of the most challenging subsets of coronary interventions despite the improvement in technology and techniques. Although data regarding percutaneous PCI CTO are still inconsistent, successful CTO recanalization has been associated with relief of angina and ischemia-related dyspnoea (Werner at al., 2018). In stable patients CTO PCI has been associated with a lower risk of death, stroke, and coronary artery bypass grafting and less recurrent angina pectoris in some registry studies (Christakopoulos et al., 2015). Additionally, CTO PCI increased left ventricle function in a subgroup of patients with LAD CTO (Henriques et al., 2016). Conversely, randomized multicentre failed to demonstrate a superiority of CTO PCI medical to OMT in terms of major adverse cardiac events (MACE) and all-cause mortality.

Takotsubo syndrome following pericardiectomy

Background: Takotsubo cardiomyopathy (TC) is defined as a temporary and reversible systolic abnormality of the left ventricle’s apical area resembling myocardial infarction (MI) in the nonexistence of coronary artery disease (CAD)[1].Only a few cases have been reported after cardiac operations or after pericardiocentesis. Aims: To emphasize the need to be aware of the possibility of the occurrence of this potentially fatal complication after cardiac surgery. Materials and methods: A-66-year old man underwent pericardiectomy.Postoperative he endured TC and progressed exacerbation of hemodynamic instability.finally, he had to be supported by intra-aortic balloon pump（IABP),extracorporeal membrane oxygenation（ECMO). Results: Patient’s left ventricle function recovered fully in two weeks. Discussion: we discussed the pathogenesis and treatment of postoperative TC. Conclusion:TC has to be carefully considered in differential diagnosis in case of acute left ventricle dysfunction following cardiac surgery. Keywords: pericardiectomy; takotsubo cardiomyopathy.

1p36 Deletion Syndrome and Left Ventricular Non-compaction Cardiomyopathy—Two Cases Report

1p36 deletion is the most common terminal deletion syndrome in humans. Herein, we report two cases, a 5-month-old female and a 14.5-year-old female, both with 1p36 deletion and left ventricular non-compaction cardiomyopathy. They presented with severely depressed left ventricle function and underwent heart transplantation with excellent outcomes. Given the incidence of heart defects and cardiomyopathy in 1p36 deletion syndrome, it should be recommended that children with this genetic condition have screening for cardiac disease. These cases add to the current literature by demonstrating the potential therapeutic options for non-compaction in 1p36 deletion syndrome and showed the favorable outcomes.

Evaluation of the Right Ventricle Function Conducted in Patients after Acute Myocardial Infarction, Using Threedimensional Echocardiography and Myocardial Strain Analysis. Summary of the Doctoral Thesis

It is well known that dysfunction of the right ventricle in ST segment elevation myocardial infarction causes such complications as rhythm disturbances, cardiogenic shock and others. Its presence is an independent prognostic indicator of all-cause mortality, cardiovascular mortality and development of heart failure. However, in clinical practice still too little attention is paid to the evaluation of the right ventricle function, despite the new echocardiographic methods available, which are capable of providing an accurate diagnostics of the right ventricle disfunction. The purpose of this work is to evaluate changes in the systolic function of the right ventricle in patients with proven acute ST elevation myocardial infarction by threedimensional echocardiography and myocardial strain techniques, and to select the most informative echocardiographic parameters for the size and function of the right ventricle for use in everyday practice. Based on the data gained during this study, the algorithm for the evaluation of the right ventricle function in patients with acute ST elevation myocardial infarction will be developed. A healthy individuals control group and a group of patients with ST elevation myocardial infarction were formed within the study. Each participant was examined according to standart echocardiography protocol. In each case new echocardiographic right venricle function evaluation methods also were applied – a three-dimensional echocardiography with following right ventricle reconstruction, volume and ejection fraction determination, as well as myocardial longitudinal strain measurements. Based on these methods, by comparing the data to the control group results, it was possible to etermine the pathology threshold for the right ventricular ejection fraction and longitudinal strain to detect right ventricle disfunction in the case of acute myocardial infarction. Three-dimensional echocardiography and evaluation of myocardial strain are new, relatively simple, sufficiently sensitive and specific methods for the diagnosis of right ventricular dysfunction in patients with ST elevation myocardial infarction. The methods are to be introduced for use in everyday clinical practice along with the standard ehocardiography parameters, which also change in ST elevation myocardial infarction: fractional area change, tricuspid annular plane systolic excursion, and visual evaluation of segmental systolic function of the right ventricle. Among new parameters ejection fraction of the right ventricle and right ventricle free wall longitudinal strain have to be determined. When evaluating the right chamber, it should be remembered that its function deterioration can be observed in case of myocardial infarction of any localization.