Intracardiac Pressure Measurements Research Articles

Long-term function of a novel autologous transcatheter pulmonary heart valve implant in an adult animal model.

Current heart valve implants entail major disadvantages in the treatment for younger patients or those with congenital heart defects. Evaluation of novel transcatheter pulmonary valve implant made from autologous pericardium with natural crosslinking agent in an in vitro setup and in vivo animal model METHODS: Valves were tested in a pulse duplicator according to ISO-standard 5840. For in vivo studies computer tomography was performed to measure sheep's native pulmonary valve dimensions. Pericardium was harvested by thoracotomy, personalized implants were manufactured and deployed in pulmonary valve position of the same sheep. Every 3 months implant functionality was evaluated by intracardiac echocardiography, intracardiac pressure measurements and cardiac magnetic resonance imaging (cMRI). Implants were explanted for macroscopic and histological examination. In vitro experiments showed compliance with regulatory requirements in terms of valve opening and insufficiency. Five sheep successfully received an autologous valve implant. Two animals had to be euthanized due to trauma sustained in the stable. Long-term valve function was excellent in three out of four animals with median implant cMRI regurgitation fraction of 9% (n = 4) at 3 months, 8% (n = 3) at 6, 8% (n = 3) at 9, 12% (n = 3) at 13, 8% (n = 2) at 17% and 8% (n = 2) at 20.5 months after implantation. Despite good adherence to neighboring tissue and endothelization, histological assessment revealed some signs of degeneration. Transcatheter pulmonary valve implants showed promising function for up to 20.5 months encouraging research to further improve this approach.

Haemodynamic changes after atrial fibrillation initiation in patients eligible for catheter ablation: a randomized controlled study.

Atrial fibrillation (AF) haemodynamics is less well studied due to challenges explained by the nature of AF. Until now, no randomized data are available. This study evaluates haemodynamic variables after AF induction in a randomized setting. Forty-two patients with AF who had been referred for ablation to the University Hospital, Linköping, Sweden, and had no arrhythmias during the 4-day screening period were randomized to AF induction vs. control (2:1). Atrial fibrillation was induced by burst pacing after baseline intracardiac pressure measurements. Pressure changes in the right and left atrium (RA and LA), right ventricle (RV), and systolic and diastolic blood pressures (SBP and DBP) were evaluated 30 min after AF induction compared with the control group. A total of 11 women and 31 men (median age 60) with similar baseline characteristics were included (intervention n = 27, control group n = 15). After 30 min in AF, the RV end-diastolic pressure (RVEDP) and RV systolic pressure (RVSP) significantly reduced compared with baseline and between randomization groups (RVEDP: P = 0.016; RVSP: P = 0.001). Atrial fibrillation induction increased DBP in the intervention group compared with the control group (P = 0.02), unlike reactions in SBP (P = 0.178). Right atrium and LA mean pressure (RAm and LAm) responses did not differ significantly between the groups (RAm: P = 0.307; LAm: P = 0.784). Induced AF increased DBP and decreased RVEDP and RVSP. Our results allow us to understand some paroxysmal AF haemodynamics, which provides a haemodynamic rationale to support rhythm regulatory strategies to improve symptoms and outcomes. No NCT01553045. https://clinicaltrials.gov/ct2/show/NCT01553045?term=NCT01553045&rank=1.

A primer for the student joining the adult cardiac surgery service tomorrow: Primer 1 of 7

A primer for the student joining the adult cardiac surgery service tomorrow: Primer 1 of 7

Mineralocorticoid Receptor in Smooth Muscle Contributes to Pressure Overload-Induced Heart Failure.

Mineralocorticoid receptor (MR) antagonists decrease heart failure (HF) hospitalization and mortality, but the mechanisms are unknown. Preclinical studies reveal that the benefits on cardiac remodeling and dysfunction are not completely explained by inhibition of MR in cardiomyocytes, fibroblasts, or endothelial cells. The role of MR in smooth muscle cells (SMCs) in HF has never been explored. Male mice with inducible deletion of MR from SMCs (SMC-MR-knockout) and their MR-intact littermates were exposed to HF induced by 27-gauge transverse aortic constriction versus sham surgery. HF phenotypes and mechanisms were measured 4 weeks later using cardiac ultrasound, intracardiac pressure measurements, exercise testing, histology, cardiac gene expression, and leukocyte flow cytometry. Deletion of MR from SMC attenuated transverse aortic constriction-induced HF with statistically significant improvements in ejection fraction, cardiac stiffness, chamber dimensions, intracardiac pressure, pulmonary edema, and exercise capacity. Mechanistically, SMC-MR-knockout protected from adverse cardiac remodeling as evidenced by decreased cardiomyocyte hypertrophy and fetal gene expression, interstitial and perivascular fibrosis, and inflammatory and fibrotic gene expression. Exposure to pressure overload resulted in a statistically significant decline in cardiac capillary density and coronary flow reserve in MR-intact mice. These vascular parameters were improved in SMC-MR-knockout mice compared with MR-intact littermates exposed to transverse aortic constriction. These results provide a novel paradigm by which MR inhibition may be beneficial in HF by blocking MR in SMC, thereby improving cardiac blood supply in the setting of pressure overload-induced hypertrophy, which in turn mitigates the adverse cardiac remodeling that contributes to HF progression and symptoms.

Intra-cardiac microcomputer allows for innovative telemedicine in chronic heart failure during coronavirus disease-2019 pandemic: a case report.

Background Heart failure patient management guided by invasive intra-cardiac and pulmonary pressure measurements through permanent intra-cardiac micro-sensors has recently been published as a strategy to individualize the therapy of patients with chronic heart failure to reduce re-hospitalization and optimize quality of life. Furthermore, the use of telemedicine could have an important impact on infective disease spread during the current coronavirus disease-2019 pandemic.Case summary Emergent hospitalization of a patient with acute on chronic heart failure, who is currently in self-isolation as a result of his comorbid profile that exposes him to high risk for severe course and mortality in case of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection was prevented using a last generation telemedicine tool.Discussion Further implementation of invasive telemedicine could prevent hospitalization for acute decompensated heart failure and consecutive exposure to a potential hospital infection with SARS-CoV-2 in high-risk patients.

A Predictive Model for Intracardiac Pressures in Patients Free From Rejection or Allograft Vasculopathy After Pediatric Heart Transplantation.

Despite the routine use of hemodynamic assessment in pediatric heart transplant (HT) patients, expected intracardiac pressure measurements in patients free of significant complications are incompletely described. A better understanding of the range of intracardiac pressures in these HT patients is important for the clinical interpretation of these indices and consequent management of patients. We conducted a retrospective chart review of pediatric HT recipients who had undergone HT between January 2010 and December 2015 at Lucile Packard Children's Hospital. We analyzed intracardiac pressures measured in the first 12 mo after HT. We excluded those with rejection, graft coronary artery disease, mechanical support, or hemodialysis. We used a longitudinal general additive model with bootstrapping technique to generate age and donor-recipient size-specific curves to characterize filling pressures through 1-y post-HT. Pressure measurements from the right atrium, pulmonary artery, and pulmonary capillary wedge pressure were obtained in 85 patients during a total of 829 catheterizations. All pressure measurements were elevated in the immediate post-HT period and decreased to a stable level by post-HT day 90. Pressure measurements were not affected by age group, donor-recipient size differences, or ischemic time. Intracardiac pressures are elevated in the early post-HT period and decrease to levels typical of the native heart by 90 d. Age, donor-to-recipient size differences, and ischemic time do not contribute to differences in expected intracardiac pressures in the first year post-HT.

The Importance of Conscious Sedation for Life-Saving Valve Procedures in Patients With Rheumatic Heart Disease From Low- to Middle-Income Countries

BackgroundSevere valve disease, which requires intervention, remains strongly associated with mortality in patients with rheumatic heart disease. Percutaneous mitral commissurotomy (PMC) is the procedure of choice for the treatment of patients with isolated or predominantly rheumatic mitral stenosis. This procedure has been performed under sedation to avoid the potential effects of general anesthesia on intracardiac pressure measurements. However, there are limited data on sedation during PMC, especially using easily available medications in low- and middle-income countries. ObjectivesThis study was designed to evaluate the efficacy and hemodynamic effects of conscious sedation during PMC in patients with significant mitral stenosis. MethodsThis study prospectively enrolled 23 patients who underwent PMC with the Inoue balloon technique for hemodynamically significant mitral stenosis. For conscious sedation, midazolam 25 μg/kg and fentanyl 1 μg/kg were administered, and 5 min after the infusion, the level of sedation was evaluated by Ramsay sedation scale. A range of invasive hemodynamic measurements, including cardiac output and pulmonary artery pressures, were recorded before and immediately after sedation. ResultsThe mean age was 44.9 ± 10.8 years, and 19 patients (83%) were women. After sedation, the majority of patients were in categories 2 and 3 of the Ramsay sedation scale (cooperative, orientated, tranquil, and responding to commands). Oxygen saturation dropped from an average of 98.5% to 96.0% without supplementary oxygen. Left ventricular systolic pressure and central aortic pressures decreased after sedation. However, none of the other parameters changed significantly after sedation, including pulmonary artery pressures, pulmonary vascular resistance, and cardiac index. ConclusionsThis simple model of conscious sedation was able to promote anxiolysis, analgesia, and comfort for the procedure without serious hemodynamic effects, which can be a reasonable choice in developing countries.

PO007 Prevalence of Bicuspid Aortic Valve and Its Associated Anomalies From 2002 to 2014 In Shahid-Rajaie Heart Hospital of Tehran

Severe valve disease, which requires intervention, remains strongly associated with mortality in patients with rheumatic heart disease. Percutaneous mitral commissurotomy (PMC) is the procedure of choice for the treatment of patients with isolated or predominantly rheumatic mitral stenosis. This procedure has been performed under sedation to avoid the potential effects of general anesthesia on intracardiac pressure measurements. However, there are limited data on sedation during PMC, especially using easily available medications in low- and middle-income countries.This study was designed to evaluate the efficacy and hemodynamic effects of conscious sedation during PMC in patients with significant mitral stenosis.This study prospectively enrolled 23 patients who underwent PMC with the Inoue balloon technique for hemodynamically significant mitral stenosis. For conscious sedation, midazolam 25 μg/kg and fentanyl 1 μg/kg were administered, and 5 min after the infusion, the level of sedation was evaluated by Ramsay sedation scale. A range of invasive hemodynamic measurements, including cardiac output and pulmonary artery pressures, were recorded before and immediately after sedation.The mean age was 44.9 ± 10.8 years, and 19 patients (83%) were women. After sedation, the majority of patients were in categories 2 and 3 of the Ramsay sedation scale (cooperative, orientated, tranquil, and responding to commands). Oxygen saturation dropped from an average of 98.5% to 96.0% without supplementary oxygen. Left ventricular systolic pressure and central aortic pressures decreased after sedation. However, none of the other parameters changed significantly after sedation, including pulmonary artery pressures, pulmonary vascular resistance, and cardiac index.This simple model of conscious sedation was able to promote anxiolysis, analgesia, and comfort for the procedure without serious hemodynamic effects, which can be a reasonable choice in developing countries.

Right Heart Catheterisation: How To Do It

Right heart catheterisation (RHC) is a minimally invasive procedure that provides direct haemodynamic measurement of intracardiac and pulmonary pressures. It is the gold standard investigation for the diagnosis and management of pulmonary hypertension. This article will describe how to perform right heart catheterisation, indications and contraindications.

Non-Invasive Intra-cardiac Pressure Measurements Using Subharmonic-Aided Pressure Estimation: Proof of Concept in Humans

This study evaluated the feasibility of employing non-invasive intra-cardiac pressure estimation using subharmonic signals from ultrasound contrast agents in humans. This institutional review board–approved proof-of-concept study included 15 consenting patients scheduled for left and right heart catheterization. During the catheterization procedure, Definity was infused intra-venously at 4–10 mL/min. Ultrasound scanning was performed with a Sonix RP using pulse inversion, three incident acoustic output levels and 2.5-MHz transmit frequency. Radiofrequency data were processed and subharmonic amplitudes were compared with the pressure catheter data. The correlation coefficient between subharmonic signals and pressure catheter data ranged from −0.3 to −0.9. For acquisitions with optimum acoustic output, pressure errors between the subharmonic technique and catheter were as low as 2.6 mmHg. However, automatically determining optimum acoustic output during scanning for each patient remains to be addressed before clinical applicability can be decided.

Right ventricular function during acute exacerbation of severe equine asthma.

Pulmonary hypertension has been described in horses with severe equine asthma, but its effect on the right ventricle has not been fully elucidated. To evaluate right ventricular structure and function after a 1-week period of pulmonary hypertension secondary to acute exacerbation of severe equine asthma. Prospective study. A clinical episode of severe equine asthma was induced experimentally in six susceptible horses. Examinations in remission and on day 7 of the clinical episode included a physical examination with clinical scoring, echocardiography, arterial blood gas measurements, venous blood sampling for cardiac biomarkers, intracardiac pressure measurements, right ventricular and right atrial myocardial biopsies, airway endoscopy and bronchoalveolar lavage. After 1 month of recovery, physical examination, echocardiography and cardiac biomarker analysis were repeated. Echocardiographic and pressure measurements were compared with those in 10 healthy control horses. All horses developed clinical signs of acute pulmonary obstruction. Right heart pressures increased significantly. Altered right ventricular function could be detected by tissue Doppler and speckle tracking echocardiography. Cardiac troponin concentrations did not increase significantly, but were highly elevated in one horse which exercised in the paddock prior to sampling. Focal neutrophil infiltration was present in two myocardial samples. Even in remission, asthmatic horses showed a thicker right ventricular wall, an increased left ventricular end-systolic eccentricity index at chordal level and decreased right ventricular longitudinal strain compared with controls. The induced clinical episode was rather mild and the number of horses was limited because of the invasive nature of the study. Pulmonary obstruction in asthmatic horses induces pulmonary hypertension with right ventricular structural and functional changes.

The role of implantable hemodynamic monitors to manage heart failure.

Heart failure is associated with high rates of hospitalization and rehospitalization, resulting in substantial clinical and economic burden. Current approaches to monitoring patients with heart failure have done little to reduce these high rates of heart failure hospitalization. Implantable hemodynamic monitors have been developed to remotely provide direct measurement of intracardiac and pulmonary artery pressures in ambulatory patients with heart failure. These devices have the potential to direct day-to-day management of patients with heart failure to reduce hospitalization rates. The use of a pulmonary artery pressure measurement system has been shown to reduce the risk of heart failure hospitalization in patients with systolic and diastolic heart failure.

Telemonitoring of Outpatients With Heart Failure

Heart failure (HF) remains a large medical problem, and prevention of decompensation and HF-related hospitalizations is important not only for the patient, but also from an economic point of view. Close monitoring is crucial and can be done through a whole spectrum of modalities. This monitoring ranges from a (nurse-based) disease management program, to structured telephone support, to remote or telemonitoring with or without the use of an implantable device.1–3 Article see p 2985 Disease management programs, usually with a specialized nurse and in the hospital, are implemented on a large scale, but the optimal level and intensity of care is still unclear.4 Structured telephone support may be useful, and a recent meta-analysis showed a reduction in HF hospitalization, but no effect on mortality.2 Remote, home, or telemonitoring using a number of (relatively simple) noninvasive variables such as heart rate, blood pressure, and body weight was also examined in a number of studies, and the same meta-analysis showed that this method reduced both hospitalizations and mortality.2 However, 2 recent large studies not included in that analysis did not show such a positive effect.5,6 In the American Telemonitoring to improve outcomes in HF (TELE-HF) study5 and in the German Telemedical Intervention Monitoring in HF (TIM-HF) study,6 which together randomly assigned 2362 HF patients, no effect on HF hospitalizations or mortality was observed. In recent years, a number of studies in the field of telemonitoring have been published that measured invasive variables. In the Chronicle Offers Management to Patients with Advanced Signs and Symptoms of HF (COMPASS-HF) study,7 a strategy based on measurement of right-sided intracardiac pressures (with a special transvenous lead: Chronicle, Medtronic) was examined. The primary (composite) end point showed a nonsignificant 21% reduction, but there was a …

Modeling and simulation of right ventricular volume measurement system during right heart catheterization

Haemodynamic monitoring is necessary for the effective management of critically ill cardiac patients. Pulmonary artery catheterization has been used for monitoring the circulation, for measurement of intracardiac pressures and to estimate preload and afterload. However, pressures may not be accurate reflection of the circulation and simultaneous measurement of volumes would improve patient treatment. However, measurement of cardiac volumes especially of the right ventricle is difficult in everyday clinical practice In this work we propose the use of pulmonary artery catheter (PAC) with ultrasonic sensors built on it, to calculate the right ventricular end-diastolic (RVEDV) and end-systolic volume (RVESV). This is achieved by using the Ultrasonic (US) beam, to measure the distances between the transducers on the catheter and the RV walls. These distances, will be used as an input to a Volume calculating algorithm, which finally provides the RVEDV and RVESV, using a Neural Network (NN). For that reason, we have used cardiac Magnetic Resonance Imaging (MRI) and have modeled the catheter and the US transducers, to get as input the distances to the surface of the cavity. With these distances, and the known cardiac volumes (calculated using MR images) we trained and validated a NN for volume calculation. The results show that the algorithm accurately calculates the RVEDV. For the RVESV, greater deviations are observed between values calculated with our algorithm and cardiac MRI.

A Comprehensive Noninvasive Hemodynamic Assessment of Systolic Heart Failure

Article see p 387 The prevalence of systolic and diastolic heart failure increases with advancing age between 5% and 10% of all subjects beyond the age of 60 years. The cause of heart failure in the majority of patients is occlusive coronary artery disease, hypertension, and idiopathic dilated cardiomyopathy. The current estimated costs for the treatment of heart failure in the United States alone are approaching $40 billion per year, and for this reason, heart failure has been identified as a major health care initiative. Some of these costs could be defrayed if recurrent hospital admissions for serial hemodynamic assessments could be replaced by noninvasive hemodynamic measurements with the use of Doppler echocardiography in a more cost-effective outpatient setting. Although right heart catheterization remains the gold standard for measurement of intracardiac pressures,1,2 enthusiasm for placement of Swan–Ganz catheters has dwindled over the past decade on account of complications that include infection, cardiac perforation, and tamponade. Doppler echocardiography is generally acknowledged to be a noninvasive alternative to Swan–Ganz catheterization for hemodynamic assessment at the bedside.3–8 Hitherto, a number of isolated noninvasive Doppler echo measurements of left ventricular (LV) filling pressure, right atrial pressure, and cardiac output and the changes following load interventions have correlated closely with measurements made by Swan–Ganz catheterization.3,8,9 What has been notable by its absence is a consensus regarding a portfolio of measurements that can be used in all patients with heart failure to provide a comprehensive hemodynamic assessment at the bedside that will determine the subsequent treatment strategy. An important prerequisite of such a panel of hemodynamic tests is that they are quick to perform, easy to interpret, previously validated, and reproducible. Doppler echocardiography in addition to enabling numerous hemodynamic measurements to be made also provides …

Effects of Exercise in Volume Overload

Aortic valve regurgitation (AR) imposes a pathologic volume overload to the left ventricle (LV), whereas aerobic exercise causes physiologic volume overloading. The impact of combining both LV volume overloads (pathologic and physiologic) is unknown. Considering the known beneficial effects of aerobic training on the cardiovascular system, we hypothesized that the positive effects would outweigh the negative ones and that exercise would improve the tolerance of the LV to AR. Forty female adult Wistar rats were randomly divided in the following groups: 1) sham sedentary (SS), 2) sham trained (ST), 3) AR sedentary (ARS), and 4) AR trained (ART). Training consisted in treadmill running for 30 min five times per week at 20 m x s(-1) for 24 wk. In vivo follow-up was made by echocardiography and invasive intracardiac pressure measurements. Hearts were harvested for tissue analysis. Echocardiography revealed less LV dilation and hypertrophy in ART versus ARS as well as improved myocardial performance index. LV ejection fractions remained similar and within normal range in ART versus ARS. Invasive cardiac pressures yielded improved dP/dt- in ART versus ARS but similar dP/dt+. beta(1)-Adrenergic receptor mRNA expression was improved in the ART group versus ARS. Our data suggest that a moderate aerobic exercise program helps minimize LV dilation and hypertrophy and improves diastolic cardiac performance in heart submitted to chronic volume overload due to severe aortic valve regurgitation in this animal model.

An Experimental Canine Model to Study Left Ventricular Function

An increasing number of patients with uni- or bi-ventricular heart failure underscores the importance of heart failure research. An isolation of the left or right ventricle would allow for an evaluation of the contralateral ventricular function, the change in hemodynamics, and the capability of each ventricle to deal with the volume challenge. This experimental canine model was developed at the laboratory of Cardiac Physiology at Massachusetts General Hospital, Harvard Medical School. The model allows an evaluation of left ventricular function with a tight control of the preload and evaluation of the contractility of the myocardium to create pressure and handle the volume overload. The left atrial pressure (LAP), left ventricular end diastolic pressure (LVEDP), left ventricular end-systolic pressure (LVES), and myocardial contractility (DP/DT) can be measured using catheters and micro-ultrasound devices. Using this model, a Frank-Starling Curve can be generated for any given circumstance. This manuscript describes the technical aspect of such a model including; preparation of the canines, cannulation, and measurement of intra-cardiac pressures.

Revisiting Animal Models of Aortic Stenosis in the Early Gestation Fetus

Mechanisms leading to left ventricular hypoplasia and endocardial fibroelastosis in the fetus remain unknown. Prevailing theory is that obstruction to blood flow through the left ventricle leads to elevated end-diastolic pressures, compromised myocardial perfusion, and endocardial ischemia. Fetal interventions are now being performed, based on the presumption that they would prevent such pathogenic mechanisms. Forty first-trimester fetal sheep (mean gestational age, 53 days) were studied. Severe fetal left ventricular outflow obstruction was created by banding the ascending aorta in 25 fetuses; 15 control fetuses underwent "sham" surgery with thoracotomy. Serial fetal echocardiography was used to assess left ventricular growth and fetal hemodynamics. Findings were correlated to morphologic and histopathologic changes, and intracardiac pressure measurements obtained from fetal cardiac catheterization. Surviving banded fetuses (n = 13) had one of two phenotypes: compensatory left ventricular hypertrophy (n = 7) or noncompensatory left ventricular dilatation (n = 6) with hydrops and severe left ventricular dysfunction. All fetuses had elevated left ventricular end-diastolic pressures (mean, 21 mm Hg; range, 14 to 28 mm Hg), which correlated to the gradient across the ascending aorta (mean, 41 mm Hg; range, 28 to 73 mm Hg). In vivo echocardiography findings were incongruous with those at autopsy, and demonstrated preservation of left ventricular growth indices in all fetuses. Endocardial fibroelastosis and myocardial fibrosis were not observed in any banded fetus. While early gestational obstruction to flow can compromise left ventricular function in the fetus, it does not retard normal growth. Similarly, an elevated left ventricular end-diastolic pressure is not sufficient to cause myocardial fibrosis or endocardial fibroelastosis in the fetus.

Platypnea–orthodeoxia syndrome combined with constrictive pericarditis after coronary artery bypass surgery

Clinical Summary A 61-year-old man presented with dyspnea 3 years after coronary artery bypass surgery. He had multiple cerebral infarctions 1 year after the operation. Because pulse oximetry was 92% in room air at his physician’s consultation, he started home oxygen therapy. After 3 years, his dyspnea got worse. Redo work-up, including ventilation/perfusion (V/Q) scanning and computed tomographic scanning, was done. The result of the V/Q scan was normal. Computed tomographic scanning showed an abnormal cyst above the heart. The cyst contained liquid and showed a compressed right atrium and right ventricular outflow (Figure 1). He consulted with our institution to perform an extensive work-up. Physical examination revealed a regular pulse, a blood pressure of 103/81 mm Hg, and no murmur in cardiac auscultation. Arterial blood gas analysis in a sitting posture showed a PaO2 of 53.8 mm Hg and a PaCO2 of 24.6 mm Hg with 15 L of oxygen supplementation by means of a face mask and a PaO2 of 63.2 mm Hg and a PaCO2 of 25.1 mm Hg in the supine position. Common blood count showed polycythemia, with a hematocrit value of 52.4%. Chest radiographic film showed any apparent pulmonary disease that could be a cause of the dyspnea. Electrocardiography revealed sinus rhythm and left atrial load. Echocardiography was performed and revealed right atrial compression. Transesophageal echocardiography revealed an atrial septal aneurysm and patent foramen ovale and a right-to-left shunt through the foramen ovale. These shunts increased in a sitting posture. Cardiac catheterization was performed and revealed a small right-to-left shunt (27.3%). A small portion of blood flowed from the superior vena cava influx directly into the inferior vena cava. Blood flowed from the inferior vena cava influx into the left atrium through the foramen ovale. The previous bypass graft (ie, the left internal thoracic artery to the left anterior descending artery) was patent. All of the right-sided intracardiac pressure measurements were normal (Table 1). Surgical removal of the cyst was performed. There were polytetrafluoroethylene* sheets surrounding the heart. There was a cyst surrounding the right atrium from the right side of the left atrium to the right ventricle. The cyst had a thick scar tissue and contained 300 mL of old, black serous liquid. Just after opening the cyst, the pulse oximetry improved, from 79% to 100%. The right atriotomy was performed during ventricular fibrillation with cardiopulmonary bypass. There was a patent foramen ovale, and the slit was closed in a continuous fashion. Because the right ventricle was covered with thick pericardium and expressed constrictive pericarditis, a complete pericardiectomy was performed. The postoperative course was uneventful, and weaning from mechanical ventilation was quite easy. The patient could be withdrawn from oxygen supplementation and was discharged on postoperative day 15.

The Heartpod Implantable Heart Failure Therapy System

Congestive heart failure has been described as the new epidemic, despite advances in drug therapy a 2-year mortality of up to 50% persists. This is despite recent improvements in drug therapy. There are limitations to the current drug treatments and cardiac resynchronization devices. The treatment of diastolic dysfunction can be suboptimal. The Savacor Company developed the Heartpod device to directly measure left atrial pressure in patients with congestive heart failure via an implantable device. The patient can in real time, download their intra-cardiac pressure measurements to a hand-held device. With this information, they can titrate their own treatment in a very precise manner.