• 【左心结构小的患者单心室缓解后的双室转换:短期结果。】 复制标题 收藏 收藏
    DOI:10.1016/j.athoracsur.2013.05.060 复制DOI
    作者列表:Kalish BT,Banka P,Lafranchi T,Tworetzky W,Del Nido P,Emani SM
    BACKGROUND & AIMS: BACKGROUND:Patients with borderline small left heart (LH) structures who initially undergo single ventricle palliation (SVP) may eventually become candidates for biventricular conversion (BC). The purpose of this study was to describe our surgical experience with BC in patients with small LH. METHODS:We reviewed our institution's records for patients who underwent BC after an initial SVP between 1995 and 2012. Patients underwent an aortopulmonary amalgamation procedure as a part of their initial palliation. Data on imaging, BC operative details, and re-interventions after BC were collected. RESULTS:Twenty-eight patients underwent BC. Twenty patients had hypoplastic left heart syndrome (HLHS), 7 patients had unbalanced common atrioventricular canal (uCAVC), and 1 had interrupted aortic arch with VSD. Stage of palliation at BC was stage 1 in 6 patients (21.4%), bidirectional Glenn in 19 (67.9%), and Fontan in 3 (10.7%). Prior to BC, the median left ventricular end-diastolic volume (LVEDV) by echocardiography was 58.1 mL/m(2) in the HLHS group and 28.1 mL/m(2) in the uCAVC group. After BC, the LVEDV increased to 91.3 mL/m(2) in the HLHS group and 58.5 mL/m(2) in the uCAVC group (p < 0.05 compared with pre-BC in both groups). Right ventricular pressure was less than half systemic in 8 patients (53.3% of those measured). Seventeen patients (61%) have required either catheter-based or surgical re-intervention. Twenty-five patients (89.3%) were alive at a median follow-up of 2.6 years. CONCLUSIONS:Biventricular conversion can be applied to patients with HLHS and uCAVC and borderline LH with acceptable short-term results. Left heart size increases after BC, but follow-up for potential left atrial hypertension is warranted.
    背景与目标: 背景:最初接受单心室舒张(SVP)的具有边缘性小左心(LH)结构的患者最终可能会成为双心室转换(BC)的候选人。这项研究的目的是描述我们在小LH患者中使用BC的手术经验。
    方法:我们回顾了本机构对1995年至2012年初次接受SVP后接受BC治疗的患者的记录。作为初次缓解的一部分,患者接受了肺肺融合手术。收集有关影像学,BC手术细节和BC术后再次干预的数据。
    结果:28例患者接受了BC。 20例患有发育不良的左心综合征(HLHS),7例不平衡的普通房室管(uCAVC),以及1例VSD中断了主动脉弓。 BC的姑息治疗阶段为1例,共6例(21.4%),双向Glenn为19例(67.9%),Fontan为3例(10.7%)。 BC前,HLHS组通过超声心动图检查得出的左心室舒张末期容积中位数(LVEDV)为58.1 mL / m(2),在uCAVC组为28.1 mL / m(2)。 BC后,HLHS组的LVEDV增至91.3 mL / m(2),uCAVC组的LVEDV增至58.5 mL / m(2)(两组均较BC前相比,p <0.05)。 8例患者的右心室压力小于全身压力的一半(占被测者的53.3%)。 17名患者(61%)需要基于导管或手术的再次干预。 25名患者(89.3%)存活,中位随访时间为2.6年。
    结论:双心室转换可应用于HLHS和uCAVC以及临界LH患者,短期结果可接受。 BC后左心大小增加,但有必要对潜在的左心房高血压进行随访。
  • 【LVAD植入后右心室衰竭并用双心室支持矫正:一种体外模型。】 复制标题 收藏 收藏
    DOI:10.1097/MAT.0000000000000455 复制DOI
    作者列表:Shehab S,Allida SM,Davidson PM,Newton PJ,Robson D,Jansz PC,Hayward CS
    BACKGROUND & AIMS: :Right ventricular failure after left ventricular assist device (LVAD) implantation is associated with high mortality. Management remains limited to pharmacologic therapy and temporary mechanical support. Delayed right ventricular assist device (RVAD) support after LVAD implantation is associated with poorer outcomes. With the advent of miniaturized, durable, continuous flow ventricular assist device systems, chronic RVAD and biventricular assist device (BiVAD) support has been used with some success. The purpose of this study was to assess combined BiVAD and LVAD with delayed RVAD support within a four-elemental mock circulatory loop (MCL) simulating the human cardiovascular system. Our hypothesis was that delayed continuous flow RVAD (RVAD) would produce similar hemodynamic and flow parameters to those of initial BiVAD support. Using the MCL, baseline biventricular heart failure with elevated right and left filling pressures with low cardiac output was simulated. The addition of LVAD within a biventricular configuration improved cardiac output somewhat, but was associated with persistent right heart failure with elevated right-sided filling pressures. The addition of an RVAD significantly improved LVAD outputs and returned filling pressures to normal throughout the circulation. In conclusion, RVAD support successfully restored hemodynamics and flow parameters of biventricular failure supported with isolated LVAD with persistent elevated right atrial pressure.
    背景与目标: :左心室辅助装置(LVAD)植入后的右心室衰竭与高死亡率相关。管理仍限于药物治疗和临时机械支持。 LVAD植入后延迟的右心室辅助设备(RVAD)支持与较差的预后相关。随着小型,耐用,连续流动的心室辅助设备系统的出现,慢性RVAD和双心室辅助设备(BiVAD)的支持已获得成功。这项研究的目的是评估BiVAD和LVAD的结合,以及在模拟人类心血管系统的四元素模拟循环回路(MCL)中的RVAD延迟支持。我们的假设是,延迟连续血流RVAD(RVAD)会产生与最初的BiVAD支持相似的血液动力学和血流参数。使用MCL,模拟了基线的双心室心力衰竭,其中左右充盈压升高,心输出量低。在双心室构型中添加LVAD可以改善心输出量,但与持续性右心衰竭以及右侧充盈压升高有关。添加RVAD可以显着改善LVAD的输出,并使整个循环中的填充压力恢复正常。综上所述,RVAD支持成功恢复了孤立性LVAD伴持续性右心房压力持续升高的双室衰竭的血流动力学和血流参数。
  • 【双心室辅助设备支持期间的脾损伤是移植的桥梁。】 复制标题 收藏 收藏
    DOI:10.1510/icvts.2006.145219 复制DOI
    作者列表:Kindo M,Gerelli S,Billaud P,Epailly E,Mazzucotelli JP,Eisenmann B
    BACKGROUND & AIMS: :Biventricular assist device (BVAD) has been shown to be effective for bridge to heart transplantation with an acceptability low incidence of adverse effects in critically ill heart failure patients. We report the case of a 44-year-old man with severe acute ischemic heart failure who was supported with the Thoratec paracorporeal biventricular assist system. After an initial uneventful postoperative course the patient experienced a splenic rupture which required a splenectomy. The pathological mechanism of this outcome remains unclear. Two months after discharge, the patient underwent heart transplantation and had no postsplenectomy sepsis or thrombotic complications at the last follow-up.
    背景与目标: :双心室辅助设备(BVAD)已被证明可有效地用于心脏移植,对于重症心力衰竭患者,不良反应的发生率较低,可以接受。我们报道了一个有严重急性缺血性心力衰竭的44岁男子的病例,该病人得到了Thoratec体外双心室辅助系统的支持。经过最初的平稳手术后,患者经历了脾破裂,需要进行脾切除术。这种结果的病理机制仍不清楚。出院后两个月,该患者接受了心脏移植,并且在最后一次随访中没有脾切除术后败血症或血栓并发症。
  • 【用于因嗜酸性粒细胞性心肌炎引起的双心室衰竭的全人工心脏植入术。】 复制标题 收藏 收藏
    DOI:10.1007/s10047-017-0954-9 复制DOI
    作者列表:Kawabori M,Kurihara C,Miller Y,Heck KA,Bogaev RC,Civitello AB,Cohn WE,Frazier OH,Morgan JA
    BACKGROUND & AIMS: :Idiopathic hypereosinophilic syndrome is a condition of unknown etiology characterized by proliferation of eosinophils and their infiltration into tissues. Although cardiac involvement is rare, eosinophilic myocarditis can lead to life-threating fulminant congestive heart failure. Treatment of patients with eosinophilic myocarditis is challenging as heart failure can be caused by biventricular dysfunction. To our knowledge, this is the first case reported in the literature describing a patient with acute severe biventricular heart failure caused by eosinophilic myocarditis with mural left ventricular apical thrombus who was successfully treated with implantation of a total artificial heart as a bridge to heart transplant.
    背景与目标: :特发性嗜酸性粒细胞增生综合征是一种病因不明的疾病,其特征在于嗜酸性粒细胞的增殖及其浸润到组织中。尽管很少累及心脏,但嗜酸性心肌炎可导致危及生命的暴发性充血性心力衰竭。嗜酸性心肌炎患者的治疗具有挑战性,因为双心室功能障碍可能会导致心力衰竭。据我们所知,这是文献中报道的首例病例,该病例描述了由嗜酸性粒细胞性心肌炎合并壁性左心室心尖部血栓引起的急性严重双室心力衰竭患者,该患者成功植入了全人工心脏作为心脏移植的桥梁。
  • 【单回路CentriMag®用于产后心肌病的双心室支持。】 复制标题 收藏 收藏
    DOI:10.1177/0267659112464713 复制DOI
    作者列表:Aggarwal A,Modi S,Kumar S,Korrapati C,Tatooles A,Pappas PS,Bhat G
    BACKGROUND & AIMS: :Peripartum cardiomyopathy (PPCM) is defined by acute heart failure in the late stages of pregnancy to a few months postpartum. Cardiogenic shock in PPCM, though rare, can be life-threatening, often requiring support with mechanical circulatory support devices. We present a case of 37-year-old Caucasian female who developed cardiogenic shock within 24 hours of the delivery of her twins. The echocardiogram demonstrated severe biventricular failure which necessitated biventricular device placement and support with a CentriMag® centrifugal pump. This biventricular support was employed, using a single-circuit CentriMag® pump, using a 'Y' connection which made weaning from right-sided support and conversion to univentricular support easier and feasible. The patient recovered four weeks later and was explanted off the CentriMag® support and did well. This technology allows for the CentriMag® to be considered as an early option for biventricular support in the treatment and management of these patients as a bridge to recovery.
    背景与目标: :围产期心肌病(PPCM)定义为妊娠晚期至产后几个月的急性心力衰竭。 PPCM中的心源性休克虽然很少见,但可能会危及生命,通常需要使用机械循环支持设备进行支持。我们介绍了一例37岁的白人女性,在她的双胞胎分娩后24小时内发生了心源性休克。超声心动图显示严重的双心室衰竭,这需要将双心室设备放置并使用CentriMag®离心泵进行支撑。使用单回路CentriMag®泵并使用“ Y”形连接来使用这种双心室支架,这使得从右侧支架的断奶和转换为单心室支架变得更加容易和可行。该患者在四个星期后康复,并从CentriMag®支架上移出,表现良好。这项技术使CentriMag®被认为是双心室支持在治疗和管理这些患者方面的早期选择,是康复的桥梁。
  • 【Valsalva动脉瘤的窦破裂伴主动脉-双室瘘和右室流出道梗阻:独特的关联。】 复制标题 收藏 收藏
    DOI:10.1007/s00246-012-0581-4 复制DOI
    作者列表:Masri SI,Bitar FF,Arabi MT,Majdalani MN,Obeid MY,Al Halees ZY,Diab KA
    BACKGROUND & AIMS: :Sinus of Valsalva aneurysms are a rare entity. Rupture of such aneurysms is a major cause of aortocardiac fistulas usually occurring between the right sinus of Valsalva and right cardiac chambers. We report an exceptional case of a ruptured congenital sinus of Valsalva aneurysm with fistulas involving both the right- and left-ventricular outflow tracts and causing RVOT obstruction. We also demonstrate the utility of computed tomography angiography and transesophageal echocardiography in diagnosing these fistulas.
    背景与目标: :窦静脉窦动脉瘤是一种罕见的实体。这种动脉瘤破裂是主动脉瘘的主要原因,通常在Valsalva的右窦和右心室之间发生。我们报告了一个例外情况,即先天性窦房静脉瘤破裂,瘘管累及右,左心室流出道,并引起RVOT阻塞。我们还演示了计算机断层扫描血管造影和经食道超声心动图在诊断这些瘘管中的实用性。
  • 【房室传导阻滞的双心室相对于右心室起搏的运动能力和N端脑钠肽水平:来自PREVENT-HF德国子研究的结果。】 复制标题 收藏 收藏
    DOI:10.1093/europace/eut217 复制DOI
    作者列表:Stockburger M,de Teresa E,Lamas G,Desaga M,Koenig C,Habedank D,Cobo E,Navarro X,Wiegand U
    BACKGROUND & AIMS: AIMS:Previous studies showed unfavourable effects of right ventricular (RV) pacing. Ventricular pacing (VP), however, is required in many patients with atrioventricular (AV) block. The PREVENT-HF study explored left ventricular (LV) remodelling during RV vs. biventricular (BIV) pacing in AV block without advanced heart failure. The pre-specified PREVENT-HF German Substudy examined exercise capacity and N-terminal pro-brain natriuretic peptide (NT-proBNP). METHODS AND RESULTS:Patients with expected VP ≥80% were randomized to RV or BIV pacing. Endpoints were peak oxygen uptake (pVO2), oxygen uptake at the anaerobic threshold (VO2AT), ventilatory efficiency (VE/VCO2), and logNT-proBNP. Considering crossover, intention to treat (ITT), and on-treatment (OT) analyses of covariance (ANCOVA) were performed. For exercise testing 44 (RV: 25, BIV: 19), and for NT-proBNP 53 patients (RV: 29, BIV: 24) were included. The ITT analysis revealed significant differences in pVO2 [ANCOVA effect 2.83 mL/kg/min, confidence interval (CI) 0.83-4.91, P = 0.007], VO2AT (ANCOVA effect 2.14 mL/min/k, CI 0.14-4.15, P = 0.03), and VE/VCO2 (ANCOVA effect -5.46, CI -10.79 to -0.13, P = 0.04) favouring BIV randomization. The significant advantage in pVO2 persisted in OT analysis, while VO2AT and VE/VCO2 showed trends favouring BIV pacing. LogNT-proBNP did not differ between groups. (ITT: ANCOVA effect 0.008, CI -0.40 to +0.41, P = 0.97; OT: ANCOVA effect -0.03, CI -0.44 to 0.30, P = 0.90). CONCLUSION:Our study suggests that BIV pacing produces better exercise capacity over 1 year compared with RV pacing in patients without advanced heart failure and AV block. In contrast, we observed no significant changes of NT-proBNP. Larger trials will allow appraising the clinical usefulness of BIV pacing in AV block. ClinicalTrials.gov Identifier: NCT00170326.
    背景与目标: 目的:先前的研究显示右心室(RV)起搏的不良影响。但是,许多房室(AV)阻滞患者需要进行心室起搏(VP)。 PREVENT-HF研究探讨了在无晚期心力衰竭的AV阻滞中RV与双心室(BIV)起搏期间的左心室(LV)重塑。预先指定的PREVENT-HF德国子研究对运动能力和N末端脑钠素前体肽(NT-proBNP)进行了研究。
    方法和结果:将预期VP≥80%的患者随机分为RV或BIV起搏组。终点为最大摄氧量(pVO2),无氧阈值下的摄氧量(VO2AT),通气效率(VE / VCO2)和logNT-proBNP。考虑交叉,进行了治疗意向(ITT)和治疗中(OT)协方差分析(ANCOVA)。运动测试包括44例(RV:25,BIV:19)和NT-proBNP 53例(RV:29,BIV:24)。 ITT分析显示pVO2的显着差异[ANCOVA效应2.83 mL / kg / min,置信区间(CI)0.83-4.91,P = 0.007],VO2AT(ANCOVA效应2.14 mL / min / k,CI 0.14-4.15,P = 0.03)和VE / VCO2(ANCOVA效应-5.46,CI -10.79至-0.13,P = 0.04)支持BIV随机化。在OT分析中,pVO2的显着优势仍然存在,而VO2AT和VE / VCO2则显示出有利于BIV起搏的趋势。 LogNT-proBNP组之间没有差异。 (ITT:ANCOVA效应为0.008,CI -0.40至0.41,P = 0.97; OT:ANCOVA效应为-0.03,CI -0.44至0.30,P = 0.90)。
    结论:我们的研究表明,对于没有晚期心力衰竭和房室传导阻滞的患者,BIV起搏比RV起搏在1年内可产生更好的运动能力。相反,我们未观察到NT-proBNP的显着变化。更大的试验将允许评估BIV起搏在房室传导阻滞中的临床实用性。 ClinicalTrials.gov标识符:NCT00170326。
  • 【2型糖尿病患者的心肌脂肪变性和双心室应变及应变率成像。】 复制标题 收藏 收藏
    DOI:10.1161/CIRCULATIONAHA.110.955542 复制DOI
    作者列表:Ng AC,Delgado V,Bertini M,van der Meer RW,Rijzewijk LJ,Hooi Ewe S,Siebelink HM,Smit JW,Diamant M,Romijn JA,de Roos A,Leung DY,Lamb HJ,Bax JJ
    BACKGROUND & AIMS: BACKGROUND:Magnetic resonance spectroscopy can quantify myocardial triglyceride content in type 2 diabetic patients. Its relation to alterations in left (LV) and right (RV) ventricular myocardial functions is unknown. METHODS AND RESULTS:A total of 42 men with type 2 diabetes mellitus were recruited. Exclusion criteria included hemoglobin A(1c) >8.5, known cardiovascular disease, diabetes-related complications, or blood pressure >150/85 mm Hg. Myocardial ischemia was excluded by a negative dobutamine stress test. LV and RV volumes and ejection fraction were quantified by magnetic resonance imaging. LV global longitudinal and RV free wall longitudinal strain, systolic strain rate, and diastolic strain rate were quantified by echocardiographic speckle tracking analyses. Myocardial triglyceride content was quantified by magnetic resonance spectroscopy and dichotomized on the basis of the median value of 0.76. The median age was 59 years (25th and 75th percentiles, 54 and 62 years). Median diabetes diagnosis duration was 4 years, and median glycohemoglobin level was 6.2 (25th and 75th percentiles, 5.9 and 6.8). There were no differences in LV and RV end-diastolic and end-systolic volume indexes and ejection fraction between patients with high (≥0.76) and those with low (<0.76) myocardial triglyceride content. However, patients with high myocardial triglyceride content had greater impairment of LV and RV myocardial strain and strain rate. The myocardial triglyceride content was an independent correlate of LV and RV longitudinal strain, systolic strain rate, and diastolic strain rate. CONCLUSIONS:High myocardial triglyceride content is associated with more pronounced impairment of LV and RV functions in men with uncomplicated type 2 diabetes mellitus.
    背景与目标: 背景:磁共振波谱技术可以量化2型糖尿病患者的心肌甘油三酯含量。它与左心室(LV)和右心室(RV)心肌功能改变的关系尚不清楚。
    方法与结果:总共招募了42名2型糖尿病男性。排除标准包括血红蛋白A(1c)> 8.5,已知的心血管疾病,糖尿病相关并发症或血压> 150/85 mm Hg。多巴酚丁胺负荷试验阴性排除了心肌缺血。左室和右室体积和射血分数通过磁共振成像定量。通过超声心动图斑点跟踪分析定量左室总纵和右室游离壁的纵向应变,收缩应变率和舒张应变率。心肌甘油三酯含量通过磁共振波谱法定量,并在0.76的中值的基础上二分。中位年龄为59岁(第25和75个百分位数,54和62岁)。糖尿病的中位诊断持续时间为4年,中位糖化血红蛋白水平为6.2(第25和第75个百分位数,分别为5.9和6.8)。高(≥0.76)和低(<0.76)心肌甘油三酯患者之间的LV和RV舒张末期和收缩末期容积指数和射血分数无差异。然而,高甘油三酸酯含量的患者对LV和RV心肌应变和应变率的损害更大。心肌甘油三酯含量与LV和RV纵向应变,收缩压应变率和舒张压应变率有独立的相关性。
    结论:高甘油三酸酯含量与2型糖尿病患者并发LV和RV功能明显受损有关。
  • 【经导管肺动脉瓣穿孔后肺闭锁完整的室间隔中度发育不良的右心室患者实现双室循环。】 复制标题 收藏 收藏
    DOI:10.1111/chd.12658 复制DOI
    作者列表:Chen RHS,K T Chau A,Chow PC,Yung TC,Cheung YF,Lun KS
    BACKGROUND & AIMS: OBJECTIVE:Transcatheter valve perforation for pulmonary atresia intact ventricular septum is the standard of care for patients with mild right ventricular hypoplasia. However, its role in moderate right ventricular hypoplasia has been less well defined. We sought to report the long-term outcome of patients with moderate hypoplastic right ventricle who had undergone the procedure. DESIGN, SETTINGS, AND PATIENTS:We performed a retrospective analysis on patients who had undergone transcatheter pulmonary valve perforation from January 1996 to January 2015 at our institution. The procedures would be carried out irrespective of the right ventricular size, as long as there were no absolute contraindications. INTERVENTION AND OUTCOME MEASURES:Demographic and procedural data were correlated with outcome measures. Outcomes analyzed included procedural success, reintervention rates, final circulation type, and functional class. Multivariate analysis and receiver operator curve were used to identify for parameters in predicting biventricular circulation. RESULTS:The procedural success rate was 92% (33 out of 36) in this group with moderate right ventricular hypoplasia (tricuspid valve z score -4.2 ± 3.0, 69.4% of patients with z score <-2.5). Early reintervention rate was 39%, mostly being insertion of modified Blalock-Taussig shunt. Overall reintervention-free survival was 53%, 30%, and 19% at 1, 6, and 12 months postintervention. Despite no significant catch-up right ventricular growth, majority of survivors (84%) enjoyed a biventricular circulation with good functional status. A tricuspid to mitral valve ratio >0.79 was a good predictor of biventricular outcome. (specificity of 100%, positive predictive value 100%) CONCLUSION: Encouraging long-term results with biventricular circulation and functional status were demonstrated with transcatheter pulmonary valve perforation in patients even with moderate hypoplastic right ventricle, which is comparable to that with mild right ventricular hypertrophy. The baseline tricuspid to mitral valve ratio was identified as a potentially useful tool in predicting biventricular circulation.
    背景与目标: 目的:经导管瓣膜穿孔治疗肺动脉闭锁完整的室间隔是轻度右室发育不全患者的标准治疗方法。但是,其在中度右心室发育不全中的作用尚未明确。我们试图报告接受该手术的中度发育不良右心室患者的长期预后。
    设计,地点和患者:我们对1996年1月至2015年1月间在本机构行经导管肺动脉瓣穿孔的患者进行了回顾性分析。只要没有绝对的禁忌症,就可以进行手术,而与右心室的大小无关。
    干预措施和结果指标:人口统计学和程序数据与结果指标相关。分析的结果包括手术成功率,再干预率,最终循环类型和功能类别。多变量分析和接收机操作员曲线用于确定预测双心室循环的参数。
    结果:该组中度右心室发育不全(三尖瓣z评分-4.2±3.0,z评分<-2.5的患者中有69.4%)的手术成功率为92%(36分之33)。早期再干预率为39%,主要是插入改良的Blalock-Taussig分流器。干预后1、6和12个月的无干预总生存率为53%,30%和19%。尽管右心室没有明显的追赶性增长,但大多数幸存者(84%)的双心室循环功能状态良好。三尖瓣对二尖瓣的比率> 0.79是双室结局的良好预测指标。 (特异性为100%,阳性预测值为100%)结论:即使是中度右室发育不良的患者,经导管肺动脉穿孔也证明了双室循环和功能状态的长期结果令人鼓舞。肥大。基线三尖瓣对二尖瓣比被确定为预测双心室循环的潜在有用工具。
  • 【连续右室起搏对急性右心室压力超负荷的影响。】 复制标题 收藏 收藏
    DOI:10.1152/ajpheart.00446.2006 复制DOI
    作者列表:Quinn TA,Berberian G,Cabreriza SE,Maskin LJ,Weinberg AD,Holmes JW,Spotnitz HM
    BACKGROUND & AIMS: :Temporary sequential biventricular pacing (BiVP) is a promising treatment for postoperative cardiac dysfunction, but the mechanism for improvement in right ventricular (RV) dysfunction is not understood. In the present study, cardiac output (CO) was optimized by sequential BiVP in six anesthetized, open-chest pigs during control and acute RV pressure overload (RVPO). Ventricular contractility was assessed by the maximum rate of increase of ventricular pressure (dP/dt(max)). Mechanical interventricular synchrony was measured by the area of the normalized RV-left ventricular (LV) pressure diagram (A(PP)). Positive A(PP) indicates RV pressure preceding LV pressure, whereas zero indicates complete synchrony. In the control state, CO was maximized with nearly simultaneous stimulation of the RV and LV, which increased RV (P = 0.006) and LV dP/dt(max) (P = 0.002). During RVPO, CO was maximized with RV-first pacing, which increased RV dP/dt(max) (P = 0.007), but did not affect LV dP/dt(max), and decreased the left-to-right, end-diastolic pressure gradient (P = 0.023). Percent increase of RV dP/dt(max) was greater than LV dP/dt(max) (P = 0.014). There were no increases in end-diastolic pressure to account for increases in dP/dt(max). In control and RVPO, RV dP/dt(max) was linearly related to A(PP) (r = 0.779, P < 0.001). The relation of CO to A(PP) was curvilinear, with a peak in CO with positive A(PP) in the control state (P = 0.004) and with A(PP) approaching zero during RVPO (P = 0.001). These observations imply that, in our model, BiVP optimization improves CO by augmenting RV contractility. This is mediated by changes in mechanical interventricular synchrony. Afterload increases during RVPO exaggerate this effect, making CO critically dependent on simultaneous pressure generation in the RV and LV, with support of RV contractility by transmission of LV pressure across the interventricular septum.
    背景与目标: :暂时性双心室起搏(BiVP)是一种有前景的术后心脏功能障碍的治疗方法,但改善右心室(RV)功能障碍的机制尚不清楚。在本研究中,在控制和急性RV压力超负荷(RVPO)期间,通过连续BiVP对六只麻醉的开胸猪进行了心输出量(CO)的优化。通过最大心室压力增加率(dP / dt(max))评估心室收缩力。机械室间同步性是通过标准化RV左心室(LV)压力图(A(PP))的面积来测量的。正A(PP)表示RV压力先于LV压力,而零表示完全同步。在对照状态下,CO在几乎同时刺激RV和LV的情况下最大化,从而增加RV(P = 0.006)和LV dP / dt(max)(P = 0.002)。在RVPO期间,通过RV优先起搏可使CO最大化,从而增加RV dP / dt(max)(P = 0.007),但不影响LV dP / dt(max),并降低从左到右的末端舒张压梯度(P = 0.023)。 RV dP / dt(max)的增加百分比大于LV dP / dt(max)(P = 0.014)。舒张末期压力没有增加以说明dP / dt(max)的增加。在对照组和RVPO中,RV dP / dt(max)与A(PP)呈线性相关(r = 0.779,P <0.001)。 CO与A(PP)的关系呈曲线关系,在RVPO期间,CO的峰值在控制状态下为正A(PP)(P = 0.004),而A(PP)接近零(P = 0.001)。这些观察结果表明,在我们的模型中,BiVP优化可通过增加RV收缩力来改善CO。这是由机械心室同步性的改变所介导的。在RVPO期间后负荷增加会加剧这种效应,使CO严重依赖于RV和LV中同时产生的压力,并通过LV压力跨室间隔的传递来支持RV收缩力。
  • 【双侧心律除颤器植入术中对侧入路结合静脉去闭塞术的意义】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Jacon P,Benhalima A,Thony F,Defaye P
    BACKGROUND & AIMS: :The authors report the case of a patient in whom a biventricular defibrillator was successfully implanted from the right, following a failed approach from the left. The patient had chronic thrombosis of the subclavian vein, and this procedure was only possible after venous deocclusion and the positioning of an endoprosthesis. The authors underline the significance of the contralateral approach in case of difficulties in inserting pacing devices, as well as the complementary benefits of interventional radiological procedures in order to allow vascular access in cases of chronic venous thrombosis.
    背景与目标: :作者报告了一个患者的情况,该患者从左侧失败的方法成功地从右侧植入了双心室除颤器。该患者患有锁骨下静脉的慢性血栓形成,只有在静脉脱塞并放置了内置假体后才可以进行此操作。作者强调了对侧入路在难以插入起搏装置的情况下的重要性,以及在慢性静脉血栓形成的情况下为了允许血管通路而进行介入放射学治疗的补充益处。
  • 【临时性双室支持和体外膜氧合:一种适用于多器官功能衰竭的心源性休克的可行治疗方法。】 复制标题 收藏 收藏
    DOI:10.1007/s10047-017-0966-5 复制DOI
    作者列表:Seguchi O,Fujita T,Watanabe T,Kuroda K,Hisamatsu E,Nakajima S,Sato T,Sunami H,Yanase M,Hata H,Kobayashi J,Nakatani T,Fukushima N
    BACKGROUND & AIMS: :Various strategies using a ventricular assist device (VAD) are applied to rescue Interagency Registry for Mechanically Assisted Circulatory Support profile 1 (Profile-1) patients. However, the optimal use of VAD in Profile-1 patients has not been completely elucidated. We retrospectively reviewed 23 Profile-1 patients [mean age 36.9 ± 16.6 years, 14 males; 11 with non-ischemic cardiomyopathy (NICM), 9 with fulminant myocarditis (FM), 2 with ischemic cardiomyopathy (ICM), and 1 with peripartum cardiomyopathy (PPCM); 18 with pre-operative percutaneous extracorporeal membrane oxygenation (p-ECMO) support] who underwent VAD implantation from 2011 to 2015 at our institution. Nine initially received left VAD (LVAD) alone (NICM in 9, ICM in 2 with ICM, and FM in 1), one with NICM received biventricular VAD (BiVAD; n = 1), and 10 received LVAD combined with right ventricular support using an ECMO circuit (BiVAD-ECMO) (FM in 8, NICM in 1, and PPCM in 1). Paracorporeal VAD was used in all patients. ECMO was used for the patients with severe pulmonary edema, inflammation, anemia, and thrombopenia. The BiVAD patient died 1.4 months after VAD implantation. The overall survival was comparable between patients with BiVAD-ECMO and LVAD (2-year survival, 80.0 and 75.0%, respectively). Three VAD strategies were initially applied in Profile-1 patients. Among them, the BiVAD-ECMO strategy is a promising therapeutic option to rescue Profile-1 patients with multiple organ failure.
    背景与目标: :使用心室辅助设备(VAD)的各种策略可用于挽救机械辅助循环支持配置文件1(Profile-1)患者的机构间注册表。但是,尚未完全阐明Profile-1患者中VAD的最佳用法。我们回顾性地回顾了23例Profile-1患者[平均年龄36.9±16.6岁,14例男性;非缺血性心肌病(NICM)11例,暴发性心肌炎(FM)9例,缺血性心肌病(ICM)2例,围产期心肌病(PPCM)1例; 18例术前经皮体外膜氧合作用(p-ECMO)支持,他们于2011年至2015年在我们机构接受了VAD植入。最初有9个单独接受左VAD(LVAD)(NICM为9个,ICM为2个,ICM为FM,1个为FM),一个NICM则接受双心室VAD(BiVAD; n = 1),另外10个接受LVAD联合右心室支持ECMO电路(BiVAD-ECMO)(FM输入为8,NICM输入为1,PPCM输入为1)。所有患者均使用了体外VAD。 ECMO用于严重肺水肿,炎症,贫血和血小板减少症的患者。 BiVAD患者在VAD植入后1.4个月死亡。 BiVAD-ECMO和LVAD患者的总体生存率相当(2年生存率分别为80.0和75.0%)。最初在Profile-1患者中应用了三种VAD策略。其中,BiVAD-ECMO策略是挽救多器官功能衰竭的Profile-1患者的有前途的治疗选择。
  • 【双室辅助设备的微创植入。】 复制标题 收藏 收藏
    DOI:10.1055/s-0034-1367736 复制DOI
    作者列表:Deuse T,Reichenspurner H
    BACKGROUND & AIMS: :As minimally invasive left ventricular assist device implantation is being advocated and more widely performed, bailout strategies for postoperative right ventricular failure (RVF) become necessary. We describe our surgical technique for additional right ventricular assist device implantation through a third mini-thoracotomy incision. This new technique allows avoidance of sternotomy even if RVF occurs.
    背景与目标: 随着微创左室辅助装置的植入和广泛应用,术后右心衰竭(RVF)的救助策略变得十分必要。我们描述了我们的外科手术技术,通过第三次迷你开胸切口进一步植入了右心室辅助装置。即使发生RVF,这种新技术也可以避免胸骨切开术。
  • 【心衰双室起搏后左心室和右心室节段功能早期变化的评估:组织多普勒成像研究。】 复制标题 收藏 收藏
    DOI:10.1177/0003319706291173 复制DOI
    作者列表:Bilge AK,Ozben B,Ozyigit T,Acar D,Hunerel D,Adalet K,Nisanci Y
    BACKGROUND & AIMS: :Tissue Doppler imaging allows assessment of systolic and diastolic regional ventricular function. The aim of this study was to assess early changes in regional systolic and diastolic functions and differences in transition time to contraction between the ventricles after cardiac resynchronization therapy. Fourteen patients were included, who underwent echocardiography before and 1 month after resynchronization. The difference between transition time to contraction of left and right ventricles decreased to 24.4 +/- 10.7 milliseconds from 65.3 +/- 18.2 milliseconds after resynchronization therapy (P = .001). There was a significant relation between the decrease in difference between transition time and increase in ejection fraction (r = 0.80, P = .002). Early or late diastolic myocardial motion increased in 7 segments of left and 2 segments of right ventricles. Systolic myocardial motion increased in 7 segments of left and in all segments of right ventricles. Resynchronization therapy improved systolic and diastolic functions in both ventricles. The difference between transition time to contraction of ventricles might be helpful in estimating optimal resynchronization.
    背景与目标: :组织多普勒成像可评估收缩和舒张区域心室功能。这项研究的目的是评估心脏再同步治疗后区域收缩和舒张功能的早期变化以及心室之间收缩过渡时间的差异。包括十四名患者,他们在再同步之前和之后1个月接受了超声心动图检查。左心室和右心室收缩之间的过渡时间之间的差异从再同步治疗后的65.3 /-18.2毫秒降低到24.4 /-10.7毫秒(P = .001)。过渡时间之间的差异减少与射血分数增加之间存在显着关系(r = 0.80,P = .002)。舒张早期或晚期心肌运动在左心室的7个部分和右心室的2个部分中增加。在左心室的7个节段和右心室的所有节段中,收缩期心肌运动均增加。重新同步治疗改善了两个心室的收缩和舒张功能。过渡时间到心室收缩之间的差异可能有助于估计最佳的再同步。
  • 【通过完整的静脉通路放置双心室Impella。】 复制标题 收藏 收藏
    DOI:10.1002/ccd.27103 复制DOI
    作者列表:Kamioka N,Patel A,Burke MA,Greenbaum A,Babaliaros V
    BACKGROUND & AIMS: :Impella (Abiomed, Danvers, MA) is an effective option for emergent treatment of critical refractory cardiogenic shock. However, in patients who have inadequate peripheral arterial access, Impella for left ventricular support sometimes requires surgical access, leading to disadvantages for emergent procedures or invasiveness for very sick patients. In addition, Impella for right ventricular support was recently reported to contribute to the management of severe biventricular dysfunction. In this report, we describe a case of refractory cardiogenic shock in a patient with inadequate vascular access who was treated with biventricular Impella via venous and caval-aortic access under conscious sedation. This technique can be used as a bridge to surgical ventricular assist device or heart transplantation. © 2017 Wiley Periodicals, Inc.
    背景与目标: :Impella(Abiomed,Danvers,MA)是紧急治疗严重难治性心源性休克的有效选择。但是,在外周动脉通路不足的患者中,用于左心室支持的Impella有时需要进行手术通路,这对重病患者的紧急手术或侵入性造成不利影响。此外,最近报道了用于右心室支持的Impella有助于严重的双室功能障碍的治疗。在本报告中,我们描述了在血管通路不足的患者中发生难治性心源性休克的情况,该患者在有意识的镇静作用下经静脉和腔-主动脉通路接受了双室Impella的治疗。该技术可以用作通向手术室辅助设备或心脏移植的桥梁。分级为4 +©2017 Wiley Periodicals,Inc.

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