Right Side Of The Heart Research Articles

Design and Analysis of an Inductive Coupling System for the Early Detection of Heart Failure

Heart failure is a common, complex clinical syndrome with high morbidity and mortality. Hemodynamic parameter evaluation is useful for early detection, clinical outcome monitoring, timely treatment, and the overall prognosis of heart failure patients. Therefore, continuous monitoring of hemodynamic parameters helps in the evaluation of patients with suspected heart failure. The hemodynamic parameters change with respect to the contraction and expansion of the heart. Hence, in this research, two circuit-less 30 mm spherical receiver coils were implanted in both the left and right sides of the heart and an external transceiver coil was placed above the chest. The changes in the reflection coefficient of the transceiver coil at the resonant frequency changed depending on the distance between the implanted coils, allowing the contraction and expansion of the heart to be determined. This work was carried out at 13.56 MHz, considering the safety limits imposed by the FCC. The proposed reflection coefficient monitoring technique may distinguish healthy patients from heart failure and heart attack patients. The reflection coefficients at a maximum distance of 50 mm for simulation and measurement are −10.3 dB and −10.6 dB, respectively, at the resonant frequency.

Long-term outcome of interventional approaches for treatment of coronary artery fistulas: a retrospective cohort study in a great referral center

BackgroundDespite the spontaneous regression of many cases of coronary artery fistulas (CAFs), symptomatic patients or cases with severe shunting may require therapeutic interventions. In the present study, we aimed to assess the outcome of treatment of CAFs using interventional approaches.MethodsThis retrospective cohort study was performed on 29 patients with CAFs that were referred to our tertiary center between 2009 and 2019. Baseline characteristics were collected by reviewing the hospital files, and the patients were followed up to assess long-term outcomes with a mean follow-up of 3.3 years.ResultsOverall, in 29 patients in our cohort study, 82.9% suffered from isolated CAFs and in the remaining cases, concurrent congenital abnormalities did exist. For treatment, coils (Cook, Pfm, Ev3) were used in 79.3%, ADO II(AGA) in 18.3%, vascular plug (AGA) in 3.4%, and a combination of coil/ vascular plug/amplatzer in 3.4%. Postoperative complications were reported in 4 patients as external iliac artery thrombosis, transient PSVT, ST-T wave changes and mild pericardial effusion that were all managed successfully with no adverse sequels. No coronary artery injury, device dislocation, dissection, ischemia or coronary dilatation occurred, and there was no death. As larger fistulas were treated by a retrograde approach through the right side of the heart, there was significant correlation between residual shunts and the mode of closure approach; the majority of the residual shunts occurred in patients in the retrograde approach group.ConclusionsTrans-catheter approach for treating CAFs leads to appropriate long-term outcome with minimal potential side effects.

Fetal pulmonary valvuloplasty for pulmonary atresia with intact ventricular septum: a single-center clinical experience.

Fetal pulmonary valvuloplasty for pulmonary atresia with intact ventricular septum: a single-center clinical experience.

Staphylococcus aureus bacteraemia, cardiac implantable electronic device, and the risk of endocarditis: a retrospective population–based cohort study

Patients with cardiac implantable electronic device (CIED) and Staphylococcus aureus bacteraemia (SAB) are at risk of having infective endocarditis (IE). The objectives were to describe a Swedish population-based cohort of patients with CIED and SAB, to identify risk factors, and to construct a predictive score for IE. Patients over 18 years old in the Stockholm Region identified to have SAB in the Karolinska Laboratory database from January 2015 through December 2019 were matched to the Swedish Pacemaker and Implantable Cardioverter-Defibrillator ICD Registry to identify the study cohort. Data were collected from study of medical records. A cohort of 274 patients with CIED and SAB was identified and in 38 episodes (14%) IE were diagnosed, 19 with changes on the CIED, and 35 with changes on the left side of the heart. The risk factors predisposition for IE, community acquisition, embolization, time to positivity of blood cultures, and growth in blood culture after start of therapy in blood cultures were independently associated to IE. A score to identify patients with IE was constructed, the CTEPP score, and the chosen cut-off generated a sensitivity of 97%, specificity of 25%, and a negative predictive value of 98%. The score was externally validated in a population-based cohort of patients with CIED and SAB from another Swedish region. We found that 14% of patients with CIED and SAB had definite IE diagnosed. The CTEPP-score can be used to predict the risk of IE and, when negative, the risk is negligible.

Cardiac Hamp mRNA Is Predominantly Expressed in the Right Atrium and Does Not Respond to Iron

Hepcidin is a liver-derived hormone that controls systemic iron traffic. It is also expressed in the heart, where it acts locally. We utilized cell and mouse models to study the regulation, expression, and function of cardiac hepcidin. Hepcidin-encoding Hamp mRNA was induced upon differentiation of C2C12 cells to a cardiomyocyte-like phenotype and was not further stimulated by BMP6, BMP2, or IL-6, the major inducers of hepatic hepcidin. The mRNAs encoding hepcidin and its upstream regulator hemojuvelin (Hjv) are primarily expressed in the atria of the heart, with ~20-fold higher Hamp mRNA levels in the right vs. left atrium and negligible expression in the ventricles and apex. Hjv-/- mice, a model of hemochromatosis due to suppression of liver hepcidin, exhibit only modest cardiac Hamp deficiency and minor cardiac dysfunction. Dietary iron manipulations did not significantly affect cardiac Hamp mRNA in the atria of wild-type or Hjv-/- mice. Two weeks following myocardial infarction, Hamp was robustly induced in the liver and heart apex but not atria, possibly in response to inflammation. We conclude that cardiac Hamp is predominantly expressed in the right atrium and is partially regulated by Hjv; however, it does not respond to iron and other inducers of hepatic hepcidin.

Tricuspid Valve Regurgitation in Hypoplastic Left Heart Syndrome: Current Insights and Future Perspectives

Hypoplastic Left Heart Syndrome (HLHS) is a congenital heart defect that requires a three-stage surgical palliation to create a single ventricle system in the right side of the heart. Of patients undergoing this cardiac palliation series, 25% will develop tricuspid regurgitation (TR), which is associated with an increased mortality risk. Valvular regurgitation in this population has been extensively studied to understand indicators and mechanisms of comorbidity. In this article, we review the current state of research on TR in HLHS, including identified valvular anomalies and geometric properties as the main reasons for the poor prognosis. After this review, we present some suggestions for future TR-related studies to answer the central question: What are the predictors of TR onset during the three palliation stages? These studies involve (i) the use of engineering-based metrics to evaluate valve leaflet strains and predict tissue material properties, (ii) perform multivariate analyses to identify TR predictors, and (iii) develop predictive models, particularly using longitudinally tracked patient cohorts to foretell patient-specific trajectories. Regarded together, these ongoing and future efforts will result in the development of innovative tools that can aid in surgical timing decisions, in prophylactic surgical valve repair, and in the refinement of current intervention techniques.

Left-Sided Heart Defects and Laterality Disturbance in Hypoplastic Left Heart Syndrome.

Hypoplastic left heart syndrome (HLHS) is a complex congenital heart disease characterized by hypoplasia of left-sided heart structures. The developmental basis for restriction of defects to the left side of the heart in HLHS remains unexplained. The observed clinical co-occurrence of rare organ situs defects such as biliary atresia, gut malrotation, or heterotaxy with HLHS would suggest possible laterality disturbance. Consistent with this, pathogenic variants in genes regulating left-right patterning have been observed in HLHS patients. Additionally, Ohia HLHS mutant mice show splenic defects, a phenotype associated with heterotaxy, and HLHS in Ohia mice arises in part from mutation in Sap130, a component of the Sin3A chromatin complex known to regulate Lefty1 and Snai1, genes essential for left-right patterning. Together, these findings point to laterality disturbance mediating the left-sided heart defects associated with HLHS. As laterality disturbance is also observed for other CHD, this suggests that heart development integration with left-right patterning may help to establish the left-right asymmetry of the cardiovascular system essential for efficient blood oxygenation.

An unusual giant coronary artery aneurysm mimicking mediastinal mass.

A 55-year-old woman was admitted with complaints of recurrent chest pain for eight days. She had a history of intermittent chest tightness and pain for 5 years. Laboratory test showed increased hypersensitive cardiac troponin I of 0.14 μg/L. The ECG showed ST segment depression in leads V1, V2, V3, and V4. Acute non-ST segment elevation myocardial infarction was diagnosed. Echocardiography revealed a hypoechoic mass (8.9 × 7.0 cm) (asterisk, Panel A, see Supplementary material online, Video S1) in front of the right side of the heart. The right atrium (RA) and right ventricle (RV) were compressed and deformed. A cystic cavity (13 mm wide) can be observed in the mass (arrowhead, Panel B, see Supplementary material online, Video S2), which was connected to the dilated right coronary artery (RCA). Enhanced chest CT showed the obviously enhanced RCA entered into the mass (asterisk, Panels C and D), the distal of which was occlusive and dilated like ‘gallbladder’ (arrowhead, Panel C, D and E). Coronary artery aneurysm (CAA) was suspected. Coronary angiography showed abnormal neoplastic dilatation in the proximal segment of the RCA and complete occlusion in the middle segment (arrowhead, panel F, see Supplementary material online, Video S3). The left coronary artery provided collateral circulation to the RCA (see Supplementary material online, Video S4). The patient underwent resection of the mass. The giant mass was observed between RA and RV (panel G) with numerous thrombi inside (panels H and I). Coronary artery bypass surgery was performed successfully after CAA resection.

Down syndrome patients with normal hearts: are they really normal?

Even though congenital heart disease is a common finding in down syndrome (DS) patients, some of them have anatomically normal hearts. However, the term "normal" might not be suitable, as these patients usually suffer from functional cardiac dysfunction. Several research highlighted that despite the absence of anatomical heart defects, subtle cardiac function derangements are present in DS patients. We aim to assess cardiac functions by Two-dimensional echocardiography and tissue Doppler imaging (TDI) in pediatric DS patients who have anatomically normal hearts. One hundred seventy-two patients with karyotyping confirmed DS with anatomically normal hearts and 165 healthy normal control children were enrolled in the current study. Their cardiac functions were assessed using both 2-dimensional echocardiography and TDI. Both patients and controls had structurally and anatomically normal hearts. In DS patients, the right side of the heart showed a significant reduction in both systolic and diastolic functions. Systolic dysfunction was evident by significantly decreased levels of Tricuspid annular plane systolic excursion and systolic wave by TDI. Diastolic dysfunction of the right ventricle was evident by prolonged deceleration time by conventional echocardiography and a significant decrease in annular tissue doppler velocity during early diastole/late diastole ratio by TDI. The E/De ratio was significantly increased. Even with anatomically normal hearts, DS patients should undergo cardiac function assessment by echocardiography & TDI. TDI is superior to conventional echocardiography in detecting subtle cardiac dysfunction especially left ventricular diastolic dysfunction in DS patients. TDI showed a significant decrease in the early/atrial ratio of mitral valve annulus and prolongation of left ventricle isometric relaxation time in DS children. Also, the left ventricle E/De ratio was prolonged denoting elevated filling pressures and diastolic dysfunction. This indicates that the TDI has higher sensitivity to detect diastolic dysfunction than conventional Echocardiography. Biventricular TDI-derived myocardial performance index was found to be significantly increased in DS children.

ОСОБЕННОСТИ ПОКАЗАТЕЛЕЙ ЭХОКАРДИОГРАФИИ У ПАЦИЕНТОВ С КОМОРБИДНОСТЬЮ БРОНХИАЛЬНОЙ АСТМЫ И ГИПЕРТОНИЧЕСКОЙ БОЛЕЗНИ

Introduction. The presence of comorbidities in patients with bronchial asthma can increase the frequency of attacks, lead to more severe symptoms during exacerbations, and reduce the quality of life of patients. Aim. The purpose is the evaluation of morphological and functional changes in the heart of patients with a comorbidity of bronchial asthma with the hypertension disease. Material and methods. The study included 55 patients, 4 groups were formed. The main group included 19 people with a combination of bronchial asthma with the hypertension disease. Primary comparison group was 20 people with bronchial asthma. The second comparison group consisted of 16 people with hypertension. The control group consisted of 25 healthy people. Echocardiographic parameters were studied and compared with the clinical and functional picture of the disease. The analysis of the results was performed by using methods of descriptive statistics. The correlation analysis was performed with considering the Spearman’s rank correlation coefficient. Results and discussion. In the analysis of the heart morphological and functional characteristics of patients with bronchial asthma and hypertension disease in comparison with the control groups there was an increase in the left atrium dimension and volume, right ventricular wall thickness, right ventricular outflow tract at proximal, a decrease in stroke volume and end- systolic volume with negligible changes of the ejection fraction, a decrease in the thickness of the posterior wall of the left ventricle and the interventricular septum. Conclusion. This article distinguishes the characteristics of progression of the disease, as well as suggests mechanisms of pathogenetic interaction in comorbidity of hypertension disease and bronchial asthma by assessing the main parameters of echocardiography. This method is used for the earliest detection of structural and functional changes. In patients with bronchial asthma and hypertension was pronounced morphological changes in the right parts of the heart and functional changes in the pulmonary circulation in comparison in patients with isolated disease. However, because of decrease in diastolic pressure in left parts of the heart and redistribution blood volume on the right side of the heart in the left parts of the heart are less susceptible to remodeling.

Assessment of pulmonary hypertension by cardiac MRI and right sided heart catheter in COPD patients

Background: Pulmonary hypertension (PH) is a progressive disorder characterized by abnormally elevated blood pressure of the pulmonary circulation which results, over time, from extensive vascular remodeling and increased pulmonary vascular resistance (PVR). Recent advances in cMRI technology have led to the development of techniques for noninvasive assessment of the morphology of the right side of the heart to be correlated to the hemodynamic parameters collected by RHC which is still the golden standard technique of PH diagnosis. Aim: To assess the role of Cardiac MRI in severe COPD patients with pulmonary artery pressure more than 35 mmHg as evaluated by Echocardiography and right sided cardiac catheterization. Patients and methods: The current study was conducted upon 20 patients with moderate or severe chronic obstructive pulmonary disease (COPD) by spirometry according to GOLD 2022 criteria who had been assessed for severe pulmonary hypertension with Pulmonary Artery Pressure more than 35 mmHg by cardiac Magnetic resonance imaging (cMRI) and right sided heart catheter (RHC). They were recruited from the outpatient clinic and department of chest specialized hospital Kobry Elkobba Armed Forces. Results: Twenty patients included in the study were 90% males, mean age about 64.50 ± 7.94 years old with mean smoking duration 33.89 ±7.03 years and 45% with co-morbidities. Spirometry done for all studied cases included FEV1/FVC, FEV1 and FVC parameters with mean range 43.40 ± 5.17, 38.90 ± 8.60, 79.45 ± 16.59 respectively. The descriptive data of HRCT showed 60% of the patients with emphysema while the rest showed mixed emphysema and ILD. V/Q scan study was positive in 4 patients which represented 20% of the patients whose all included in group B (mPA > 43.5 mmHg). All studied COPD patients who showed severe PHT by a measurement of mPAP > 35 mmHg by RHC with normal PCW pressure underwent cMRI study to assess right ventricular structure and morphology. Conclusion: Cardiac MRI showed a great rule in the evaluation of the morphological changes associated with the condition of COPDPH in the right side of the heart which should affect its functions. The cardiac MRI is not the best tool in assessment of the right side of the heart in COPD patients due to many causes like the difficulty of holding breaths with COPDPH patients during the maneuver to snap accurate clear shots of the heart, the hypoxia in those patients which makes the maneuver more difficult, the associated co-morbidities may interfere with completing the maneuver like the chronic kidney disease that prohibit the use of gadolinium dye and other co-morbidities like morbid obesity that will not allow the patient to get through the MRI

Why Living with Pulmonary Arterial Hypertension Requires a Holistic Approach: A Patient and Clinician Perspective

Pulmonary arterial hypertension (PAH) is a rare disease caused by high pressure in the blood vessels leading from the heart to the lung. PAH affects many parts of a patient's life, which means that patients should be managed by a clinical team of different specialists, including doctors, advance practice providers, nurses, social workers, and therapists. This article is co-authored by a patient living with PAH and an acute care nurse practitioner specializing in the management of patients with pulmonary hypertension. In the first section of this commentary, the patient describes her experience of living with PAH. The specialist nurse practitioner then discusses the management of PAH, to provide a clinician perspective in the context of the patient's experiences.

Clinical Characteristics and Surgical Outcomes of Right Heart Myxoma and Its Comparison with Left Heart Myxoma: A Single-Center Retrospective Study.

Cardiac myxomas are commonly located in the left atrium but rarely affect the right side of the heart. We retrospectively analyzed 28 patients receiving surgical treatment for right heart myxomas at our center and aimed to summarize the clinical features and surgical outcomes of right heart myxomas. Between May 2001 and June 2022, 244 patients with sporadic cardiac myxomas underwent complete surgical resection. Twenty-eight patients (28/244, 11.48%) were right heart myxomas. Among the 28 right heart myxoma cases, 25 underwent median sternotomy and 3 underwent robotic or total thoracoscopic procedures. The clinical features, operative information, and follow-up data of right heart myxoma were comprehensively reviewed, and clinical characteristics between right heart myxoma and left heart myxoma were also compared. A significant difference was noted in sex between right heart myxoma and left heart myxoma (P <.05). Right heart myxoma had a higher asymptomatic rate (17.86% vs. 3.70%, P =.007) and a lower embolization rate (3.57% vs. 30.09%, P =.003) than left heart myxoma. The most common attachment site of right heart myxoma is the atrial septum. The mean operative duration and cardiopulmonary bypass time of right heart myxoma resection were 207.71 ± 53.40 minutes and 63.86 ± 29.73 minutes, respectively, with an in-hospital mortality rate of 3.57%. During the follow-up, 2 patients died of noncardiac causes. The overall 1-, 2-, and 5-year actuarial survival rates after right heart myxoma resection were 95.8%, 90.8%, and 84.7%, respectively. As a rare cardiac tumor, the clinical characteristics of right heart myxoma are different from typical left heart myxoma in some aspects, such as sex, asymptomatic rate, and embolization rate. Prompt surgical resection of right heart myxoma gives excellent early and midterm results.

Laparotomy in a patient with Ebsteins anomaly- from OT to ICU.

Ebstein’s anomaly (EA) is a rare cyanotic congenital heart disease, affecting 1/200,000 live births and accounts for &lt;1% of congenital heart diseases.1 First described by Wilhelm Ebstein in 1866 2 , the anomaly consists of downward displacement of the septal and posterior leaflet of tricuspid valve resulting in atrialization of the right ventricle and tricuspid regurgitation. The resulting functional impairment of right ventricle retard the forward flow of blood through right side of the heart, thereby causing a hypoplastic Right ventricle(RV), or RV outflow tract obstruction. This creates an accessory conduction pathways resulting in tachyarrythmias, pulmonary hypertension, intracardiac shunting. 3 Acute decompensated heart failure and sudden collapse are the most common cause of death.4

Laparotomy in a Patient with Ebsteins Anomaly- From OT to ICU

Ebstein’s anomaly (EA) is a rare cyanotic congenital heart disease, affecting 1/200,000 live births and accounts for &lt;1% of congenital heart diseases [1]. First described by Wilhelm Ebstein in 1866 [2], the anomaly consists of downward displacement of the septal and posterior leaflet of tricuspid valve resulting in atrialization of the right ventricle and tricuspid regurgitation. The resulting functional impairment of right ventricle retard the forward flow of blood through right side of the heart, thereby causing a hypoplastic Right ventricle (RV), or RV outflow tract obstruction. This creates an accessory conduction pathways resulting in tachyarrythmias, pulmonary hypertension, intra-cardiac shunting [3].Acute decompensated heart failure and sudden collapse are the most common cause of death [4].

A randomized controlled trial (PAMI trial) on our new trend periareolar minimally invasive (PAMI) technique versus inframammary approach for minimally invasive cardiac surgery

BackgroundA minimally invasive approach has become standard for mitral valve surgery. The periareolar approach has grown in popularity regarding the cosmesis for patients. We have adopted a new modification to the periareolar approach: the periareolar minimally invasive (PAMI) technique. The objectives of the current study are to test the hypothesis that the PAMI approach is more feasible and safer than the inframammary approach in addition to identify risk factors and assess outcomes of both periareolar and inframammary approach.MethodsA randomized controlled trial of 3 months compared the PAMI technique to the inframammary approach for minimally invasive cardiac surgery.ResultsA total of 102 patients were enrolled and randomized into two groups: 53 received minimally invasive cardiac surgery through the periareolar approach, and 49 were the control group using the inframammary approach.Using intention-to-treat analysis, the periareolar approach was superior to the inframammary approach in surgical site infection (two cases in comparison to 8 with P = 0.004), and the number needed to treat for effectiveness was 8.No early deaths occurred, 97 cases (95.1%) needed no reoperation, and 5 cases (4.9%) were reopened for bleeding. The primary endpoints compared were the duration of procedure, duration of mechanical ventilation, amount of bleeding, ICU stay, and hospital stay. We found no statistically significant differences between the groups.At 3 months, the secondary endpoints evaluated were the rate of surgical site infection, respiratory complications, groin complications, pericardial effusion, breast hematoma, and cosmoses using a Likert scale. We found no statistically significant difference between the groups, except for surgical site infection (P = 0.004) and cosmesis (P< 0.001).ConclusionsThe results of this PAMI trial are suggestive that the PAMI technique is most probably applicable for the right side of the heart, such as in atrial septal defect closure, tricuspid disease, and mitral valve surgery.Trial registrationPAMI Trial NCT04726488 Registered January 27, 2021

242 PRIMARY CARDIAC LYMPHOMA: A CASE REPORT

Abstract Introduction Primary cardiac lymphomas in immunocompetent patients are an uncommon malignancy, accounting for 1.3% of primary cardiac tumors, while metastases secondaries to extracardiac lymphomas are more common. Mean age at diagnosis is 63 years old. They mainly involve the right side of the heart, particularly right atrium. Symptoms of primary cardiac lymphoma are non-specific. Cardiac lymphoma typically follows an aggressive clinical course and the prognosis is poor, with more than 60% of patients dying within 2 months of diagnosis. Predictors of worse outcome are immune status, left ventricular involvement, arrhythmias and the presence of an extracardiac disease. Case report 48-year-old obese and hypertensive man, in therapy for OSAS. In February 2022 admission to the emergency department due to jugular pressure and mild exertion dyspnoea. Neck CT excluded inflammatory collections; echocardiography showed normal cavitary dimensions and biventricular systolic function, absence of major valvulopathies and circumferential pericardial effusion of n.d.d. with TD max 2.5 cm and partial collapse of the right atrium, for which started corticosteroid therapy. Chest CT showed mediastinal lymphadenopathy and persistence of pericardial effusion. In April, due to worsening dyspnoea, cardiac CT demonstated a solid mass at the passage from the superior vena cava to the right atrium (50×37×67 mm), leading to compression-infiltration phenomena on the superior vena cava, and thrombosis of the right mammary vein. Cardiac MR confirmed a voluminous expansive-infiltrative lesion, with an irregular lobular profile, projecting into the superior vena cava and extended to the right atrium. This mass appears very iperintensive in T2 stir sequences with an early contrast impregnation and uneven intralesional late enhancement (picture 1). With suspicion of lymphoma, after collegial discussion between thoracic surgeons, cardiologists, interventional radiologists and cardiac surgeons, a right transjugular radio- and echo-guided biopsy was performed to complete diagnostic iter; biopsy was positive for peripheral B lymphocyte-derived large-cell diffuse lymphoma with large necrotic and subnecrotic areas. Chemotherapy showed initial benefit,with a clear reduction in size of the cardiac mass and mediastinal lymphnodes at 2 months follow up, with regression of dyspnoea. Conclusions In our patient, despite an early lymphoma onset and a typical poor prognosis compared to literature, an early diagnostic-therapeutic iter, an immunocompetent status, the absence of extracardiac disease and a preserved left ventricular ejection fraction, ensured an immediate clinical benefit with an improvement of his quality of life.

1132 CATHETER INTERVENTION TO TREAT MIGRATED TEMPORARY EPICARDIAL PACING WIRE INTO THE PULMONARY ARTERY

Abstract Catheter intervention to treat migrated temporary epicardial pacing wire into the pulmonary artery Introduction Temporary epicardial pacing wires (TEPW) are routinely inserted postoperatively for treating electrophysiological disturbances after open-heart surgeries. They are typically placed on the surface of the right ventricle and the right atrial appendage. They are usually removed before discharge, but in case of difficult removal, they are cut flush to the skin, and thus retained. Leaving TEPW can be associated to complications, especially with wires migration. As described in literature, TEPW migration is rare and typically involves the right side of the heart, even if any part of the body can be involved. A review proposed an algorithm for removal decision making, based on the risk of serious complications like infection, dissection and perforation. We present a case of a transcatheter removal of a TEPW migrated into the pulmonary artery, in an asymptomatic patient. Case presentation A 52 year-old man, with previous history of Hodgkin Lymphoma treated with radiotherapy and Chemotherapy; CAD (inferior AMI treated with CABG); constrictive pericarditis causing many on-hospital admissions for heart failure; valvular disease: together with the CABG intervention, in 2012, he underwent mitral valvular repair and aortic valvuloplasty; in 2018, because of mitral valve repair failure, he underwent mitral valve substitution with a mechanic valve together with tricuspid repair; in the same year, because of worsening aortic regurgitation, he underwent TAVI. During routine follow-up exams, three years later, in 2021, the patient underwent a total body CT scan that showed the presence of a hyperintensity signal in the region between the right atrium and the right ventricle, crossing the tricuspid valve, with a final loop in the right ventricle infundibulum, suspected to be a TEPW. A transthoracic echocardiogram confirmed the position of the extraneous body, that was causing no impingement to the leaflets of the tricuspid valve, without worsening tricuspid regurgitation. A fluoroscopy showed the presence of a metallic wire, divided into two segments, the former extended from the right atrium till the right subclavian vein passing through the superior cava vein; the latter extended from the right ventricle till the left pulmonary artery. The patient underwent a transcatheter intervention with a right femoral vein access, to try to remove the TEPWs. The former located in the right atrium had a extravascular location, so it was left inside. The other one was removed. After advancing a Swan-Ganz catheter into the pulmonary artery, it was exchanged with a multipourpose catheter and a Multi-Snare 20 mm retrieval system captured the wire and dragged till the inferior cava vein; a second retrieval system, a Snare STD 12-20 mm, was finally able to anchor firmly the wire and to carry it outside. No complications occurred after the procedure; an echocardiogram excluded intracardiac problems. The patient was discharge the day after the procedure, in good clinical conditions. Discussion In this case, a transcatheter removal of the TEPW was performed, even if the presence of the wires caused no symptoms and/or complications to the patient. Anyway, because of the presence of both a prosthetic valve and a mechanic valve, in a setting of constrictive pericarditis and the consequent possibility of several in-hospital admission in conditions of acute heart failure with worsening of tricuspid regurgitation, the persistence of the wire could represent a risk factor for infective endocarditis and for severe tricuspid regurgitation. Removing it with a fast and safe transcatheter femoral approach, a potential cause of other complications was avoided.

288 LAY LADY LAY, A TRICKY CASE OF PLATYPNEA ORTHODEOXIA SYNDROME

Abstract Platypnea orthodeoxia syndrome (POS) is characterized by dispnoea and a fall in oxygen saturation levels when in the upright position that resolves lying down in the supine position. It is secondary to a right to left shunt (R-L shunt), typically trough a patent foramen ovale (PFO). Normally, in the presence of a PFO, R-L shunt does not occur unless there is a clinical condition that raises right side pressures like venous thromboembolism, hydrothorax, pneumothorax or chronic pulmunary hypertension. Although its physiopathological mechanisms are not entirely understood, in the POS, R-L shunt mostly occurs due to anatomical alteration of the interatrial septum in the upright position. Venous flow therefore can pass from the inferior vena cava through the PFO or an atrial septal defect (ASD) to the left side of the heart. We present a case of a 77 y.o. woman with no relevant past medical hystory, that was admitted to hospital care because of a mild pulmonary embolism and deep vein trombosis of the right popliteal vein. She was promptly treated for PE with direct oral anticoagulation achieving the resolution of the embolism. Despite the CT scan showed the complete resolution of the embolism her dysponoea did not improve. Her blood gas analysis showed normocapnic hypoxiemic respiratory insufficiency with a suspicious lowering of oxygen saturation levels when in the upright position which however improved in the supine position. She also had a transient episode of dysarthria and hypostenia to the right upper limb, the negative head CT scan was suggestive of a transient ischaemic attack. A pulmonary scintigraphy showed arterious renal perfusion as in a right to left shunt. She then underwent a transoesophageal echocardiography which showed an hypermobile interatrial septum with evidence of a patent foramen ovale with left to right shunt. The exame was in fact executed in the supine position. Given these findings, we concluded for a diagnosis of POS. Because of this records, the severity of the shunt and the suggestive clinical hystory of ortodeoxya she underwent PFO closure positioning an Amplatzer PFO Occluder 25 mm. The procedure was carried out without complications and led to complete resolution of the symptoms and the signs of platipnoea-ortodeoxya.

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.