1,720,998 research outputs found
Photo-realistic 3D Echocardiographic View of the Mitral Valve
No full textThree-dimensional (3D) real-time echocardiography offers significant additional clinical information to traditional 2-dimensional
echocardiography, improving visualization of cardiac structures and transcatheter device implantation.
The recent development of high-definition photo-realistic rendering (EPIQ CVX, TrueVue, Philips Healthcare, Andover, USA) has been
proposed as a new technological advancement aiming to increase the perception of 3D anatomical details, as in the case of degenerative
mitral valve (MV) disease showing ruptured chords, height of the prolapse, and overriding of the posterior leaflet with respect to the
anterior leaflet (Figure 1, and Video 1A and 1B of the supplementary data).
The technology allows users to change the lighting conditions to improve contrast. The light source can be moved around an annular plane
to change the shadows of the MV (Video 2A and 2B of the supplementary data) or can be positioned at different heights with respect to a
defined structure. In the case of MV analysis, the light source can be placed in the left atrium (Figure 2A), in the left atrium is just above the
mitral annular plane (Figure 2B), in the left ventricle just below the mitral annular plane (Figure 2C), or deep in the left ventricle (Figure 2D).
The photorealistic lighting effect has the potential advantage of improving our preoperative perception of cardiac anatomy (Figure 3A,
and Video 3A of the supplementary data). It may also help in the assessment of morphological changes after cardiac procedures, such as
transapical beating heart MV repair with neochord implantation showing a physiologic restoration of leaflet coaptation with simultaneous
2D-multiplane echocardiographic views (Figure 3B, and video 3B of the supplementary data).
In future, the clinical adoption of photo-realistic 3D echocardiography may improve our knowledge of this innovative technology,
defining its real benefits and limitations
Cardiac arrest due to acute massive aortic root thrombosis after pericardial bioprosthetic aortic valve replacement
Full text linkLong-Term Fate of the Neoaortic Root After Neonatal Ross Operation: A Case Series
No full textThe aim of this study is to analyze the adaptation properties of the pulmonary autograft in four infants who underwent the Ross operation before one year of life. The patients underwent serial echocardiographic assessments of the autograft diameters at short- and long-term follow-up and values were reported as the Z scores for normal aortic and pulmonary diameters. At a median follow-up time of 18.5 years (range: 18.2-19.4 years), all the patients are alive, none requiring autograft reinterventions. This series shows excellent adaptation potential of the “infant pulmonary autograph” in the long-term, during somatic growth of the patient
Heart transplantation from donation after circulatory death: a meta-analysis of national registries
No full textBackground: Although it has been widely recognized that heart transplantation (HT) following donation after circulatory death (DCD) can be a successful strategy to expand the donor pool, its clinical outcomes compared to donation after brain death (DBD) are still the subject of intense investigation. We reviewed the clinical characteristics of HT after DCD from the three largest multicenter nationwide registries, highlighting technical aspects, donor and recipient selection, and early outcomes. Moreover, we performed a meta-analysis of survival outcomes of DCD vs. DBD using reconstructed individual patient time-to-event data. Methods: The PubMed, Web of Science, and Scopus databases were searched in January 2024 to identify the most recent reports from three large multicenter nationwide registries (United States, United Kingdom, and Australia) of HT after DCD. Clinical characteristics were summarized using descriptive statistics, and survival curves were reconstructed for DBD using individual patient time-to-event data. The pooled hazard ratio (HR) with confidence interval (CI) was calculated via Cox regression. Results: A total of 646 DCD HT patients and 7,253 DBD controls were included in this review. In the majority of cases, donors were young males. The mean age of recipients ranged from 48 to 57 years, and the majority were males with idiopathic dilated cardiomyopathy. Up to 40% of patients required postoperative mechanical circulatory support with extracorporeal membrane oxygenation (ECMO). The meta-analysis estimated a pooled 1-year survival of 91.1% (95% CI: 88.6-93.7%) and 90.1% (95% CI: 89.4-90.8%) for DCD and DBD patients, respectively (P=0.91), with a pooled HR of 0.88 (95% CI: 0.65-1.20). Conclusions: Although the generally more favorable clinical profile of DCD donors and recipients may constitute a potential selection bias, our meta-analysis documented similar early and medium-term survival outcomes for DCD and DBD HT
Reversing Inoperability in Eisenmenger Syndrome: The "Drug-and-Banding" Approach
No full textEisenmenger syndrome (ES) has been considered a cause of inoperability in patients with congenital heart disease (CHD). Even if long-standing vasodilators are efficient to reduce pulmonary vascular resistance (PVR), the best approach to grant stable repair of these patients is still unknown. We describe the case of a 28-year-old man with a diagnosis of untreated large ventricular septal defect and established ES. After few years of vasodilator therapy, the patient underwent pulmonary banding with significant reduction of his PVR. His CHD was then repaired, with clinical and functional improvement at 2-year follow-up
Myocardial histopathology in late-repaired and unrepaired adults with tetralogy of Fallot
No full textCurrent Understanding and Future Directions of Transcatheter Devices to Assist Failing Fontan
Full text link: Even if the Fontan operation is the surgical treatment of choice in patients with univentricular physiology, it remains a palliative strategy. Consequently, when Fontan patients reach adulthood, the majority of them develop late clinical sequelae of a failing cavo-pulmonary circuit (eg, liver failure, protein-losing enteropathy, and arrhythmias). Although heart transplantation represents the gold standard to treat this condition, Fontan patients usually accede to this therapy late, when risk of mortality is significantly increased, and a shortage of donor hearts limits transplantation in this special population. Mechanical circulatory support is an emerging field, but it is still in the experimental stage. Current mechanical circulatory devices have been used in Fontan circulation but are associated with the need for high-risk redo surgery. Percutaneous pumps are an emerging field that is still under investigation, with multiple prototypes developed. This review aims to analyze the hemodynamic profile of the developed intravascular pumps and their application in the preclinical scenario in the Fontan circulation
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