Degree Of Pulmonary Hypertension Research Articles

Echocardiography evaluation of neonatal vein of Galen aneurysmal malformation.

In neonatal vein of Galen aneurysmal malformation, vein of Galen aneurysmal malformation echocardiography remains the mainstay for early detection and explains various haemodynamic changes occurring due to a large systemic arterio-venous shunt. However, there is limited evidence of echocardiography in risk stratifying neonatal vein of Galen aneurysmal malformation vein of Galen aneurysmal malformation. The objective of this study was to identify echocardiographic parameters that could be associated with major outcomes and guide timing of neuro-intervention. In this retrospective chart review, infants < 28 days of age with the diagnosis of vein of Galen aneurysmal malformation vein of Galen aneurysmal malformation were included. Demographic, clinical, and echocardiographic parameters were compared in neonates who survived or died with neonatal presentation. A risk algorithm model based on key echocardiographic parameters was developed to determine those who are at risk of early death. Of the 19 neonates included, with median birth weight 3.1 kg (IQR 2.58-3.36), nine (47%) neonates died at median age of 5 days (IQR 4-17). All neonates showed retrograde diastolic flow at the level of descending aorta by colour Doppler on the first post-natal echocardiogram at median age of 2 days (IQR 1-5.5). An aortic antegrade-to-retrograde velocity time integral ratio of < 1.5 and supra-systemic pulmonary artery pressure had 100% positive predictive value of death (p = 0.029), whereas aortic antegrade-to-retrograde velocity time integral ratio of > 1.5 and sub-systemic pulmonary artery pressure had 100% positive predictive value of survival (p = 0.029). Combination of aorta antegrade-to-retrograde velocity time integral ratio and degree of pulmonary hypertension on the first post-natal echocardiogram may help stratify the severity of disease and guide optimal timing for neuro-intervention for neonatal vein of Galen aneurysmal malformation.

Monocrotaline model of Pulmonary hypertension in immature rats from the perspective of Serotonergic regulation

Pulmonary hypertension (PH) is a multifactorial disease characterized by an average pulmonary artery pressure of 25mmHg or higher. Although PH is generally classified into five distinct groups, pulmonary arterial hypertension (PAH), especially the idiopathic subgroup (IPAH) or congenital heart disease (CHD) subgroup, has been the focus of most of our research from a serotonergic regulatory perspective. There are many models of pulmonary hypertension in experimental practice. Each model aim at certain goals and is based on various mechanisms. The monocrotaline model of pulmonary hypertension is one of the best models for studying pulmonary hypertension due to endothelial dysfunction. However, in experimental practice, this model is used only for adulthood. At present, the influence of the serotonergic system is not taken into account in the treatment of children with pulmonary hypertension. We have modified the monocrotaline model of pulmonary hypertension for immature rats. A positive correlation was found between the concentration of serotonin metabolites in the urine and the degree of pulmonary hypertension, which can become a potential marker of pulmonary hypertension.

Right ventricular global dysfunction score: a new concept of right ventricular function assessment in patients with heart failure with reduced ejection fraction (HFrEF).

Right ventricular (RV) function is currently being evaluated solely according to the properties of RV myocardium. We have tested a concept that in patients with heart failure with reduced ejection fraction (HFrEF), RV assessment should integrate the information about both RV function as well as size. A total of 836 stable patients with HFrEF (LVEF 23.6 ± 5.8%, 82.8% males, 68% NYHA III/IV) underwent echocardiographic evaluation and were prospectively followed for a median of 3.07 (IQRs 1.11; 4.89) years for the occurrence of death, urgent heart transplantation or implantation of mechanical circulatory support. RV size (measured as RV-basal diameter, RVD1) was significantly associated with an adverse outcome independent of RV dysfunction grade (p = 0.0002). The prognostic power of RVD1 was further improved by indexing to body surface area (RVD1i, p < 0.05 compared to non-indexed value). A novel parameter named RV global dysfunction score (RVGDs) was calculated as a product of RVD1i and the degree of RV dysfunction (1-4 for preserved RV function, mild, moderate and severe dysfunction, respectively). RVGDs showed a superior prognostic role compared to RV dysfunction grade alone (ΔAUC >0.03, p < 0.0001). In every subgroup of RVGDs (<20, 20-40, 40-60, >60), patients with milder degree of RV dysfunction but more dilated RV had similar outcome as those with more severe degree of RV dysfunction but smaller RV size (all p > 0.50), independent of tricuspid regurgitation severity and degree of pulmonary hypertension. RV dilatation is a manifestation of RV dysfunction. The evaluation of RV performance should integrate the information about both RV size and function.

5-HT2-Receptors and 5-HIAA – Therapeutic Targets for Evaluation of Severity, Progression and Effectiveness of Treatment in Immature Male Rats in a Monocrotalin Model of Pulmonary Hypertension

Suppression of the proliferation of vascular endothelial cells and the interaction of endothelial with smooth muscle cells in pulmonary hypertension (PH) are impaired. Participation of the 5-HT2a-receptor in the mitogenic effect on endothelial, and 5-HT2b-receptor – on vascular smooth muscle cells was revealed. The main organ that metabolizes serotonin is the lung. In the endothelial cells of the vessels of the lungs under the action of the enzyme monoamine oxidase And serotonin is converted to 5-hydroxyindoleacetic acid (5-HIAA), which is subsequently excreted in the urine. Currently, the role of 5-HT2-receptors is not taken into account in the treatment of children with pulmonary hypertension. We have modified the monocrotaline model of pulmonary hypertension for immature rats. A scheme for the administration of a 5-HT2-receptor blocker for the prevention and treatment of pulmonary hypertension in immature rats was developed and tested. A positive correlation was found between the concentration of 5-HIAA in urine and the degree of pulmonary hypertension, which can become a potential marker of pulmonary hypertension. The data obtained indicate the development of pulmonary hypertension in immature rats after a single injection of monocrotaline in the form of replacement of lung tissue with fibrous tissue, the development of pneumosclerosis and bronchiectasis. Also, in animals in this model, changes in the structure of the heart muscle and vascular wall are formed with the development of fibrous tissue, which may indicate the involvement of 5HT2-receptors in the activation of fibroblasts and, accordingly, in the pathogenesis of pulmonary hypertension.

Modern possibilities of correction of broncho-obstructive syndrome in chronic heart failure of ischemic origin in combination with chronic obstructive pulmonary disease: simple randomized parallel group study

AIM: To evaluate the efficacy and safety of complex basic therapy for chronic heart failure (CHF) of ischemic origin in combination with chronic obstructive pulmonary disease (COPD) with the inclusion of prolonged bronchodilators.&#x0D; MATERIALS AND METHODS: The study included 67 patients (50 men and 17 women) with CHF IIIII functional class (FC) with left ventricular ejection fraction (LVEF) of 45% in combination with moderate-to-severe COPD (GOLD). The patients were divided into three groups: group 1 (n=30) received formoterol as part of therapy, group 2 (n=19) received aclidinium, and group 3 (n=18) received a fixed combination of aclidinum and formoterol. The basic therapy for CHF included nebivolol, losartan, eplerenone, diuretics, low-dose glucocorticosteroids, nitrates, and cardiac glycosides (if necessary). The clinical condition of patients, intracardiac hemodynamics, was indicated using echocardiography, a 6-min walking test (6MWT), bifunctional 24-h monitoring of blood pressure and heart rate, and spirometry. Quality of life was assessed using the Minnesota Living with Heart Failure Questionnaire, St. Georges Respiratory Questionnaire, and Modified Medical Research Council dyspnea scale.&#x0D; RESULTS: After 6 months of therapy, the clinical and instrumental parameters and quality of life improved in all groups. At the end of the observation period, the average FC of CHF and dyspnea severity decreased by 17.5, 18.2, 20.1 20.5, 24.2, and 28.1%, respectively. The increase in exercise tolerance was 22.1, 22.6, and 29.2%. An improvement in intracardiac hemodynamics was noted. The LVEF increased by 17.1, 20.5, and 24.6%, and the myocardial mass index decreased by 8.7, 14.2, and 17.4%. The total peripheral vascular resistance, degree of pulmonary hypertension, and duration and frequency of painless myocardial ischemia significantly decreased. The best results were obtained in group 3 using nebivolol, reninangiotensinaldosterone system antagonists, and a combination of long-acting bronchodilators. Therapy was well tolerated by all study groups, with no serious adverse side effects.&#x0D; CONCLUSION: The inclusion of nebivolol and losartan in basic therapy, while taking long-acting bronchodilators, improves the clinical and functional states of patients and quality of life, and slows down disease progression. When used in a fixed combination, the use of aclidinium and formoterol improves spirometry to a greater extent.

Effects of chronic neonatal hyperoxia-induced bronchopulmonary dysplasia on breathing, energy expenditure, and growth in young, adolescent, and adult mice

Bronchopulmonary dysplasia (BPD) is a common chronic lung disease associated with preterm birth. Growth failure is common in infants with BPD and is associated with increased resting metabolic rate (RMR). Whether increased RMR and growth failure are a consequence of BPD lung pathology per se, or a consequence of clinical interventions remains unknown. Herein, we sought to determine the effects of BPD-like lung injury on breathing, growth, and energy expenditure in C57BL/6J male mice exposed to chronic hyperoxia (Hx; 70% O2; n=5) or normoxia (Nx; n=6) in the neonatal period (postnatal day (P) 0-14). Consistent with prior reports and human BPD, Hx lungs at P21 had reduced alveoli and alveolar density indicated via H&amp;E lung sections. Also, Hx mice had altered respiratory responses to acute hypoxia (10 min; 12% O2) including a reduced hypoxic ventilatory response (108±6 Nx vs 89±4 % Hx; p&lt;0.05) and drive to breathe (tidal volume/inspiratory time; 0.98±0.06 vs 0.76±0.04; p&lt;0.05). The pattern of breathing during the acute challenge favors longer inspiratory time (132±6 vs 170±9 ms, p&lt;0.05) which may reflect a compensatory response to reduced alveoli. Despite these differences, no differences in body composition (body, fat and fat-free masses, and total body water) were observed at P21, 6wks, or 8wks of life. Furthermore, there were no differences in ingestive behaviors, or total or resting aerobic heat production (kcal/h) at 8 wks of age, yet Hx mice had reduced locomotor activity (199±10 vs 154±11 m/d; p&lt;0.05) which may indicate reduced exercise capacity. In a subset of mice (n=2/group), a 20% increase in right ventricular mass was noted, consistent with some degree of pulmonary hypertension, along with a 3% decrease in hematocrit, which may reflect a programmed change in hematopoiesis after early-life Hx. Together, these data document the impact of BPD-like lung injury on key physiological parameters and support the iconoclastic concept that BPD pathology per se does not drive increased RMR or growth failure. By extension, other factors – possibly including side-effects of well-intentioned clinical interventions – may underly growth failure in children with BPD. We speculate that sodium depletion resulting from diuretic therapy, which is common for this condition and known to impact infant growth, may be an important contributor to growth failure in infants with BPD. GCM: AHA 20CDA35310121; JLG: DK133121, HL134850, and HL084207; JLS: DK133121 This is the full abstract presented at the American Physiology Summit 2023 meeting and is only available in HTML format. There are no additional versions or additional content available for this abstract. Physiology was not involved in the peer review process.

Association Between Early Prostacyclin Therapy and Extracorporeal Life Support Use in Patients With Congenital Diaphragmatic Hernia

Prostacyclin (PGI2) is a therapeutic option to treat congenital diaphragmatic hernia (CDH)-associated pulmonary hypertension in neonates. Its use may decrease the need for extracorporeal life support (ECLS). To evaluate the association of early PGI2 therapy with ECLS use and outcomes among patients with CDH. This was a cohort study from the CDH Study Group (CDHSG) registry of patients born from January 2007 to December 2019. Patients were from 88 different tertiary pediatric referral centers worldwide that contributed data to the CDHSG. Patients were included in the study if they were admitted within the first week of life. Propensity score matching was performed using estimated gestational age, birth weight, transfer status, 1-minute and 5-minute Apgar scores, highest and lowest partial pressure of arterial carbon dioxide in the first 24 hours of life, and degree of pulmonary hypertension as covariates to generate a matched cohort of exposed and unexposed patients. Data were analyzed from January 2021 to December 2022. Early PGI2 therapy was defined as initiation of PGI2 within the first week of life. Patients who received ECLS were included in the early PGI2 group if PGI2 was started prior to ECLS. The primary outcome of the study was the proportion of patients receiving ECLS in the exposed and unexposed groups. Of 6227 patients who met inclusion criteria (mean [SD] gestational age, 37.4 [2.36] weeks; 2618 [42%] female), 206 (3.3%) received early PGI2 therapy. ECLS was used in 46 of 206 patients who received PGI2 (22.2%) and 1682 of 6021 who did not (27.9%). After propensity score matching, there were 147 patients in the treatment and control groups. Thirty-four patients who received PGI2 (23.3%) and 63 who did not (42.9%) received ECLS. Those who received PGI2 were less likely to receive ECLS (adjusted odds ratio, 0.39; 95% CI, 0.22-0.68) and had shorter mean (SD) duration of ECLS (8.6 [3.73] days vs 12.6 [6.61] days; P < .001), although there was no significant difference in in-hospital mortality. In this study, there was decreased use of ECLS and decreased ECLS duration among patients with CDH who started PGI2 therapy during the first week of life. These results identify a potential advantage of early prostacyclin therapy in this population.

Axial CT measured main pulmonary artery diameter to predict the presence and degree of pulmonary hypertension

We performed this study to investigate if main pulmonary artery (mPA) diameter measured by axial chest computed tomography (CT) can predict the presence and degree of echocardiography-measured pulmonary hypertension (ePH) among emergency department (ED) patients. This retrospective cross-sectional study enrolled patients who underwent both chest CT and echocardiography within 24 h at the ED. The ePH was estimated using right ventricular systolic pressure (RVSP). RVSP &lt;40 mmHg was classified as normal; 40–49 mmHg, mild ePH; 50–75 mmHg, moderate ePH; and ≥76 mmHg, severe ePH. Among 485 adult patients, 297 (61.2%) had normal RVSP and mean mPA of 30.3 mm. The numbers of patients with mild, moderate and severe ePH were 92 (19.0%), 85 (17.5%) and 11 (2.3%) with corresponding mean mPA diameters of 32.4, 34.5 and 35.9 mm, respectively. The best mPA diameters for predicting mild, moderate and severe ePH were 30.6, 31.8 and 33.8 mm, with area under the receiver operating characteristic curve of 0.697, 0.727 and 0.797 and sensitivities of 72.9%, 71.9% and 81.8%, respectively. Axial CT-measured mPA diameter can predict the presence and degree of ePH among ED patients. If the CT-measured mPA diameter is greater than 30.6 mm, the possibility of pulmonary hypertension should be considered and applied to the patient’s treatment.

Approach to Echocardiography in Heart Failure with Preserved Ejection Fraction.

As echocardiography is universally performed in the evaluation of suspected heart failure with preserved ejection fraction (HFpEF), a number of structural and functional characteristics relevant to both the diagnosis and phenotyping of HFpEF can be elucidated. Exclusion of alternate causes of heart failure is a critical first step performed principally by echocardiography. Once HFpEF is confirmed, echocardiography may provide insight into pathophysiology and phenotyping by quantifying atrial mechanics, pericardial restraint, degree of pulmonary hypertension, and atrial valvular regurgitation. Although current echo-Doppler assessment of filling pressures is insensitive to diagnose HFpEF, there are emerging technologies such as left atrial (LA) strain that hold promise for noninvasive diagnosis.

Artificial intelligence-enabled phenotyping of patients with severe aortic stenosis: on the recovery of extra-aortic valve cardiac damage after transcatheter aortic valve replacement

ObjectiveA novel artificial intelligence-based phenotyping approach to stratify patients with severe aortic stenosis (AS) prior to transcatheter aortic valve replacement (TAVR) has been proposed, based on echocardiographic and haemodynamic data....

Changes in Some Vascular Biomarkers in Patients with Severe COVID-19 with Various Degrees of Pulmonary Hypertension.

The aim of the study was to evaluate the levels of cardiac biomarkers endothelin 1, B-natriuretic peptide (BNP), N-terminal pro-B-type natriuretic peptide (Nt-proBNP), NO2, and NO3 in patients with COVID-19 pneumonia and various degrees of pulmonary hypertension. Group 1 included patients with pulmonary artery systolic pressure <25 mm Hg, group 2 with 25-40 mm Hg, and group 3 with 40-60 mm Hg. In the group of patients with pulmonary artery systolic pressure <25 mm Hg, the level of NT-proBNP was higher than in the rest two groups by 41.3% (p=0.015) and 38.2% (p=0.015), respectively. The levels of nitrites and nitrates in group 1 patients were lower: NO2 was reduced by 31.1% (p=0.026) and 62.8% (p=0.008), and NO3 was reduced by 28% (p=0.029) and by 54.6% (p=0.006), respectively. No other changes in the parameters in patients receiving oxygen therapy were found. These findings suggest that severe course of COVID-19 in patients with severe pulmonary hypertension is associated with impaired nitrite and nitrate metabolism and reduced levels of Nt-proBNP.

Clinical significance of dynamics between oxidative stress levels during mechanical lung ventilation in premature infants with persistent pulmonary hypertension

The aim of this study was to determine the clinical significance of the levels and dynamics of the urinary 8-hydroxy-2-deoxyguanosine, degree of pulmonary hypertension on choosing the duration and form of respiratory support in premature infants with respiratory distress syndrome in combination with perinatal asphyxia.&#x0D; Materials and methods. The levels of the urinary 8-hydroxy-2-deoxyguanosine (8-OHdG), ng/ml were determined by enzyme immunoassay (ELISA) method and the degree of pulmonary hypertension (PH) - by echocardiography in 60 premature new-borns at 26-32 weeks of gestation on the 1st and the 3rd–5th days of life. A comparative analysis of indicators was carried out in 2 groups: I – 32 children with respiratory distress syndrome (RDS); II – 28 children with RDS combined with perinatal asphyxia. All infants received a respiratory support, depending on the clinical condition, blood gas analyses, and the chest X-ray.&#x0D; Results. The level and dynamics of the urinary 8-OHdG correlated to degree of PH, form, and duration of respiratory support. Children of the group II on the 1st day of life had echocardiogram indicators of mild PH and indicators of the urinary 8-OHdG 2.27±0.39 ng/ml; by 3rd–5th days of life – level of the urinary 8-OHdG increased to 4.10±0.42 ng/ml and the level of PH – to moderate, required 76.2 % longer respiratory support compared to children of the group I.&#x0D; Conclusions. Prematurely born infants with RDS in combination with perinatal asphyxia have a higher oxidative stress (OS) levels and more significant pulmonary hypertension, which requires a longer respiratory support by 76.2 % and more often use of high frequency oscillatory ventilation (HFOV) by 9.3 %

Blood serum concentration of troponin in patients with COVID-19 of various severities

BACKGROUND: The search for available predictors of hospital survival and mortality rates during the COVID-19 pandemic is an urgent problem.&#x0D; AIM: The study aimed to determine the role of troponin in the immediate prognosis of patients with COVID-19.&#x0D; MATERIALS AND METHODS: The study included 85 patients with a new coronavirus infection upon admission, who underwent a blood test for troponin. All patients underwent an echocardiographic study according to a standard protocol, and the effect of troponin levels on nosocomial survival and mortality rates, correlation of this indicator with the left ventricular ejection fraction, degree of pulmonary hypertension, laboratory parameters, and degree of respiratory failure determined by computed tomography of the lungs and oxygen saturation indicators were analyzed. Correlation analysis with autopsy parameters was performed.&#x0D; RESULTS: A high level of troponin indicated the worst prognosis of patients during hospitalization. The laboratory marker level correlated significantly with the parameters of the left ventricular ejection fraction. Its highest level was determined in patients with type 1 myocardial infarction. Troponin was not correlated with the degree of respiratory failure, as well as the state of the myocardium in the autopsy material.&#x0D; CONCLUSIONS: Determining the troponin levels as a routine laboratory marker can be recommended for stratifying the risk of myocardial damage in patients with COVID-19 during hospitalization.

Echocardiography application in patients with COVID‑19

The article highlights the experience of ultrasound and functional diagnostics imaging doctor’s work in the «red zone» at the time of new COVID‑19 coronavirus infection pandemic. Echocardiography is a valuable tool in the assessment of right ventricular disfunction and pulmonary hypertension degree, acute virus myocarditis and acute coronary syndrome. Transthoracic and transesophageal echocardiography is used to monitor the patient’s condition during treatment with extracorporeal membrane oxygenation (ECMO) and multiple organ failure syndrome.

Treatment of non-restrictive cor triatriatum sinister during concomitant cardiac surgery

BackgroundCor triatriatum is a rare congenital heart disease representing the 0.4% of all congenital cardiac anomalies. To date, no specific genetic alteration has been associated to cor triatriatum. The left-sided presentation (cor triatriatum sinister (CTS)) generally consists in a fibromuscular membrane that divides the left atrium into two chambers, therefore generating a varying grade of flow obstruction depending on the shape, location, and membrane fenestration size. Cor triatriatum sinister can be isolated or associated to other congenital heart defects such as ostium secundum atrial septal defect, patent foramen ovale or abnormal pulmonary veins drainage.Case presentationOur case is a 63-year-old woman who was diagnosed with a non-restrictive membrane during a hospitalization for acute heart failure. In the following 6 months, she started to become symptomatic. However, the onset of symptoms was more likely related to mitral valve regurgitation worsening and previously unknown coronary artery disease, rather than to CTS. She underwent bi-atrial surgical ablation (Cox Maze IV procedure) for atrial fibrillation (AF), surgical resection of interatrial membrane with mitral annuloplasty, and myocardial revascularization.ConclusionThe onset and severity of symptoms in patients with CTS mostly depend on membrane fenestration size, grade of stenosis generated and pulmonary veins drainage site. However, some cases may remain asymptomatic until adulthood; the degree of pulmonary hypertension and congestive heart failure is determined by the presence of additional cardiac anomalies and the fibromuscular membrane fenestration. In some cases, CTS may remain asymptomatic, thus the diagnosis can be incidental.

Right Ventricular Function in Acute Respiratory Distress Syndrome: Impact on Outcome, Respiratory Strategy and Use of Veno-Venous Extracorporeal Membrane Oxygenation.

Acute respiratory distress syndrome (ARDS) is characterized by protein-rich alveolar edema, reduced lung compliance and severe hypoxemia. Despite some evidence of improvements in mortality over recent decades, ARDS remains a major public health problem with 30% 28-day mortality in recent cohorts. Pulmonary vascular dysfunction is one of the pivot points of the pathophysiology of ARDS, resulting in a certain degree of pulmonary hypertension, higher levels of which are associated with morbidity and mortality. Pulmonary hypertension develops as a result of endothelial dysfunction, pulmonary vascular occlusion, increased vascular tone, extrinsic vessel occlusion, and vascular remodeling. This increase in right ventricular (RV) afterload causes uncoupling between the pulmonary circulation and RV function. Without any contractile reserve, the right ventricle has no adaptive reserve mechanism other than dilatation, which is responsible for left ventricular compression, leading to circulatory failure and worsening of oxygen delivery. This state, also called severe acute cor pulmonale (ACP), is responsible for excess mortality. Strategies designed to protect the pulmonary circulation and the right ventricle in ARDS should be the cornerstones of the care and support of patients with the severest disease, in order to improve prognosis, pending stronger evidence. Acute cor pulmonale is associated with higher driving pressure (≥18 cmH2O), hypercapnia (PaCO2 ≥ 48 mmHg), and hypoxemia (PaO2/FiO2 < 150 mmHg). RV protection should focus on these three preventable factors identified in the last decade. Prone positioning, the setting of positive end-expiratory pressure, and inhaled nitric oxide (INO) can also unload the right ventricle, restore better coupling between the right ventricle and the pulmonary circulation, and correct circulatory failure. When all these strategies are insufficient, extracorporeal membrane oxygenation (ECMO), which improves decarboxylation and oxygenation and enables ultra-protective ventilation by decreasing driving pressure, should be discussed in seeking better control of RV afterload. This review reports the pathophysiology of pulmonary hypertension in ARDS, describes right heart function, and proposes an RV protective approach, ranging from ventilatory settings and prone positioning to INO and selection of patients potentially eligible for veno-venous extracorporeal membrane oxygenation (VV ECMO).

Right Bochdalek congenital diaphragmatic hernia: a tertiary center\u2019s experience over 13 years

BackgroundRight Bochdalek congenital diaphragmatic hernia (RB-CDH) is far less common than left Bochdalek congenital diaphragmatic hernia, accounting for only 13% of cases. There are limited published data on the outcomes and survival rate of RB-CDH.We aimed at investigating the clinical characteristics and analyzing the risk factors of survival in neonates with RB-CDH treated in our center over a period of 13 years.ResultsFifteen infants with RB-CDH were identified. Most of the patients were full term (74%). The mean birth weight was 2.90± 0.72 kg. The ratio of male to female was 2:1. The mean APGAR score at 1 min was 5.31±2.34, and 7.30±1.59 at 5 min. Ten patients (67%) were imaged by antenatal ultrasound. Eleven patients (73.33%) survived to go for surgical repair. The hernia sac was found in 5 patients (45%). Most hernial defects were closed in a primary fashion. The mean age at the operative repair was 8.11±9.90 days. The average NICU stay for all patients was 40.47±50.38 days. The mean follow-up period was 20.45±9.34 months. Three patients had postoperative complications. The total survival rate in neonates with RB-CDH was 9/15 (60%). Nine out of 11 (82%) neonates survived after surgical repair. Four patients (27%) died before surgical repair. Ventilation-related bilateral pneumothorax was a contributing cause of death in three patients. Birth weight was found lower in the non-survivor’s group (P < 0.05). Moreover, the degree of pulmonary hypertension was more severe among non-survivors. No statistical significance was observed between other variables and mortality.ConclusionWe found that low birth weight and the presence of severe PHTN were risk factors for mortality in neonates with RB-CDH. These results are in line with previous studies on prognostic factors in CDH. Ventilator-related pneumothorax appears to be a significant contributing cause of death. Long-term follow-up studies of infants born with RB-CDH are needed as small number of cases limits large-volume RB-CDH studies.

Pulmonary hypertension with or without right ventricular failure as short-term prognostic predictors in patients with AHF

Abstract Funding Acknowledgements Type of funding sources: None. Introduction Different registries have reported Right Ventricular Failure (RVF) as a predictor of IH mortality in patients with AHF. However, the association of different degrees of Pulmonary Hypertension (PH) associated with or without RVF as prognostic predictors of IH mortality and Rehospitalization (RH) at 60 days is not well stablished. Methods We included 394 consecutive patients from January 2012 to August 2020 with the primary diagnosis of AHF and different degrees of PH with or without RVF. IH mortality and RH after 60 days of patients with AHF and the presence of RVF with or without PH were evaluated and stratified by severity into mild, moderate and severe PH and forms of presentation of AHF. Univariate, bivariate and multivariate analysis was performed by logistic regression of the independent variables. The qualitative variables were analyzed by the chi square test and the quantitative variables by T Test. P was considered significant at values &amp;lt;0.05. Results The mean age was 74 years, 40% female, HBP 49%, dyslipidemia 52%, obesity 52%, type 2 DM 42%, smoking 28% and COPD 26%. 16% were de novo AHF and 84% with exacerbated CHF. Global RVF 6%. PH was present in 60%, being 24% mild, 25% moderate, 10% severe. The Left ventricular Ejection fraction (LVEF) mean was 52% (SD ± 15.1); Preserved 60%, Intermediate Range 18% and Reduced 22%. The IH mortality was 6.6% and the RH rate at 60 days was 21%. In the bivariate analysis for IH mortality, RVF was identified as an independent predictor of mortality (p = 0.001) nor for RH (p = 0.857). The different levels of PH were not identified as predictors of IH Mortality as well as RH. LVEF ranges did not show significant differences, nor in the forms of AHF presentation. The combined analysis of RVF or Left with different degrees of PHT did not show significant differences in IH mortality and RH.In the multivariate analysis by logistic regression for IH mortality, the presence of RVF maintained independence as a predictor variable (p = 0.004). Conclusion In our population of patients with AHF, the presence of RVF is a predictor of IH mortality regardless of the presence of PH, the PH and LVEF ranges. The presence of RVF was not associated with a higher rate of RH at 60 days.

Effect of Concomitant Tricuspid Annuloplasty on Early Outcomes of Mitral Valve Replacement: A Study on Rheumatic Heart Disease Patients.

IntroductionMitral valve abnormalities in rheumatic heart disease commonly lead to functional tricuspid regurgitation. Tricuspid annuloplasty (TA) is often performed in these cases along with mitral valve replacement (MVR). Our aim was to compare the perioperative morbidity and mortality among those patients that underwent mitral valve replacement with tricuspid annuloplasty versus those that underwent isolated mitral valve replacement.MethodsA retrospective analysis of 158 patients that underwent mitral valve replacement, with or without tricuspid annuloplasty, secondary to rheumatic heart disease between January 2017 and August 2020. Patients who underwent additional cardiothoracic surgical procedures (aortic valve replacement and coronary artery bypass grafting) were excluded to reduce confounders.ResultsThe study group consisted of 158 patients (mean age 41; 73 male, 85 female) that underwent MVR with TA (n=22; 13.9%) or without TA (n=136; 86.1%). Both groups had similar comorbidity frequencies and medication history. Preoperative echocardiography showed a comparable degree of pulmonary hypertension and ejection fraction between the two groups. The TA+MVR group had similar intraoperative (81.8% vs 66.9%; p=0.161) and postoperative (45.5% vs 45.6%; p=0.991) blood products usage compared to the MVR only group. Concurrent TA resulted in similar in-hospital mortality (4.5% vs 4.4%; p=0.977) as well as early postoperative complications, namely, prolonged ICU stay (13.6% vs 10.3%; p=0.639), prolonged ventilation (0 vs 2.2%; p=0.482), re-intubation (9.1% vs 2.9%; p= 0.161), and reopening for bleeding tamponade (0 vs 5.1%; p=0.276).ConclusionsTA concurrently with MVR does not appear to increase in-hospital mortality or early postoperative complications.

Ultrafast-track extubation after pediatric cardiac surgery; benefits and safety

Background: Ultrafast-track extubation after cardiac surgery my facilitate rapid recovery. However, the overall risk-benefit is still debatable. The objective of this study was to report the effect of ultrafast-track extubation in pediatric patients undergoing cardiac surgery.&#x0D; Methods: This is a retrospective study that included 260 patients who had surgery for congenital heart diseases between 2015 and 2019. Patients were divided into two groups. Group A included patients who had ultrafast-track extubation protocol (n = 140), and group B was the conventional anesthesia group (n = 120).&#x0D; Results: The mean age was 3.68 ± 2.1 and 3.8 ± 1.6 years for groups A and B, respectively (p= 0.08). The total operative time was higher in group A (326± 18.15 vs. 274.6±28.1 minutes; p 0.001), and the degree of pulmonary hypertension were higher in group B (p= 0.02). The rate of ventilator-related complications was higher in group B (P = 0.02). There was a significant reduction in mean length of intensive care unit stay between the ultrafast-track extubation and the conventional groups (65.3 ± 33.7 and 81.6±70.2 hours, respectively; p= 0.001). The total hospital stay was significantly reduced in group A (6.7 ± 2.7 vs. o 7.43±2.65 days for group A and B, respectively, p= 0.03).&#x0D; Conclusions: The application of ultrafast-track extubation protocol could lead to a reduction in the ventilator-related complications, the length of intensive care unit and hospital stays without increasing postoperative complications.