Right Side Of The Heart Research Articles

Electrophysiological characteristics of right- and left-sided Mahaim accessory pathways: A single-center experience in China.

Mahaim-type accessory pathways (MAPs) are rare accessory pathways (APs) with specific properties. They are mostly located in the right side of the heart but rarely exist on the left side. This study aims to analyze the clinical and electrophysiological (EP) characteristics of both-sided MAPs. A total of 2,249 patients with AP from our center were enrolled between 1 January 2011 and 27 March 2022. During the EP study (EPS) 17 patients were diagnosed with MAPs (right-sided: n = 13, left-sided: n = 4) according to the properties of Mahaim fibers. MAPs constitute 0.75% of all APs. Out of 1,553 patients with left-sided APs, four patients (0.26%) were diagnosed with Mahaim fiber-mediated tachycardia. Out of 696 patients with right-sided APs, 13 patients (1.9%) were diagnosed with Mahaim fiber. Most Mahaim fibers were located at the free wall of the tricuspid and mitral annuli. Seven patients of right-sided MAPs were of atriofasicular type, six patients had right-sided MAPs, and all of the patients with left-sided MAPs were of atrioventricular (AV) type. The M potential only was detected in long-length MAPs. Coexistence with other supraventricular tachycardias (SVTs) was also observed both in patients with right-sided and left-sided MAPs. All the patients underwent radiofrequency ablation successfully. Only one patient had tachycardia recurrence during a follow-up. Although MAPs are commonly located at right sides, left sites are not impossible. The M potential contributes to the improvement of the successful ablation.

FEASIBILITY OF NEW CMR POST-PROCESSING SOFTWARE PROTOTYPES IN ASSESSING THE RIGHT HEART AND TRICUSPID FUNCTION

<h3>Introduction</h3> As right heart dysfunction is frequently encountered in cardiac surgical cases, increasing attention is being paid to pre-operative right atrial and ventricular (RV) dysfunction and secondary tricuspid insufficiency for optimal patient risk evaluation and decision-making. However, cardiac evaluations have long focused on the left side of the heart, and consequently there is a void of post-processing analysis techniques designed to assess the right heart, limiting the information available. Indications for cardiovascular magnetic resonance (CMR) prior to surgical interventions are rapidly increasing. CMR is ideal for right heart assessments as it is not limited by acoustic windowing issues yet lags behind other modalities such as echo and CT for assessing the tricuspid valve. Advancements with CMR software can quantify tricuspid annular excursion in 2D planes using a rapid-automated long-axis strain prototype. A second new technique is 4D-flow CMR, which has the potential to overcome the limitations posed by the through plane and angular motion of the valve. 4D flow measures blood trajectories and velocity in any direction over the entire cardiac cycle, yet it was designed for aortic and left ventricular measures. We investigated the feasibility of a 4D-blood flow prototype for measuring trans-tricuspid flow in relation to other novel right heart rapid-automated long-axis parameters. <h3>Methods</h3> In 30 healthy controls and 15 cardiovascular patients with an RV fractional area change between 30-50% and no known severe valve disease, a 4D-flow block encompassing the entire heart was imaged with CMR. Using a prototype dynamic-valve-tracking module, a contour was placed on the tricuspid annulus of the 4D images throughout the entire cardiac cycle. Forward and backwards flow through the valve was measured, with a specific focus on max flow during early diastole (E). A second prototype for rapid-automated long-axis strain analysis was implemented to measure the atrio-tricuspid annular motion (A-TAM) defined as the change in the longitudinal extent from the roof of the right atrium to the tricuspid valve, and for the tricuspid annular plane systolic excursion (TAPSE). <h3>Results</h3> One patient was excluded from flow analysis due to poor gating. In all remaining exams, an E wave was detected, and maximal tricuspid flow was 307±70ml/s in controls, and 251±79ml/s in patients (p=0.025). Moreover, with 4D analysis, mild tricuspid insufficiency was observed in 6/14 (43%) patients with a regurgitant fraction of 5% or more, which was not observed in controls. Patients also demonstrated reduced right atrial and ventricular function shown by a reduced A-TAM (28±13% vs 14±10%, p<0.001) and TAPSE (25±4 vs 17±5mm, p<0.001) in patients compared to controls. <h3>Conclusion</h3> In this feasibility analysis, dynamic flow analysis can be applied to CMR 4D-blood flow acquisitions of the right heart to measure tricuspid valve flow patterns and quantify tricuspid insufficiencies. Further comparisons of analysis with these prototypes to gold-standard techniques, and the association of these markers with anaesthesia outcomes are required for further validation.

Image Segmentation for Mitral Regurgitation with Convolutional Neural Network Based on UNet, Resnet, Vnet, FractalNet and SegNet: A Preliminary Study

The heart’s mitral valve is the valve that separates the chambers of the heart between the left atrium and left ventricle. Heart valve disease is a fairly common heart disease, and one type of heart valve disease is mitral regurgitation, which is an abnormality of the mitral valve on the left side of the heart that causes an inability of the mitral valve to close properly. Convolutional Neural Network (CNN) is a type of deep learning that is suitable for use in image analysis. Segmentation is widely used in analyzing medical images because it can divide images into simpler ones to facilitate the analysis process by separating objects that are not analyzed into backgrounds and objects to be analyzed into foregrounds. This study builds a dataset from the data of patients with mitral regurgitation and patients who have normal hearts, and heart valve image analysis is done by segmenting the images of their mitral heart valves. Several types of CNN architecture were applied in this research, including U-Net, SegNet, V-Net, FractalNet, and ResNet architectures. The experimental results show that the best architecture is U-Net3 in terms of Pixel Accuracy (97.59%), Intersection over Union (86.98%), Mean Accuracy (93.46%), Precision (85.60%), Recall (88.39%), and Dice Coefficient (86.58%).

Chronic thromboembolic pulmonary hypertension resulting in decompensated right heart failure

Chronic thromboembolic pulmonary hypertension is a notoriously underdiagnosed cause of severe pulmonary hypertension. It is a form of precapillary pulmonary hypertension (PH) that results from intraluminal thrombus organization and fibrous formation which ultimately results in the complete obliteration of pulmonary arteries, resulting in increased pulmonary vascular resistance which leads to the development of pulmonary hypertension and as a result right heart failure. The mechanism involves the narrowing of the pulmonary artery which increases blood pressure within the lungs and impairs blood flow which increases the workload of the right side of the heart ultimately causing right heart failure. Pulmonary hypertension can also cause arrhythmias, blood clots, and bleeding in the lungs. Even though CTEPH is a deadly condition, among all forms of pulmonary hypertension, CTEPH is the only curable form. Echocardiography is the initial assessment tool for suspected PH. A right heart catheterization may be performed to confirm the presence of pulmonary hypertension. Confirmation of CTEPH requires a V/Q scan. Although ventilation/perfusion scintigraphy has a major role in the evaluation of patients with suspected CTEPH, nowadays CTA chest is being used widely as it produces much better-quality images compared to V/Q scan. Without treatment, the prognosis is very poor. Out of three treatment modalities such as; pulmonary endarterectomy (PEA) surgery, balloon pulmonary angioplasty (BPA), and medical therapy, surgery is the gold standard. The physician must be familiar with the disease entity, early diagnosis, and appropriate treatment to improve survival. Here we present a literature review on this topic.

Ossa cordis and os aorta in the one-humped camel: Computed tomography, light microscopy and morphometric analysis.

The present study describes the morphological characteristics of the camel heart Ossa cordis, and os aorta using computed tomography soft tissue window (CT) alongside 3D render volume reconstructions and light microscopy. The current study techniques demonstrated the Ossa cordis and os aorta in the cardiac window with more precision than the black and white (ghost), and angiography images. Transverse and sagittal CT images additionally demonstrated the presence of Ossa cordis and os aorta. This study is the first to record two small Ossa cordis sinistrum and one os aorta in the camel heart, in addition to the more commonly observed singular, large, os cordis dextrum. The os cordis dextrum was always located in the upper part of the interventricular septum, near to its junction with the atrium, forming an elongated rectangular shape when observed transversally. The wider cranial part was composed from bone, whereas the caudal aspect was narrow and contained both bone and cartilage. Light microscopy identified that the os cordis dextrum consisted of trabecular bone, marrow spaces, and hyaline cartilage. Two Ossa cordis sinistrum were detected on the left side of the heart, one in the right fibrous ring and another in the interventricular septum, microscopy showed that both contained only trabecular bone with osteocytes, osteoblasts, and osteoclasts. At the level of ascending aorta, there was also trabecular bone containing osteocytes, an os aorta.

Pulmonary Embolism With Underlying Family History Presenting as Syncope: A Case Report

An artery blockage by a foreign body, such as a blood clot/fat/air/cholesterol/amniotic fluid, is called an embolism. The most serious conditions caused by an embolism are stroke and pulmonary embolism. Pulmonary embolism (PE) occurs when a foreign body blocks the vessel that carries blood from the heart to the lungs. Deep vein thrombosis (DVT) has the potential to embolize and travel through the right side of the heart and become lodged in the blood-supplying artery of the lungs: the pulmonary artery. DVT is one of the major causes of pulmonary embolism. Pulmonary embolism is a life-threatening disease that can sometimes be problematic to point at, especially when the patient has no obvious symptoms. The risk factors may not be strikingly palpable, and there may also be an intersection between the symptoms and signs of pulmonary embolism and other diseases. Syncope is a comparatively easy clinical symptom to detect but has varied etiologies that lead to a standard cause in only 58% of syncopal events. It is a difficult correlation to make when syncope is the presenting symptom of pulmonary embolism. Family history in the case of undiagnosed pulmonary embolism presenting with symptoms that point in no particular direction becomes crucial in determining the disease.

Novel rare mutation in a conserved site of PTPRB causes human hypoplastic left heart syndrome.

Hypoplastic left heart syndrome (HLHS) is a rare but fatal birth defect in which the left side of the heart is underdeveloped. HLHS accounts for 2% to 4% of congenital heart anomalies. Whole genome sequencing (WGS) was conducted for a family trio consisting of a proband and his parents. A homozygous rare variant was detected in the PTPRB (Protein Tyrosine Phosphatase Receptor Type B) gene of the proband by functional annotation and co-segregation analysis. Sanger sequencing was used to confirm genotypes of the variant. The in silico prediction tools, including Mutation Taster, SpliceAI, and CADD, were used to predict the impact of the mutation. The allele frequencies across populations were compared based on multiple databases, including "1000 genomes" and "gnomAD". We used two vectors (pcMINI and pcDNA3.1) to generate a minigene construct to validate the mutational effect at the transcriptional level. Family-based WGS analyses showed that only a homozygous splice acceptor variant (NC_000012.12: g.70636068T>G, NM_001109754.4: c.56-2A>C, NG_029940.2: g.6373A>C) at the exon-intron border of PTPRB gene associates with HLHS. This variant is also within the region with the enhancer activity based on UCSC genome annotation. Genotyping and Sanger sequencing revealed that the proband's parents are heterozygous for this variant. Evolutionary conservation analysis revealed that the site (NC_000012.12: g.70636068) is extremely conserved across species, supporting the evolutionary functional constraints of the ancestral wild type (T). In silico tools universally predicted a deleterious or disease-causing impact of the mutation from T to G. The mutation was not found in the 1000 genomes and gnomAD databases, which indicates that this mutation is very rare in most human populations. A splicing assay indicated that the mutated minigene caused aberrant splicing of mRNA, in which a 3bp missing in the second exon resulted in the deletion of one amino acid (NP_001103224.1:p.Glu19del) compared to the normal protein of PRPTB (also the VE-PTP). Structure prediction revealed that the deletion occurred within the C-region of the signal peptide of VE-PTP, suggesting signal peptide-related defects as a potential mechanism for the HLHS cellular pathogeny. We report a rare homozygous variant with splicing error in PTPRB associated with HLHS. Previous model species studies revealed conserved functions of PTPRB in cardiovascular and heart development in mice and zebrafish. Our study is the first report to show the association between PTPRB and HLHS in humans.

Hemodynamics-driven mathematical model of third heart sound generation.

The proto-diastolic third heart sound (S3) is observed in various hemodynamic conditions in both normal and diseased hearts. We propose a novel, one-degree of freedom mathematical model of mechanical vibrations of heart and blood that generates the third heart sound, implemented in a real-time model of the cardiovascular system (CircAdapt). To examine model functionality, S3 simulations were performed for conditions mimicking the normal heart as well as heart failure with preserved ejection fraction (HFpEF), atrioventricular valve regurgitation (AVR), atrioventricular valve stenosis (AVS) and septal shunts (SS). Simulated S3 showed both qualitative and quantitative agreements with measured S3 in terms of morphology, frequency, and timing. It was shown that ventricular mass, ventricular viscoelastic properties as well as inflow momentum play a key role in the generation of S3. The model indicated that irrespective of cardiac conditions, S3 vibrations are always generated, in both the left and right sides of the heart, albeit at different levels of audibility. S3 intensities increased in HFpEF, AVR and SS, but the changes of acoustic S3 features in AVS were not significant, as compared with the reference simulation. S3 loudness in all simulated conditions was proportional to the level of cardiac output and severity of cardiac conditions. In conclusion, our hemodynamics-driven mathematical model provides a fast and realistic simulation of S3 under various conditions which may be helpful to find new indicators for diagnosis and prognosis of cardiac diseases.

SQUAMOUS CELL CARCINOMA OF THE LUNG LEADING TO MALIGNANT CARDIAC TAMPONADE DUE TO LARGE CARDIAC METASTASES

SQUAMOUS CELL CARCINOMA OF THE LUNG LEADING TO MALIGNANT CARDIAC TAMPONADE DUE TO LARGE CARDIAC METASTASES

A reappraisal of pediatric thoracic surface anatomy.

Accurate knowledge of surface anatomy is essential for physical examination, invasive procedures, and anatomy education. Individual factors such as age make surface landmarks variable so accurate descriptions are needed. The aim of this study is to describe age-related surface landmarks for intrathoracic structures in children. A total of 156 thoracic computed tomography scans of children aged 0-18 years were categorized into six groups, and the associations between major intrathoracic structures and surface landmarks were analyzed. Sternal angle is an accurate surface landmark for the azygos vein-superior vena cava junction in all age groups. However, the aortic arch (except in the 0-1year group), the bifurcation of the pulmonary trunk and the tracheal bifurcation in those aged 15-18 years were not within this plane. The left brachiocephalic vein was located behind the ipsilateral sternoclavicular joint except in the 1-3 years group, and the right was behind it in children older than 6 years. The apex of heart was at the 5th intercostal space level in the 0-1 and 12-18 years groups; however, it was higher in the other groups. The lower borders of the lungs were at the sixth costal cartilage level in the midclavicular line, eighth intercostal space level in the midaxillary line, and T12 adjacent to the vertebral column in the 15-18 years group; the lower borders were at higher levels in younger children. Defining the variations in surface anatomy by in vivo studies will increase its clinical and pedagogical value.

Prenatal ultrasonographic characteristics and prognosis of isolated redundant foramen ovale flap

ObjectiveTo analyze the prenatal ultrasonographic characteristics and prognosis of the isolated redundant foramen ovale flap (RFOF). MethodsFrom January 2014 to December 2021, we collected data on fetal echocardiography analyses and perinatal outcomes for fetuses with isolated RFOF in Peking University People's Hospital. ResultsWe found that 0.31% (87/28308) of participants have RFOF. The four-chamber results of the foramen ovale flap (FOF) showed that it was stiff and extended >50% or reached the lateral wall of the left atrium (LA) in diastole. As seen from the foramen ovale(FO) channel and four-chamber views, the hypermobile and redundant flap were observed shrinking and stretching with the fetal cardiac cycle, which is similar to jellyfish. The lateral displacement of flow from LA to the left ventricle (LV) around the FOF on color doppler demonstrated thin linear blood flow from the right to left and a reversal of flow across FO. A uniphasic, but not biphasic, pattern of FOF displacement was observed on M-mode. Stages I (23/87) and II (51/87) had a higher ratio of ventricular disproportion than Stage 0 (11/87) and III (2/87). We observed the RA/LA (right/left atrium) ​> ​1.2 in 53 cases (60.9%), RV/LV (right/left ventricle) ​> ​1.2 in 53 cases (60.9%), PA/AO (pulmonary/aortic artery) ​> ​1.2 in 53 cases (60.9%), and moderate or severe tricuspid regurgitation in 10 cases and moderate pericardial effusion in 2 cases (2.2%). Seventy-four RFOF cases had follow-up data. Neonatal death occurred in 2 cases; 72 fetuses survived with normal or minor heart defects. ConclusionRFOF should be considered if the left side of the heart of a fetus is smaller and related to hypermobile FOF. For isolated RFOF cases, a monthly follow-up is recommended to monitor arrhythmia or fetal hydrop status. Prompt treatment is recommended for those with adequate gestational age and lung maturity.

Characterization of an iPSC line NCHi006-A from a patient with hypoplastic left heart syndrome (HLHS)

Hypoplastic left heart syndrome (HLHS) is a severe congenital heart defect characterized by underdeveloped structures on the left side of the heart, including hypoplasia of the left ventricle and stenosis or atresia of the aortic and mitral valves. Here, we generated an iPSC line from the peripheral blood mononuclear cells of a male patient with HLHS through Sendai virus-mediated transfection of 4 Yamanaka factors. This iPSC line exhibited normal morphology, expressed pluripotency markers, had a normal karyotype, and could differentiate into cells of three germ layers. This iPSC line can be used for studying cellular and developmental etiologies of HLHS.

Ex vivo experimental characterizations for understanding the interrelationship between tissue mechanics and collagen microstructure of porcine mitral valve leaflets

Unidirectional blood flow in the left side of the heart is regulated by the mitral valve. To better understand the mitral valve function, researchers have examined the structural and mechanical properties of the mitral valve leaflets; however, limitations of the previous studies include the use of mechanics- and structure-altering tissue modifications (e.g., optical clearing) that limit the ability to quantify the unique load-dependent reorientation and realignment of the collagen fibers as well as their interrelation with the valve tissue mechanics. Herein, we aimed to circumvent these limitations by utilizing an integrated polarized-light imaging and biaxial testing system for understanding the mechanics–microstructure interrelationship for porcine mitral valve leaflets. We further performed constitutive modeling and evaluated the accuracy of the affine fiber kinematics theory. From the tissue mechanics perspective, the posterior leaflet was more extensible in the radial direction than the anterior leaflet (14.2% difference in radial tissue stretch), while exhibiting smaller collagen and elastin moduli based on the determined constitutive model parameters. From the collagen microstructure’s standpoint, the posterior leaflet had smaller increases in optical anisotropy (closely related to the degree of fiber alignment) than the anterior leaflet (32.8±7.7% vs. 50.0±19.7%). Further, the leaflets were found to possess two distinct fiber families – one family oriented along the circumferential tissue direction, and another more disperse family with a 30°–40° offset from the first fiber family. Finally, affine fiber kinematics consistently underpredicted the collagen fiber reorientations Overall, this study improved our understanding of the mitral valve leaflets that is essential for facilitating tissue-emulated valve replacement and cardiac valve modeling frameworks.

Diagnosis and treatment of the rare procedural complication of malpositioned pacing leads in the left heart: a single center experience

Objectives. This study assessed the management approach and outcome of the pacemaker or implantable cardioverter-defibrillator (ICD) leads malpositioned in the left heart. Malpositioned leads (MPLs) may have deleterious consequences, and appropriate management remains uncertain. Methods. The study population included all patients referred to a single institution for MPL in the left side of the heart after pacemaker or ICD implantation during the period from 2015 to 2021. The approach and outcome of lead management were retrospectively assessed. Results. During the study period, 6887 patients underwent device implantation. MPL was diagnosed in five patients (0.07%). In four cases, the pacing lead was placed in a coronary sinus (CS) branch, while the pacing lead was inside the left ventricle (LV) in one case. Symptoms suggestive of lead malposition were reported by 2 patients (40%). One of the patients presented with recurrent TIAs. Another presented with inappropriate ICD shocks. In one asymptomatic case, an ICD lead changed position from the right ventricle to the CS, suggesting idiopathic lead migration. In 4/5 patients, the leads were removed or repositioned by percutaneous approach, with no major periprocedural complications. Conclusions. In this series of MPL in the left heart, two patients presented with thromboembolic events or inappropriate ICD shocks. These serious complications highlight the critical need for early correct diagnosis and proper management of MPL.

Operative management of cardiac papillary fibroelastomas

ObjectivePapillary fibroelastomas are associated with an increased risk of embolic strokes. Excision of papillary fibroelastomas may be the primary indication for surgery (primary) or performed during other cardiac operations (secondary). The present study summarizes our experience with primary and secondary fibroelastoma surgery. MethodsWe analyzed the medical records of patients who underwent surgical excision of papillary fibroelastoma between January 1998 and February 2020. Patient characteristics, indications for operation, tumor size and location, and operative and long-term outcomes were evaluated. ResultsAmong the 294 patients (median age: 66 years, 62% female), papillary fibroelastoma was the primary indication for surgery in 136 patients (46%), and 51% of patients had a history of stroke or transient ischemic attack. When papillary fibroelastoma was a secondary indication for surgery (158 patients, 54%), the lesion was identified preoperatively in 39%. Papillary fibroelastomas were located most commonly on the aortic valve and least commonly in the right side of the heart. For valvular papillary fibroelastoma resected from a normal valve, valve shave was sufficient in 96% (196/205). Operative mortality was low in both groups (primary, 0% vs secondary, 2.5%, P = .13), and early neurologic events occurred in 1.3%. Recurrence rate was 15.8% at 10 years. The estimated survival for patients with primary papillary fibroelastoma at 10 years was 78.4%, whereas for secondary papillary fibroelastoma removal it was 53.6% (log rank, P = .003). ConclusionsResection of papillary fibroelastomas can be performed safely, with preservation of the native valve, and with low rates of neurologic events. Operative and long-term outcomes after fibroelastoma resection are excellent.

Permanent Pacemaker Insertion in a Patient with Persistent Left Superior Vena Cava

Implantation of a permanent pacemaker (PPM) in a patient with venous anomalies can be quite difficult, especially in a patient with persistent left superior vena cava (PLSVC). Our patient was a 63-year-old female who presented with complaints of dizziness and an episode of syncope. Her electrocardiogram was suggestive of a complete heart block. We approached the right side of the heart through the right infraclavicular cephalic vein initially, as that is the preferred site in our hospital. We encountered difficulty negotiating the leads through the right side, which raised the possibility of PLSVC. We report the various steps we took while inserting the PPM in this case.

Transseptal puncture during catheter ablation associated with higher radiation exposure.

Electroanatomic mapping systems are increasingly used during ablations to decrease the need for fluoroscopy and therefore radiation exposure. For left-sided arrhythmias, transseptal puncture is a common procedure performed to gain access to the left side of the heart. We aimed to demonstrate the radiation exposure associated with transseptal puncture. Data were retrospectively collected from the Catheter Ablation with Reduction or Elimination of Fluoroscopy registry. Patients with left-sided accessory pathway-mediated tachycardia, with a structurally normal heart, who had a transseptal puncture, and were under 22 years of age were included. Those with previous ablations, concurrent diagnostic or interventional catheterisation, and missing data for fluoroscopy use or procedural outcomes were excluded. Patients with a patent foramen ovale who did not have a transseptal puncture were selected as the control group using the same criteria. Procedural outcomes were compared between the two groups. There were 284 patients in the transseptal puncture group and 70 in the patent foramen ovale group. The transseptal puncture group had a significantly higher mean procedure time (158.8 versus 131.4 minutes, p = 0.002), rate of fluoroscopy use (38% versus 7%, p < 0.001), and mean fluoroscopy time (2.4 versus 0.6 minutes, p < 0.001). The acute success and complication rates were similar. Performing transseptal puncture remains a common reason to utilise fluoroscopy in the era of non-fluoroscopic ablation. Better tools are needed to make non-fluoroscopic transseptal puncture more feasible.

The Right Heart.

The Right Heart Ingrid Gould I remarked to a friend, “We haven’t spoken since my arrest!” Alarm and confusion clouded his face, given my half-century of squeaky-clean living. “Cardiac arrest,” I clarified. “The fire department rebooted me.” An electrophysiologist diagnosed Arrhythmogenic Right Ventricular Dysplasia, prescribed medication, and implanted a defibrillator. For the next three-and-a-half years, he helped me live with a disease I didn’t know existed until he told me I had it. The disease progressed—an ironic, disease-centric term since its advancement was to my detriment— prompting my cardiologist to recommend seeing someone who specialized in heart failure. I resisted the very idea of heart failure, a terrible term for a struggling organ, but took her advice and scheduled an appointment. The new cardiologist urged transplant testing, a lengthy process. I agreed, figuring that by the time I needed a new heart in 15–20 years, they’d be rolling off 3D printers. To record occasional transplant musings and inchoate fears and perhaps, over time, untangle them, I began journaling. I chronicled my passage through the echocardiogram, heart catheterization, 31 tubes of bloodwork, interviews with different clinical specialties, a pulmonary function test in a machine reminiscent of Star Trek’s Transporter, and more. Testing had barely begun when my medication stopped working—a Halloween shock. I began a harsher medication, underwent an ablation, and spent six weeks in a wearable defibrillator, a vest with abundant wires, and a purse-sized battery pack that made me resemble a character in [End Page 123] the Jetsons. This attire did not bring holiday comfort or joy to the TSA1 when I flew to visit my sister. As my R-waves faded to a whisper, I swapped the vest for a second implanted defibrillator, substantially more sensitive than the first. In early 2018, we learned I had qualified for transplant listing, though I wished to get as much mileage as possible from the original engine. My cardiologist warned, “There is no Plan B—no machine, device, or medication for the long-term. You will need a transplant.” He explained that since most cardiac patients have left-heart problems, companies develop products for the left side of the heart. My problem was on the right—a tiny market. He also cautioned that a patient needs to be sick enough to warrant transplant and well enough to remain a candidate, survive the surgery, and recover. Although clinically I was ready, I was not personally ready. I felt too good to trade an excellent quality of life for the promised miserable post-transplant year. The cardiologist wisely asked if I wanted to speak with another patient. When I requested someone beyond the dreaded first year, he put me in touch with two women who had received new hearts a few years earlier and befriended each other. They soon became my invaluable mentors and cherished friends. I will never forget seeing them stride into our first meeting and thinking, “They are beautiful! They look totally normal!” By May, climbing four flights of stairs took as much effort as five used to take. Tests confirmed further deterioration and suggested I had 7–13 months of declining health before my heart would give out completely. We chose a date for hospital admission, and I started telling people outside my immediate family. Most were flabbergasted, believing heart transplants were the last hope of the desperately ill. I did not look moribund, though, apparently, I was. The eight months after my first transplant appointment let me prepare psychologically to bid farewell to my heart—the metaphor for kindness, love, and bravery in our culture—and to welcome a new organ from a generous person less medically fortunate than I. In the hospital, I met others awaiting their hearts. A sudden intimacy arises when mortal choices catapult people into a medical realm suggestive of science fiction. Add the emotional intensity that accompanies knowing your extended life comes courtesy of a person who breathes no more on this earth and you wonder how an organ recipient integrates sorrow and gratitude. Two weeks after I was hospitalized, my cardiologist informed me the wait was over...

A clinical case of Ewing’s sarcoma with metastatic lesion of the left chambers of the heart

Ewing’s sarcoma is a malignant bone tumor. It occurs more often in teenagers between 10–15 years old and metastasizes to the lungs and nervous system. Heart disease is atypical and occurs in only a few cases. We present a clinical case of late diagnosis of Ewing’s sarcoma in a 26-year-old patient with metastases in the left side of the heart. According to instrumental tests, hypermobile, ribbon-like formations were visualized on the cusps of the aortic and mitral valves with damage to the chordal apparatus. Coronary angiography was performed with embolextraction from the middle third of the left anterior descending artery and its diagonal branch, due to the clinical picture of anterior acute myocardial infarction with ST segment elevation. An urgent cardiac surgery was performed, in the attempt to prevent fatal incidents. During the revision, in addition to damage to the aortic and mitral valves of the heart, metastatic masses grew into the layer of the myocardium, the removal of which is technically impossible.In the early postoperative period, the patient died due to embolization into the brain and coronary arteries. Diagnosis of Ewing’s sarcoma requires timely diagnosis and treatment in order to prevent the rapid spread and development of life-threatening and fatal complications.

Longitudinal Associations Between Cumulative Physical Activity and Change in Structure and Function of the Left Side of the Heart: The Tromsø Study 2007-2016.

BackgroundCurrent knowledge about the relationship between physical activity (PA) and cardiac remodeling is mainly derived from cross-sectional studies of athletes, and there is a knowledge gap of this association in the general adult and elderly population. Therefore, we aimed to explore the longitudinal association between cumulative PA and change in cardiac structure and function in a general adult and elderly population.MethodsThis longitudinal study includes 594 participants from the sixth (Tromsø6, 2007–08) and seventh (Tromsø7, 2015–16) survey of the Tromsø Study. Cardiac structure and function were assessed by echocardiography at two time points, and PA was self-reported by questionnaire at both time points. PA volume was expressed as cumulative PA (Low, Moderate, and Hard) and the association with left atrial (LA) and left ventricular (LV) structure and function was assessed using ANCOVA.ResultsOverall, LA diameter index (LADi) increased significantly more in Hard compared to Moderate PA (+0.08 cm/m2, 95% CI 0.01–0.15, p = 0.020) from Tromsø6 to Tromsø7. When stratified by sex or age, higher levels of cumulative PA were associated with increased LADi in males and in participants <65 years only. Indexed LV mass (LVMi) increased significantly more in Moderate than in Low PA (+3.9 g/m2.7, 95% CI 0.23–7.57, p = 0.037). When stratified by sex or age, these changes in LVMi and indexed LV diameter (LVDi) were only significant in females. No significant associations were observed between cumulative PA and change in relative wall thickness, E/e' ratio, e' velocity, LV ejection fraction, and LADi/LVDi ratio.ConclusionHigher levels of cumulative PA were associated with increased LADi in males and participants <65 years, and with increased LVMi and LVDi in females. Despite cardiac chamber enlargement, the pump function of the heart did not change with higher levels of PA, and the atrioventricular ratio was unchanged. Our results indicate that cardiac chamber enlargement is a physiological response to PA.