فهرست مطالب

Multidisciplinary Cardiovascular Annals - Volume:8 Issue: 2, 2017
  • Volume:8 Issue: 2, 2017
  • تاریخ انتشار: 1396/01/30
  • تعداد عناوین: 5
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  • Behshid Ghadrdoost, Hooman Bakhshandeh, Mohsen Ziyaeifard, Rasoul Farasatkish, Tooraj Babaei, Ali Sadeghpour Tabaei, Zahra Faritous, Alireza Azad, Seyed Mostafa Alavi * Page 1
    Background
    In clinical area, assessment of body fluid and determination of the intravascular volume after major surgeries such as heart surgery is a significant challenge. The initial purpose of intravascular volume assessment in patients with hemodynamic instability is to determine whether they would benefit from fluid administration or not.
    Objectives
    This study aims to compare pulse pressure variation (PPV) compared to thoracic fluid content in checking out and optimizing fluid volume in mechanically ventilated patients admitted to intensive care unit after cardiac surgery.
    Methods
    In the present study a prospective descriptive-analytic design was used. Thirty mechanically ventilated patients admitted to intensive care units of Rajaie heart center, Tehran, Iran, were recruited in the current study after cardiac surgery based on inclusion criteria. Data collection tools included demographic and clinical data sheets. Hemodynamic parameters such as CVP and pulse pressure were recorded by bedside monitoring. Thoracic fluid content (TFC) was measured by non-invasive continuous cardiac output monitoring (NICCOMO) system. Data were analyzed in SPSS version 15, using statistical tests.
    Results
    The mean values of CVP, before and five minutes after fluid administration were significantly different (10.10 ± 6.01 mmHg and 12.37 ± 6.34 mmHg, respectively, P = 0.015). The mean changes in arterial pulse pressure, before and five minutes after fluid administration were significantly different (16.94 ± 8.32 mmHg and 12.77 ± 4.02 mmHg, respectively, P = 0.005). PPV greater than 13% had sensitivity, specificity and positive predictive value of 40%, 71% and 75% respectively while CVP greater than 5 mmHg had sensitivity, specificity and positive predictive of 13%, 85% and 66% respectively compared with cardiac index as the gold standard for fluid responsiveness. These findings suggest a higher diagnostic power of PPV compared to CVP to assess fluid volume.
    Conclusions
    It seems that in the mechanically ventilated patients after heart surgery, PPV dynamic index is preferred to CVP static index to evaluate and maintain fluid volume.
    Keywords: Pulse Pressure Variation, Central Venous Pressure, Thoracic Fluid Content, Mechanical Ventilation, Intensive Care Unit, Cardiac Surgery
  • Stefan Peters * Page 2
    Arrhythmogenic cardiomyopathy is electrocardiographically characterized by right precordial T-wave inversions and epsilon waves as major criteria. Additionally, terminal activation delay of 55 ms or more serves as a minor criterion. Although ther are more and more evident pathological data of right ventricles without dilatation or aneurysm, typical fibrofatty abnormalities and myocardial atrophy exist. The ECGs of these patients lack the right precordial T-wave inversion and epsilon waves. Lead aVR and lead V1 could become more and more relevant. 413 cases with arrhythmogenic cardiomyopathy (292 males, mean age 46.3 ± 11.6 years) and a collective of normal proband (1496 patients, 859 males with an age range of 18 - 81 years) were analyzed with regard to ECG appearance of lead aVR and the amplitude of inverted T-waves in lead V1. With a specificity of 99.9%, a positive predictive value of 99.7% and a negative predictive value of 98% lead V1 and aVR were most relevant to diagnose arrhythmogenic cardiomyopathy if an amplitude of Q waves of 3mm or more, R waves of 2 mm or less, inverted T waves of 2 mm or less in lead aVR and inverted T waves in lead V1 were present. These two leads appear most relevant to make the diagnosis of arrhythmogenic cardiomyopathy even in cases without right ventricular dilatation and right ventricular aneurysms.
    Keywords: Arrhythmogenic Cardiomyopathy, lead aVR, Lead V1, Amplitude of Inverted T, waves
  • Mahdi Daliri *, Mona Yadollahi, Amir Nasser Jadbabaei Page 3
    Heart failure is a leading cause of death around the world. Heart transplantation is the only reliable therapy for improving functional capacity, quality of life, life expectancy, and limiting the options for heart failure patients. In fact, a large number of patients with severe heart failure in need of heart transplantation are unable to receive therapy with up to 30% mortality before a heart is donated. In recent decades, cardiac replacement and assisting therapies have presented promising outcomes to treat these end-stage patients as alternative solutions. These devices are capable of providing temporary to permanent, partial or full assistance. Such devices can be divided into two categories based on location and mechanism of augmentation: 1) devices exposed directly to blood including ventricular assistive devices (VADs) and total artificial hearts (TAHs) and 2) devices that augment cardiac output through compression of ventricles or another part of circulatory system with no direct contact to blood such as extra-cardiac compression devices (ECCDs). In recent years, novel ECCDs which compress tissue and muscles to indirectly assist blood pumping have been developed to circumscribe problems associated with blood-contacting devices and the risks involved with piercing arterial and ventricular walls. Not only do ECCDs aim to reduce risks from the patient and surgeon perspective, the complexity of engineering an intra-corporeal extra-cardiac device is also reduced.
    Keywords: Ventricular Assist Device, VAD, Extra Cardiac Compression Device
  • Manuchehr Hekmat, Sima Rafieyian, Shahla Roodpeyma * Page 4
    Introduction
    Fontan/Krutzer (F/K) palliation is a surgical option that can be offered to patients with single ventricle. The outcome of F/K procedure is affected by several factors including: patient, procedure, management, and gradual increase in right-sided venous pressure. By the pass of time right ventricular failure deteriorate the function of system.
    Case Presentation
    This study presents a 28-year-old man with tricuspid atresia who underwent F/K procedure at the age of 18 years. Postoperative course, complications, and outcomes are discussed.
    Conclusions
    F/k procedure will increase the survival of patients. The long-term outcomes of patients are associated with numerous complications. In the absence of patients’ compliance, and close follow-up, the consequence is catastrophic.
    Keywords: Fontan, Kreutzer Procedure, Outcomes, Tricuspid Atresia, Univentricular Heart
  • Kambiz Mozaffari, Maryam Moradian, Bahador Baharestani, Hojjat Mortezaeian, Hooman Bakhshandeh * Page 5
    Introduction
    Heart tumors in children are very rare, however in case of presence, they may cause significant morbidity.
    Case Report: We present a nine-month-old female infant who was admitted to the emergency ward due to severe tachypnea. Echocardiography showed a huge echogenic mass in the right atrium occupying almost half of its cavity. It was originated from the roof of RA and would herniate to the right ventricle during diastole causing tricuspid valve stenosis. The excised specimen was similar to a cardiac myxoma. Microscopically, a myxoid background was seen with foci of spindle cell proliferation. Further study of the tumor showed that it was of smooth muscle origin. After nine months of follow-up from the surgery date, she was healthy.
    Conclusions
    Considering benign nature of the tumor and its derivation from smooth muscle, it is appropriate to designate it “Benign Tumor with Perivascular myoid differentiation”. This is a rare, interesting entity which conforms to our findings.
    Keywords: Heart Neoplasms, Infant, Rare Diseases, Pediatric