The accurate assessment of cardiac motion is crucial for diagnosing and monitoring cardiovascular diseases.In this context,digital volume correlation(DVC)has emerged as a promising technique for tracking cardiac motio...The accurate assessment of cardiac motion is crucial for diagnosing and monitoring cardiovascular diseases.In this context,digital volume correlation(DVC)has emerged as a promising technique for tracking cardiac motion from cardiac computed tomography angiographic(CTA)images.This paper presents a comprehensive performance evaluation of the DVC method,specifically focusing on tracking the motion of the left atrium using cardiac CTA data.The study employed a comparative experimental approach while simultaneously optimizing the existing DVC algorithm.Multiple sets of controlled experiments were designed to conduct quantitative analyses on the parameters“radius”and“step”.The results revealed that the optimized DVC algorithm enhanced tracking accuracy within a reasonable computational time.These findings contributed to the understanding of the efficacy and limitations of the DVC algorithm in analyzing heart deformation.展开更多
Background and aims:Idiopathic premature ventricular contractions(PVCs)may cause subtle changes in left atrium(LA)structure and function.Here,we investigated whether serum sodium,body mass index(BMI),N-terminal pro-B-...Background and aims:Idiopathic premature ventricular contractions(PVCs)may cause subtle changes in left atrium(LA)structure and function.Here,we investigated whether serum sodium,body mass index(BMI),N-terminal pro-B-type natriuretic peptide(NT-proBNP)and other characteristics might be associated with LA in these patients.Methods:A total of 268 consecutive patients diagnosed with idiopathic PVCs were retrospectively analyzed.We assessed associations of enlarged LA and with the clinical features obtained from 24-hour Holter monitoring,electro-cardiography and serum data in patients with PVCs.Results:Patients with an enlarged LA(n=101),compared with a normal LA(n=167),had significantly lower serum sodium(140.9±3.0 mmol/L vs 141.7±2.8 mmol/L;P=0.022),higher BMI(24.5±2.7 kg/m2 vs 21.7±2.5 kg/m2;P<0.001),higher NT-proBNP[99.3(193.6)pg/mL vs 77.8(68.8)pg/mL;P<0.001]and lower average heart rates(73.0±8.0 bpm vs 75.3±7.6 bpm;P=0.019).No significant differences were observed in P-wave dispersion,QRS duration,PVC coupling interval,pleomorphism,circadian rhythm,non-sustained ventricular tachycardia,serum potassium,serum magnesium,hypersensitive C-reactive protein,low-density lipoprotein cholesterol,symptoms and PVC duration.Conclusions:Beyond the burden of PVCs,attributes such as serum sodium,BMI,NT-proBNP and average heart beats may potentially correlate with LA enlargement in individuals with idiopathic PVCs.展开更多
Usually, cardiac calcifications are observed in aortic and mitral valves, atrio-ventricular plane, mitral annulus, coronary arteries, pericaridium(usually causing constrictive pericarditis) and cardiac masses. Calcifi...Usually, cardiac calcifications are observed in aortic and mitral valves, atrio-ventricular plane, mitral annulus, coronary arteries, pericaridium(usually causing constrictive pericarditis) and cardiac masses. Calcifications of atrial walls are unusual findings that can be identified only using imaging with high spatial resolution, such as cardiac magnetic resonance and computed tomography. We report a case of a 43-year-old patient with no history of heart disease that underwent cardiac evaluation for mild dyspnoea. The echocardiogram showed a calcific aortic valve and a hyper-echogenic lesion located in atrio-ventricular plane. The patient was submitted to cardiac magnetic resonance and to computed tomography imaging to better characterize the localization of mass. The clinical features and location of calcified lesion suggest an infective aetiology causing an endocarditis involving the aortic valve, atrioventricular plane and left atrium. Although we haven't data to support a definite and clear diagnosis, the clinical features and location of the calcified lesion suggest an infective aetiology causing an endocarditis involving the aortic valve, atrio-ventricular plane and left atrium. The patient was followed for 12 mo both clinically and by electrocardiogram and echocardiography without worsening of clinical, electrocardiographic and echocardiographic data. Cardiac magnetic resonance imaging and computed tomography are ideal methods for identifying and following over time patients with calcific degeneration in the heart.展开更多
BACKGROUND Pulmonary artery-to-left atrial fistula is a variant of pulmonary arteriovenous fistula and is a developmental anomaly.Delayed presentation,cyanosis and effort intolerance are some of the important features...BACKGROUND Pulmonary artery-to-left atrial fistula is a variant of pulmonary arteriovenous fistula and is a developmental anomaly.Delayed presentation,cyanosis and effort intolerance are some of the important features.The diagnosis is confirmed by computed tomography or pulmonary artery angiography.Catheter-based closure is preferred to surgery.CASE SUMMARY Left pulmonary artery-to-left atrial fistula is rare.A 40-year-old male presented with effort intolerance,central cyanosis,and recurrent seizures.He had a large and highly tortuous left pulmonary artery-to-left atrial fistula associated with a large aneurysmal sac in the course.Catheter-based closure was performed using a vascular plug.CONCLUSION Left pulmonary artery-to-left atrial fistula is relatively uncommon compared to right pulmonary artery-to-left atrial fistula.Percutaneous closure by either a transeptal technique or guide wire insertion into the pulmonary vein through the pulmonary artery is preferred.The need for an arteriovenous loop depends on the tortuosity of the course of the fistula and the size of the device to be implanted because a larger device needs a larger sheath,necessitating firm guide wire support to facilitate negotiation of the stiff combination of the delivery sheath and dilator.展开更多
BACKGROUND Veno-arterial extra corporeal membrane oxygenation(VA-ECMO)support is commonly complicated with left ventricle(LV)distension in patients with cardiogenic shock.We resolved this problem by transeptally conve...BACKGROUND Veno-arterial extra corporeal membrane oxygenation(VA-ECMO)support is commonly complicated with left ventricle(LV)distension in patients with cardiogenic shock.We resolved this problem by transeptally converting VAECMO to left atrium veno-arterial(LAVA)-ECMO that functioned as a temporary paracorporeal left ventricular assist device to resolve LV distension.In our case LAVA-ECMO was also functioning as a bridge-to-transplant device,a technique that has been scarcely reported in the literature.CASE SUMMARY A 65 year-old man suffered from acute myocardial injury that required percutaneous stents.Less than two weeks later,noncompliance to antiplatelet therapy led to stent thrombosis,cardiogenic shock,and cardiac arrest.Femorofemoral VA-ECMO support was started,and the patient underwent a second coronary angiography with re-stenting and intra-aortic balloon pump placement.The VA-ECMO support was complicated by left ventricular distension which we resolved via LAVA-ECMO.Unfortunately,episodes of bleeding and sepsis complicated the clinical picture and the patient passed away 27 d after initiating VA-ECMO.CONCLUSION This clinical case demonstrates that LAVA-ECMO is a viable strategy to unload the LV without another invasive percutaneous or surgical procedure.We also demonstrate that LAVA-ECMO can also be weaned to a left ventricular assist device system.A benefit of this technique is that the procedure is potentially reversible,should the patient require VA-ECMO support again.A transeptal LV venting approach like LAVA-ECMO may be indicated over ImpellaTM in cases where less LV unloading is required and where a restrictive myocardium could cause LV suctioning.Left ventricular over-distention is a well-known complication of peripheral VA-ECMO in cardiogenic shock and LAVA ECMO through transeptal cannulation offers a novel and safe approach for treating LV overloading,without the need of an additional percutaneous access.展开更多
<strong>Introduction</strong>: Cardiac myxomas represent the most frequent forms of primary tumors of the heart. The most frequent location is the interatrial septum. We report the clinical case of a myxom...<strong>Introduction</strong>: Cardiac myxomas represent the most frequent forms of primary tumors of the heart. The most frequent location is the interatrial septum. We report the clinical case of a myxoma of the left atrium and discuss its epidemiological and therapeutic aspects through a review of the literature. <strong>Observation</strong>: This was a 41-year-old female patient who presented with sudden rotational dizziness associated with vomiting. MRI revealed multiple punctiform bilateral supra and subtentorial strokes of different ages, recent and semi-recent, suggesting an embologenic etiology. Transesophageal echocardiography found a large pedunculated, homogeneous, avascular tumor hanging from the interatrial septum. The patient is operated on urgently under cardiopulmonary bypass for resection of a large tumor located in the left atrium. The pathological examination concluded with the diagnosis of myxoma of the left atrium. The postoperative follow-up was straightforward and the patient was discharged from the hospital via home hospitalization. <strong>Conclusion</strong>: The diagnosis of cardiac myxomas is suspected in the presence of symptoms associated with echocardiographic images of intracardiac masses and confirmed by histological study. Embolic accidents are one of the formidable complications of myxomas. Surgical management is urgent, especially in the presence of predictive morphological features of embolism on echocardiography.展开更多
Objectives This study was to investigate the differences between modeling and non-modeling left atrium （LA） in CartoXP system guided catheter ablation for paroxysmal atrial fibrillation （PAF）. Methods From Jan to ...Objectives This study was to investigate the differences between modeling and non-modeling left atrium （LA） in CartoXP system guided catheter ablation for paroxysmal atrial fibrillation （PAF）. Methods From Jan to Dec in 2008 total 31 cases with PAF were enrolled. All were treated by the same electrophysiologist with CartoXP guidance. Catheter ablation was accomplished without left atrium and pulmonary veins modeling in 17 patients （non-modeling group） and with left atrium modeling in 14 patients （modeling group）. The detailed ablation method was based on circumferential pulmonary veins isolation （CPVI）. And linear ablation of tricuspid valvular isthmus was performed individually. The ablation endpoint was a complete isolation of pulmonary vein potential from left atrium and no further induced continuous fast atrial arrhythmia including atrial fibrillation （AF）, atrial flutter （AFL） and atrial tachycardia （AT）. Each step for the procedures and the follow-up outcomes were compared correspondingly. Results The total procedure time was 107.23 ± 28.92 min in modeling group vs 93.47 ±26.09 min in non-modeling group （ P 〉 0.05 ）. The X-ray exposure time was significantly longer in modeling group （21.09 ±6. 49 rain） than in non-modeling group （14. 16 ± 5.35 min）. The CPVI times of right pulmonary veins and left pulmonary veins were 28. 14 ± 9. 26 min was 27.29 ± 18.53 min in modeling group respectively, vs 18.00 ±4. 51 min and 23.94 ± 7. 10 min in non-modeling group respectively, （P 〈 0. 05 ）. There is no significant difference between modeling group （85.7%） and non-modeling group （82.4%） over follow-up period of 2 to 13 months. Confusions CartoXP system guided catheter ablation of PAF without modeling of left atrium and pulmonary veins took less time in X-ray exposure and ablation steps, comparing with left atrium modeling procedure.展开更多
Hemodynamic instability secondary to left atrial (LA) compression by an aortic aneurysm is a rare entity. We report?the case of a 43-year old woman with no previous diagnosis of congestive heart failure who was admitt...Hemodynamic instability secondary to left atrial (LA) compression by an aortic aneurysm is a rare entity. We report?the case of a 43-year old woman with no previous diagnosis of congestive heart failure who was admitted for an initial diagnosis of pulmonary embolism (PE) based on shortness of breath, hypotension and D-Dimers?elevation. The electrocardiogram and blood counts were within normal limits. The chest X-ray revealed widening of the mediastinum. Transthoracic echocardiography demonstrated LA compression by a large descending thoracic aortic aneurysm. Left and right ventricle systolic functions were preserved. Chest angiography showed LA and left pulmonary artery (LPA) compression by a descending aortic aneurysm and an intramural hematoma with no evidence of PE evidence. Emergency surgery could not be done because of her financial status. She was treated medically and was discharged 1?week later with significant improvement. However she remained hypotensive.展开更多
A 49-year-old man had an abnormal shadow on chest X-ray. Enhanced chest computed tomography (CT) revealed an 8-cm diameter right lung mass invading the right chest wall, with a tumor thrombus extending from the superi...A 49-year-old man had an abnormal shadow on chest X-ray. Enhanced chest computed tomography (CT) revealed an 8-cm diameter right lung mass invading the right chest wall, with a tumor thrombus extending from the superior pulmonary vein into the left atrium. Transesophageal echocardiography confirmed that the tumor adjoined the side wall of the atrium. Endobronchial and CT-guided needle biopsy demonstrated a low-grade carcinoma or small cell carcinoma. Operative findings through left atriotomy under cardiopulmonary bypass showed no tumor invasion of the atrium wall, but protrusion through the pulmonary vein. Frozen sections revealed a non-small cell carcinoma. We performed right upper lobectomy with parietal pleura and mediastinal lymph node dissection after detachment of cardiopulmonary bypass. Pathological examination demonstrated a large-cell neuroendocrine carcinoma p-T4N0M0, stage IIIA. The patient recovered without postoperative complications and tolerated two cycles of adjuvant chemotherapy. He was doing well without symptoms of recurrence 42 months after surgery.展开更多
Aim: To present the aneurysmal dilatation of left atrium due to rheumatic mitral valve disease and its clinical consequences such as arrhythmic, thromboembolic and compressive manifestations. Introduction: Extreme enl...Aim: To present the aneurysmal dilatation of left atrium due to rheumatic mitral valve disease and its clinical consequences such as arrhythmic, thromboembolic and compressive manifestations. Introduction: Extreme enlargement of left atrium, usually referred to as giant, gigantic or aneurysmal dilatation is an uncommon finding with a reported incidence of 0.3% in rheumatic heart disease. It is an important clinical risk identifier to predict the outcome of cardiovascular disease. Case reports: Aneurysmal left atrium correlating with the length of pure mitral regurgitation jet in a 18-year-old girl, posterior mitral leaflet prolapse with regurgitation jet swirling around the entire interatrial septum in a 37-year-old male, Giant left atrium in mixed mitral valve disease in a 37-year-old female and a thrombosed giant left atrium resembling as “coconut” in a 50-year-old female were reported. Conclusion: Giant left atrium may be misinterpreted as right-sided pleural effusion, pericardial effusion and mediastinal tumor on X-ray chest and so echocardiographic evaluation is mandatory to exclude the aneurysmal left atrium in such conditions.展开更多
Pulmonary vein thrombosis is a rare disease and is usually represented as a complication of atrial fibrillation, pulmonary tumors, and Iobectomy. Although it is a potentially life threatening condition, the venous dis...Pulmonary vein thrombosis is a rare disease and is usually represented as a complication of atrial fibrillation, pulmonary tumors, and Iobectomy. Although it is a potentially life threatening condition, the venous disease is easy to misdiagnose because of the non-specific symptoms, In this article, we present a 30-year-old patient who suffered from pulmonary vein thrombosis without any causes. He was diagnosed with other pulmonary disorders till the thrombus within the pulmonary vein extended into the left atrium. Left atrium mass resection and a left lower Iobectomy were undertaken with relative urgency. The postoperative course was uneventful. The patient received a long course of oral anticoagulant therapy.展开更多
Objective To investigate the effects of ethanol on physiological characteristics of the isolated guinea pig left atrium and papillary muscles.Methods The effects of ethanol on contractility, post-rest potentiation a...Objective To investigate the effects of ethanol on physiological characteristics of the isolated guinea pig left atrium and papillary muscles.Methods The effects of ethanol on contractility, post-rest potentiation and positive staircase phenomenon were observed in isolated left atrium and papillary muscles of guinea pig.Results Ethanol(50.0,100.0,200.0mmol·L -1)prominently inhibited the contraction of papillary muscles. Ethanol(12.5,25.0,50.0,100.0,200.0mmol·L -1) inhibited the contraction of left atrium, and markedly decreased the post-rest potentiation of myocardial contractility in left atrium. High concentration of ethanol(100,200mmol·L -1) depressed the positive staircase phenomenon of isolated guinea pig left atrium.Conclusion These results suggest that ethanol induces inhibitory effects of the contractility, post-rest potentiation, positive staircase phenomenon of left atrium. The mechanism by which ethanol induces the negative inotropic effects may be related to decrease the amount of calcium released from the intracellular stores.展开更多
Dystrophic cardiac calcification is often associated with conditions causing systemic inflammation and when present,is usually extensive,often encompassing multiple cardiac chambers and valves.We present an unusual ca...Dystrophic cardiac calcification is often associated with conditions causing systemic inflammation and when present,is usually extensive,often encompassing multiple cardiac chambers and valves.We present an unusual case of dystrophic left atrial calcification in the setting of end stage renal disease on hemodialysis diagnosed by echocardiography and computed tomography.Significant calcium deposition is confined within the walls of the left atrium with no involvement of the mitral valve,and no hemodynamic effects.展开更多
Objectives To investigate the relationship between serum uric acid （SUA） and left atrial spontaneous echo contrast （LA-SEC） in non-valvular atrial fibrillation （AF） patients. Methods We retrospectively screened ...Objectives To investigate the relationship between serum uric acid （SUA） and left atrial spontaneous echo contrast （LA-SEC） in non-valvular atrial fibrillation （AF） patients. Methods We retrospectively screened 1,476 consecutive hospitalized patients with AF who underwent transesophageal echocardiography prior to radiofrequency catheter ablation, left atrial appendage closure and electric cardiover- sion at Guangdong General Hospital. Data on the clinical baseline characteristics of all patients were collected from electronic medical re- cords and analyzed. Results After exclusion of patients with left atrial thrombus, 1,354 patients entered into present study and 57 were LA-SEC. The mean female SUA level （380.88 ± 94.35 μmol/L vs. 323.37 ± 72.19μmol/L, P 〈 0.001） and male SUA level （416.97 ± 98.87 μmol/L vs. 367.88 ＋ 68.50 μmol/L, P = 0.008） were both significantly higher in patients with LA-SEC than in the controls. The mean left atrial dimension （41.32 ± 5.12 mm vs. 36.12 ± 5.66 mm, P 〈 0.001） was markedly larger in patients with LA-SEC. In multivariate regression analysis, SUA level was an independent risk factor for LA-SEC （OR： 1.008, P 〈 0.001）. In receiver operating characteristic curve analysis, the corresponding area under the curve for SUA predicting LA-SEC in female and male were 0.670 and 0.657, respectively. SUA level is significantly higher in non-valvular AF patients with LA-SEC. Conclusion SUA level is an independent risk factor and has a moderate predictive value for LA-SEC among non-valvular AF patients in Southern China.展开更多
The symptom cluster of shortness of breath(SOB) contributes significantly to the outpatient workload of cardiology services. The workup of these patients includes blood chemistry and biomarkers, imaging and functional...The symptom cluster of shortness of breath(SOB) contributes significantly to the outpatient workload of cardiology services. The workup of these patients includes blood chemistry and biomarkers, imaging and functional testing of the heart and lungs. A diagnosis of diastolic heart failure is inferred through the exclusion of systolic abnormalities, a normal pulmonary function test and normal hemoglobin, coupled with diastolic abnormalities on echocardiography. Differentiating confounders such as obesity or deconditioning in a patient with diastolic abnormalities is difficult. While the most recent guidelines provide more avenues for diagnosis, such as incorporating the left atrial size, little emphasis is given to understanding left atrial function, which contributes to at least 25% of diastolic left ventricular filling; additionally, exercise stress testing to elicit symptoms and test the dynamics of diastolic parameters, especially when access to the "gold standard" invasive tests is lacking, presents clinical translational gaps. It is thus important in diastolic heart failure work up to understand left atrial mechanics and the role of exercise testing to build a comprehensive argument for the diagnosis of diastolic heart failure in a patient presenting with SOB.展开更多
基金supported by the Australian Research Council(ARC)(Grant No.DP200103492)the National Natural Science Foundation of China(Grant Nos.12172089,12372307,and 61821002)+2 种基金Medical Research Future Fund(Grant Nos.2016165 and 2023977)the CBT Early Career Researcher Grant funded and the Roland Bishop Biomedical Engineering Research Award by Queensland University of Technologythe Springboard Funding and the Global Collaboration Funding by London South Bank University.Computational resources and services used in this work were provided by the High-Performance Computing and Research Support Group,Queensland University of Technology,Brisbane,Australia.
文摘The accurate assessment of cardiac motion is crucial for diagnosing and monitoring cardiovascular diseases.In this context,digital volume correlation(DVC)has emerged as a promising technique for tracking cardiac motion from cardiac computed tomography angiographic(CTA)images.This paper presents a comprehensive performance evaluation of the DVC method,specifically focusing on tracking the motion of the left atrium using cardiac CTA data.The study employed a comparative experimental approach while simultaneously optimizing the existing DVC algorithm.Multiple sets of controlled experiments were designed to conduct quantitative analyses on the parameters“radius”and“step”.The results revealed that the optimized DVC algorithm enhanced tracking accuracy within a reasonable computational time.These findings contributed to the understanding of the efficacy and limitations of the DVC algorithm in analyzing heart deformation.
文摘Background and aims:Idiopathic premature ventricular contractions(PVCs)may cause subtle changes in left atrium(LA)structure and function.Here,we investigated whether serum sodium,body mass index(BMI),N-terminal pro-B-type natriuretic peptide(NT-proBNP)and other characteristics might be associated with LA in these patients.Methods:A total of 268 consecutive patients diagnosed with idiopathic PVCs were retrospectively analyzed.We assessed associations of enlarged LA and with the clinical features obtained from 24-hour Holter monitoring,electro-cardiography and serum data in patients with PVCs.Results:Patients with an enlarged LA(n=101),compared with a normal LA(n=167),had significantly lower serum sodium(140.9±3.0 mmol/L vs 141.7±2.8 mmol/L;P=0.022),higher BMI(24.5±2.7 kg/m2 vs 21.7±2.5 kg/m2;P<0.001),higher NT-proBNP[99.3(193.6)pg/mL vs 77.8(68.8)pg/mL;P<0.001]and lower average heart rates(73.0±8.0 bpm vs 75.3±7.6 bpm;P=0.019).No significant differences were observed in P-wave dispersion,QRS duration,PVC coupling interval,pleomorphism,circadian rhythm,non-sustained ventricular tachycardia,serum potassium,serum magnesium,hypersensitive C-reactive protein,low-density lipoprotein cholesterol,symptoms and PVC duration.Conclusions:Beyond the burden of PVCs,attributes such as serum sodium,BMI,NT-proBNP and average heart beats may potentially correlate with LA enlargement in individuals with idiopathic PVCs.
文摘Usually, cardiac calcifications are observed in aortic and mitral valves, atrio-ventricular plane, mitral annulus, coronary arteries, pericaridium(usually causing constrictive pericarditis) and cardiac masses. Calcifications of atrial walls are unusual findings that can be identified only using imaging with high spatial resolution, such as cardiac magnetic resonance and computed tomography. We report a case of a 43-year-old patient with no history of heart disease that underwent cardiac evaluation for mild dyspnoea. The echocardiogram showed a calcific aortic valve and a hyper-echogenic lesion located in atrio-ventricular plane. The patient was submitted to cardiac magnetic resonance and to computed tomography imaging to better characterize the localization of mass. The clinical features and location of calcified lesion suggest an infective aetiology causing an endocarditis involving the aortic valve, atrioventricular plane and left atrium. Although we haven't data to support a definite and clear diagnosis, the clinical features and location of the calcified lesion suggest an infective aetiology causing an endocarditis involving the aortic valve, atrio-ventricular plane and left atrium. The patient was followed for 12 mo both clinically and by electrocardiogram and echocardiography without worsening of clinical, electrocardiographic and echocardiographic data. Cardiac magnetic resonance imaging and computed tomography are ideal methods for identifying and following over time patients with calcific degeneration in the heart.
文摘BACKGROUND Pulmonary artery-to-left atrial fistula is a variant of pulmonary arteriovenous fistula and is a developmental anomaly.Delayed presentation,cyanosis and effort intolerance are some of the important features.The diagnosis is confirmed by computed tomography or pulmonary artery angiography.Catheter-based closure is preferred to surgery.CASE SUMMARY Left pulmonary artery-to-left atrial fistula is rare.A 40-year-old male presented with effort intolerance,central cyanosis,and recurrent seizures.He had a large and highly tortuous left pulmonary artery-to-left atrial fistula associated with a large aneurysmal sac in the course.Catheter-based closure was performed using a vascular plug.CONCLUSION Left pulmonary artery-to-left atrial fistula is relatively uncommon compared to right pulmonary artery-to-left atrial fistula.Percutaneous closure by either a transeptal technique or guide wire insertion into the pulmonary vein through the pulmonary artery is preferred.The need for an arteriovenous loop depends on the tortuosity of the course of the fistula and the size of the device to be implanted because a larger device needs a larger sheath,necessitating firm guide wire support to facilitate negotiation of the stiff combination of the delivery sheath and dilator.
基金Supported by EUROSETS srl Italy for the Open Access Fee.
文摘BACKGROUND Veno-arterial extra corporeal membrane oxygenation(VA-ECMO)support is commonly complicated with left ventricle(LV)distension in patients with cardiogenic shock.We resolved this problem by transeptally converting VAECMO to left atrium veno-arterial(LAVA)-ECMO that functioned as a temporary paracorporeal left ventricular assist device to resolve LV distension.In our case LAVA-ECMO was also functioning as a bridge-to-transplant device,a technique that has been scarcely reported in the literature.CASE SUMMARY A 65 year-old man suffered from acute myocardial injury that required percutaneous stents.Less than two weeks later,noncompliance to antiplatelet therapy led to stent thrombosis,cardiogenic shock,and cardiac arrest.Femorofemoral VA-ECMO support was started,and the patient underwent a second coronary angiography with re-stenting and intra-aortic balloon pump placement.The VA-ECMO support was complicated by left ventricular distension which we resolved via LAVA-ECMO.Unfortunately,episodes of bleeding and sepsis complicated the clinical picture and the patient passed away 27 d after initiating VA-ECMO.CONCLUSION This clinical case demonstrates that LAVA-ECMO is a viable strategy to unload the LV without another invasive percutaneous or surgical procedure.We also demonstrate that LAVA-ECMO can also be weaned to a left ventricular assist device system.A benefit of this technique is that the procedure is potentially reversible,should the patient require VA-ECMO support again.A transeptal LV venting approach like LAVA-ECMO may be indicated over ImpellaTM in cases where less LV unloading is required and where a restrictive myocardium could cause LV suctioning.Left ventricular over-distention is a well-known complication of peripheral VA-ECMO in cardiogenic shock and LAVA ECMO through transeptal cannulation offers a novel and safe approach for treating LV overloading,without the need of an additional percutaneous access.
文摘<strong>Introduction</strong>: Cardiac myxomas represent the most frequent forms of primary tumors of the heart. The most frequent location is the interatrial septum. We report the clinical case of a myxoma of the left atrium and discuss its epidemiological and therapeutic aspects through a review of the literature. <strong>Observation</strong>: This was a 41-year-old female patient who presented with sudden rotational dizziness associated with vomiting. MRI revealed multiple punctiform bilateral supra and subtentorial strokes of different ages, recent and semi-recent, suggesting an embologenic etiology. Transesophageal echocardiography found a large pedunculated, homogeneous, avascular tumor hanging from the interatrial septum. The patient is operated on urgently under cardiopulmonary bypass for resection of a large tumor located in the left atrium. The pathological examination concluded with the diagnosis of myxoma of the left atrium. The postoperative follow-up was straightforward and the patient was discharged from the hospital via home hospitalization. <strong>Conclusion</strong>: The diagnosis of cardiac myxomas is suspected in the presence of symptoms associated with echocardiographic images of intracardiac masses and confirmed by histological study. Embolic accidents are one of the formidable complications of myxomas. Surgical management is urgent, especially in the presence of predictive morphological features of embolism on echocardiography.
文摘Objectives This study was to investigate the differences between modeling and non-modeling left atrium （LA） in CartoXP system guided catheter ablation for paroxysmal atrial fibrillation （PAF）. Methods From Jan to Dec in 2008 total 31 cases with PAF were enrolled. All were treated by the same electrophysiologist with CartoXP guidance. Catheter ablation was accomplished without left atrium and pulmonary veins modeling in 17 patients （non-modeling group） and with left atrium modeling in 14 patients （modeling group）. The detailed ablation method was based on circumferential pulmonary veins isolation （CPVI）. And linear ablation of tricuspid valvular isthmus was performed individually. The ablation endpoint was a complete isolation of pulmonary vein potential from left atrium and no further induced continuous fast atrial arrhythmia including atrial fibrillation （AF）, atrial flutter （AFL） and atrial tachycardia （AT）. Each step for the procedures and the follow-up outcomes were compared correspondingly. Results The total procedure time was 107.23 ± 28.92 min in modeling group vs 93.47 ±26.09 min in non-modeling group （ P 〉 0.05 ）. The X-ray exposure time was significantly longer in modeling group （21.09 ±6. 49 rain） than in non-modeling group （14. 16 ± 5.35 min）. The CPVI times of right pulmonary veins and left pulmonary veins were 28. 14 ± 9. 26 min was 27.29 ± 18.53 min in modeling group respectively, vs 18.00 ±4. 51 min and 23.94 ± 7. 10 min in non-modeling group respectively, （P 〈 0. 05 ）. There is no significant difference between modeling group （85.7%） and non-modeling group （82.4%） over follow-up period of 2 to 13 months. Confusions CartoXP system guided catheter ablation of PAF without modeling of left atrium and pulmonary veins took less time in X-ray exposure and ablation steps, comparing with left atrium modeling procedure.
文摘Hemodynamic instability secondary to left atrial (LA) compression by an aortic aneurysm is a rare entity. We report?the case of a 43-year old woman with no previous diagnosis of congestive heart failure who was admitted for an initial diagnosis of pulmonary embolism (PE) based on shortness of breath, hypotension and D-Dimers?elevation. The electrocardiogram and blood counts were within normal limits. The chest X-ray revealed widening of the mediastinum. Transthoracic echocardiography demonstrated LA compression by a large descending thoracic aortic aneurysm. Left and right ventricle systolic functions were preserved. Chest angiography showed LA and left pulmonary artery (LPA) compression by a descending aortic aneurysm and an intramural hematoma with no evidence of PE evidence. Emergency surgery could not be done because of her financial status. She was treated medically and was discharged 1?week later with significant improvement. However she remained hypotensive.
文摘A 49-year-old man had an abnormal shadow on chest X-ray. Enhanced chest computed tomography (CT) revealed an 8-cm diameter right lung mass invading the right chest wall, with a tumor thrombus extending from the superior pulmonary vein into the left atrium. Transesophageal echocardiography confirmed that the tumor adjoined the side wall of the atrium. Endobronchial and CT-guided needle biopsy demonstrated a low-grade carcinoma or small cell carcinoma. Operative findings through left atriotomy under cardiopulmonary bypass showed no tumor invasion of the atrium wall, but protrusion through the pulmonary vein. Frozen sections revealed a non-small cell carcinoma. We performed right upper lobectomy with parietal pleura and mediastinal lymph node dissection after detachment of cardiopulmonary bypass. Pathological examination demonstrated a large-cell neuroendocrine carcinoma p-T4N0M0, stage IIIA. The patient recovered without postoperative complications and tolerated two cycles of adjuvant chemotherapy. He was doing well without symptoms of recurrence 42 months after surgery.
文摘Aim: To present the aneurysmal dilatation of left atrium due to rheumatic mitral valve disease and its clinical consequences such as arrhythmic, thromboembolic and compressive manifestations. Introduction: Extreme enlargement of left atrium, usually referred to as giant, gigantic or aneurysmal dilatation is an uncommon finding with a reported incidence of 0.3% in rheumatic heart disease. It is an important clinical risk identifier to predict the outcome of cardiovascular disease. Case reports: Aneurysmal left atrium correlating with the length of pure mitral regurgitation jet in a 18-year-old girl, posterior mitral leaflet prolapse with regurgitation jet swirling around the entire interatrial septum in a 37-year-old male, Giant left atrium in mixed mitral valve disease in a 37-year-old female and a thrombosed giant left atrium resembling as “coconut” in a 50-year-old female were reported. Conclusion: Giant left atrium may be misinterpreted as right-sided pleural effusion, pericardial effusion and mediastinal tumor on X-ray chest and so echocardiographic evaluation is mandatory to exclude the aneurysmal left atrium in such conditions.
文摘Pulmonary vein thrombosis is a rare disease and is usually represented as a complication of atrial fibrillation, pulmonary tumors, and Iobectomy. Although it is a potentially life threatening condition, the venous disease is easy to misdiagnose because of the non-specific symptoms, In this article, we present a 30-year-old patient who suffered from pulmonary vein thrombosis without any causes. He was diagnosed with other pulmonary disorders till the thrombus within the pulmonary vein extended into the left atrium. Left atrium mass resection and a left lower Iobectomy were undertaken with relative urgency. The postoperative course was uneventful. The patient received a long course of oral anticoagulant therapy.
基金ThisresearchwassupportedbytheNationalNaturalScienceFoundationofChina (No .39870 334No .39970 2 73) ,theHighEducationalSpecialResearchFoundationforDoctorialSubject (No.2 0 0 10 6 980 34)andKeyItemofScientificTechnologyforMinistryofEducation (No .0 116 1)
文摘Objective To investigate the effects of ethanol on physiological characteristics of the isolated guinea pig left atrium and papillary muscles.Methods The effects of ethanol on contractility, post-rest potentiation and positive staircase phenomenon were observed in isolated left atrium and papillary muscles of guinea pig.Results Ethanol(50.0,100.0,200.0mmol·L -1)prominently inhibited the contraction of papillary muscles. Ethanol(12.5,25.0,50.0,100.0,200.0mmol·L -1) inhibited the contraction of left atrium, and markedly decreased the post-rest potentiation of myocardial contractility in left atrium. High concentration of ethanol(100,200mmol·L -1) depressed the positive staircase phenomenon of isolated guinea pig left atrium.Conclusion These results suggest that ethanol induces inhibitory effects of the contractility, post-rest potentiation, positive staircase phenomenon of left atrium. The mechanism by which ethanol induces the negative inotropic effects may be related to decrease the amount of calcium released from the intracellular stores.
基金Supported by the "East Carolina Heart Institute"
文摘Dystrophic cardiac calcification is often associated with conditions causing systemic inflammation and when present,is usually extensive,often encompassing multiple cardiac chambers and valves.We present an unusual case of dystrophic left atrial calcification in the setting of end stage renal disease on hemodialysis diagnosed by echocardiography and computed tomography.Significant calcium deposition is confined within the walls of the left atrium with no involvement of the mitral valve,and no hemodynamic effects.
文摘Objectives To investigate the relationship between serum uric acid （SUA） and left atrial spontaneous echo contrast （LA-SEC） in non-valvular atrial fibrillation （AF） patients. Methods We retrospectively screened 1,476 consecutive hospitalized patients with AF who underwent transesophageal echocardiography prior to radiofrequency catheter ablation, left atrial appendage closure and electric cardiover- sion at Guangdong General Hospital. Data on the clinical baseline characteristics of all patients were collected from electronic medical re- cords and analyzed. Results After exclusion of patients with left atrial thrombus, 1,354 patients entered into present study and 57 were LA-SEC. The mean female SUA level （380.88 ± 94.35 μmol/L vs. 323.37 ± 72.19μmol/L, P 〈 0.001） and male SUA level （416.97 ± 98.87 μmol/L vs. 367.88 ＋ 68.50 μmol/L, P = 0.008） were both significantly higher in patients with LA-SEC than in the controls. The mean left atrial dimension （41.32 ± 5.12 mm vs. 36.12 ± 5.66 mm, P 〈 0.001） was markedly larger in patients with LA-SEC. In multivariate regression analysis, SUA level was an independent risk factor for LA-SEC （OR： 1.008, P 〈 0.001）. In receiver operating characteristic curve analysis, the corresponding area under the curve for SUA predicting LA-SEC in female and male were 0.670 and 0.657, respectively. SUA level is significantly higher in non-valvular AF patients with LA-SEC. Conclusion SUA level is an independent risk factor and has a moderate predictive value for LA-SEC among non-valvular AF patients in Southern China.
文摘The symptom cluster of shortness of breath(SOB) contributes significantly to the outpatient workload of cardiology services. The workup of these patients includes blood chemistry and biomarkers, imaging and functional testing of the heart and lungs. A diagnosis of diastolic heart failure is inferred through the exclusion of systolic abnormalities, a normal pulmonary function test and normal hemoglobin, coupled with diastolic abnormalities on echocardiography. Differentiating confounders such as obesity or deconditioning in a patient with diastolic abnormalities is difficult. While the most recent guidelines provide more avenues for diagnosis, such as incorporating the left atrial size, little emphasis is given to understanding left atrial function, which contributes to at least 25% of diastolic left ventricular filling; additionally, exercise stress testing to elicit symptoms and test the dynamics of diastolic parameters, especially when access to the "gold standard" invasive tests is lacking, presents clinical translational gaps. It is thus important in diastolic heart failure work up to understand left atrial mechanics and the role of exercise testing to build a comprehensive argument for the diagnosis of diastolic heart failure in a patient presenting with SOB.
