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Alizadehasl A, Galeshi B, Peighambari M, Pouraliakbar H, Moradian M, Hashemi A. A forgotten diagnosis in right heart failure: A case report and literature review. Clin Case Rep 2021; 9:2040-2047. [PMID: 33936637 PMCID: PMC8077272 DOI: 10.1002/ccr3.3938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 01/22/2021] [Accepted: 01/30/2021] [Indexed: 11/06/2022] Open
Abstract
Carcinoid heart disease is a well-known complication of carcinoid syndrome that affects morbidity and mortality. Carcinoid heart disease may be asymptomatic in the early stages; therefore, patients with carcinoid syndrome should be screened to prevent misdiagnosis.
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Affiliation(s)
- Azin Alizadehasl
- Cardio‐Oncology Research CenterRajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Bahar Galeshi
- Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Mehdi Peighambari
- Heart Valve Disease Research CenterRajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Hamidreza Pouraliakbar
- Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
| | - Maryam Moradian
- Rajaie Cardiovascular Medical and Research CenterIran University of Medical SciencesTehranIran
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Alizadehasl A, Parsa NA, Azarfarin R, Maleki M. Innovations in cardiovascular imaging. Trends Cardiovasc Med 2021; 32:112-123. [PMID: 33545328 DOI: 10.1016/j.tcm.2021.01.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 01/09/2021] [Accepted: 01/25/2021] [Indexed: 02/07/2023]
Abstract
Cardiovascular diseases are culpable for the majority of mortalities the world over, hence the significance of advances in preventive medicine and imaging. Cardiovascular imaging constitutes the cornerstone of not only early but also precise diagnoses. Indeed, advanced imaging enables cardiologists to make efficacious management plans for various heart conditions. The present article discusses essential innovations in cardiovascular imaging.
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Affiliation(s)
- Azin Alizadehasl
- Professor of Cardiology, Echocardiologist, Head of Cardio-Oncology Department and Research Center, Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran.
| | - Niloufar Akbari Parsa
- Echocardiography Research Center, Rajaei Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Rasoul Azarfarin
- Professor of Cardiac Anesthesiology, Cardio-Oncology Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Majid Maleki
- Professor of Cardiology, Interventional Cardiologist Echocardiologist, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran
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Erickson CT, Patel MD, Choudhry S, Bisselou KS, Sekarski T, Craft M, Li L, Khuffash AE, Hamvas A, Kutty S, Singh GK, Levy PT. Persistence of right ventricular dysfunction and altered morphometry in asymptomatic preterm Infants through one year of age: Cardiac phenotype of prematurity. Cardiol Young 2019; 29:945-953. [PMID: 31287038 PMCID: PMC6715519 DOI: 10.1017/s1047951119001161] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
INTRODUCTION Prematurity impacts myocardial development and may determine long-term outcomes. The objective of this study was to test the hypothesis that preterm neonates develop right ventricle dysfunction and adaptive remodelling by 32 weeks post-menstrual age that persists through 1 year corrected age. MATERIALS AND METHODS A subset of 80 preterm infants (born <29 weeks) was selected retrospectively from a prospectively enrolled cohort and measures of right ventricle systolic function and morphology by two-dimensional echocardiography were assessed at 32 weeks post-menstrual age and at 1 year of corrected age. Comparisons were made to 50 term infants at 1 month and 1 year of age. Sub-analyses were performed in preterm-born infants with bronchopulmonary dysplasia and/or pulmonary hypertension. RESULT In both term and preterm infants, right ventricle function and morphology increased over the first year (p < 0.01). The magnitudes of right ventricle function measures were lower in preterm-born infants at each time period (p < 0.01 for all) and right ventricle morphology indices were wider in all preterm infants by 1 year corrected age, irrespective of lung disease. Measures of a) right ventricle function were further decreased and b) morphology increased through 1 year in preterm infants with bronchopulmonary dysplasia and/or pulmonary hypertension (p < 0.01). CONCLUSION Preterm infants exhibit abnormal right ventricle performance with remodelling at 32 weeks post-menstrual age that persists through 1 year corrected age, suggesting a less developed intrinsic myocardial function response following preterm birth. The development of bronchopulmonary dysplasia and pulmonary hypertension leave a further negative impact on right ventricle mechanics over the first year of age.
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MESH Headings
- Bronchopulmonary Dysplasia/complications
- Bronchopulmonary Dysplasia/pathology
- Echocardiography
- Female
- Humans
- Hypertension, Pulmonary/complications
- Hypertension, Pulmonary/pathology
- Infant
- Infant, Newborn
- Infant, Premature
- Infant, Premature, Diseases/diagnostic imaging
- Infant, Premature, Diseases/etiology
- Infant, Premature, Diseases/pathology
- Male
- Retrospective Studies
- Ventricular Dysfunction, Right/diagnostic imaging
- Ventricular Dysfunction, Right/etiology
- Ventricular Dysfunction, Right/pathology
- Ventricular Remodeling
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Affiliation(s)
- Collin T. Erickson
- Department of Pediatric Cardiology and Cardiovascular Surgery, University of Nebraska College of Medicine and Children’s Hospital and Medical Center, Omaha, Nebraska
| | - Meghna D. Patel
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
- Department of Pediatrics, Stanford University School of Medicine, Stanford, CA
| | - Swati Choudhry
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
- Section of Pediatric Cardiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
| | - Karl Stessy Bisselou
- Department of Pediatric Cardiology and Cardiovascular Surgery, University of Nebraska College of Medicine and Children’s Hospital and Medical Center, Omaha, Nebraska
| | - Tim Sekarski
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Mary Craft
- Department of Pediatric Cardiology and Cardiovascular Surgery, University of Nebraska College of Medicine and Children’s Hospital and Medical Center, Omaha, Nebraska
| | - Ling Li
- Department of Pediatric Cardiology and Cardiovascular Surgery, University of Nebraska College of Medicine and Children’s Hospital and Medical Center, Omaha, Nebraska
| | - Afif El Khuffash
- Department of Neonatology, The Rotunda Hospital & School of Medicine, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Aaron Hamvas
- Department of Pediatrics, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - Shelby Kutty
- Department of Pediatric Cardiology and Cardiovascular Surgery, University of Nebraska College of Medicine and Children’s Hospital and Medical Center, Omaha, Nebraska
- Division of Pediatric Cardiology, Johns Hopkins Medical Institutions, Baltimore, MD
| | - Gautam K. Singh
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
| | - Philip T. Levy
- Department of Pediatrics, Washington University School of Medicine, St. Louis, Missouri
- Division of Newborn Medicine, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts, USA
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Rana M, Yusuff H, Zochios V. The Right Ventricle During Selective Lung Ventilation for Thoracic Surgery. J Cardiothorac Vasc Anesth 2018; 33:2007-2016. [PMID: 30595486 DOI: 10.1053/j.jvca.2018.11.030] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2018] [Indexed: 12/25/2022]
Abstract
The right ventricle (RV) has been an area of evolving interest after decades of being ignored and considered less important than the left ventricle. Right ventricular dysfunction/failure is an independent predictor of mortality and morbidity in cardiac surgery; however, very little is known about the incidence or impact of RV dysfunction/failure in thoracic surgery. The pathophysiology of RV dysfunction/failure has been studied in the context of acute respiratory distress syndrome (ARDS), cardiac surgery, pulmonary hypertension, and left ventricular failure, but limited data exist in literature addressing the issue of RV dysfunction/failure in the context of thoracic surgery and one-lung ventilation (OLV). Thoracic surgery and OLV present as a unique situation where the RV is faced with sudden changes in afterload, preload, and contractility throughout the perioperative period. The authors discuss the possible pathophysiologic mechanisms that can affect adversely the RV during OLV and introduce the term RV injury to the myocardium that is affected adversely by the various intraoperative factors, which then makes it predisposed to acute dysfunction. The most important of these mechanisms seems to be the role of intraoperative mechanical ventilation, which potentially could cause both ventilator-induced lung injury leading to ARDS and RV injury. Identification of at-risk patients in the perioperative period using focused imaging, particularly echocardiography, is paramount. The authors also discuss the various RV-protective strategies required to prevent RV dysfunction and management of established RV failure.
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Affiliation(s)
- Meenal Rana
- University Hospitals of Leicester National Health Service Trust, Department of Cardiothoracic Anesthesia and Critical Care Medicine, Glenfield Hospital, Leicester, UK; Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, Centre of Translational Inflammation Research, University of Birmingham, Birmingham, UK
| | - Hakeem Yusuff
- University Hospitals of Leicester National Health Service Trust, Department of Cardiothoracic Anesthesia and Critical Care Medicine, Glenfield Hospital, Leicester, UK; Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, Centre of Translational Inflammation Research, University of Birmingham, Birmingham, UK.
| | - Vasileios Zochios
- University Hospitals Birmingham National Health Service Foundation Trust, Department of Critical Care Medicine, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, UK; Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, Centre of Translational Inflammation Research, University of Birmingham, Birmingham, UK
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Silber D, Lachmann J. Invasive Hemodynamics of Pulmonary Disease and the Right Ventricle. Interv Cardiol Clin 2017; 6:329-343. [PMID: 28600088 DOI: 10.1016/j.iccl.2017.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Pulmonary hypertension (PH) falls into 5 groups, as defined by the World Health Organization. Swan-Ganz catheters determine precapillary versus postcapillary PH. The hemodynamic values of PH at rest and with vasodilatory challenge categorize the etiology of PH and guide treatment. RV maladaptations to increased pulmonary vascular resistance (PVR) and the chronicity of the right ventricle's (RV) response to increased PH and/or increased PVR can be understood with pressure-volume (PV) loops constructed with use of conductance catheters. These PV loops demonstrate the RV's ability to increase stroke volume in acutely and chronically increased PVR.
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Affiliation(s)
- David Silber
- Winthrop Cardiology Associates, PC, NYU-Winthrop Hospital, 212 Jericho Turnpike, Mineola, NY 11501, USA.
| | - Justine Lachmann
- Winthrop Cardiology Associates, PC, NYU-Winthrop Hospital, 212 Jericho Turnpike, Mineola, NY 11501, USA
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Patel N, Kipfmueller F. Cardiac dysfunction in congenital diaphragmatic hernia: Pathophysiology, clinical assessment, and management. Semin Pediatr Surg 2017. [PMID: 28641753 DOI: 10.1053/j.sempedsurg.2017.04.001] [Citation(s) in RCA: 48] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Cardiac dysfunction is an important consequence of pulmonary hypertension in congenital diaphragmatic hernia and a determinant of disease severity. Increased afterload leads to right ventricular dilatation and diastolic dysfunction. Septal displacement and dysfunction impair left ventricular function, which may also be compromised by fetal hypoplasia. Biventricular failure contributes to systemic hypotension and hypoperfusion. Early and regular echocardiographic assessment of cardiac function and pulmonary artery pressure can guide therapeutic decision-making, including choice and timing of pulmonary vasodilators, cardiotropes, ECMO, and surgery.
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Affiliation(s)
- Neil Patel
- Neonatal Unit, Royal Hospital for Children, 1345 Govan Rd, Glasgow G51 3TF, UK.
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