Onset Of Right Heart Failure Research Articles

Healing a Heart of Stone: Percutaneous Extraction of Cardiopulmonary Cement Embolism

An 80-year-old male patient presented to our emergency department with new onset of right heart failure. Transthoracic echocardiography showed an intracardiac foreign body interfering with the tricuspid valve causing moderate-to-severe regurgitation ([Figures 1A and 1B][1]). In his recent medical

Lung transplantation in an intensive care patient with pulmonary alveolar microlithiasis - a case report.

Pulmonary alveolar microlithiasis (PAM) is an autosomal recessive disease characterized by the deposition of phosphate and calcium in the alveoli. The disease progresses asymptomatically until later stages. When it becomes symptomatic, lung transplantations performed before the onset of right heart failure may improve life expectancy and quality. Here we present a case report concerning the very first Turkish PAM patient to have undergone lung transplantation surgery. Patient information: A 52 year-old female, Caucasian patient, already diagnosed with PAM in infancy, was admitted to the intensive care unit, diagnosed with pneumonia and hospitalized for 20 days. We decided to refer the patient to a specialized center for lung transplantation. Bilateral lung transplantation was performed in Vienna 14 months later and no recurrence was observed during the first postoperative year. Bilateral lung transplantation may improve both the life expectancy and the quality of life of PAM diagnosed patients with severe respiratory failure who do not suffer from right heart failure. The risk of recurrence should not be considered as a justifying reason to avoid transplantation as a treatment method.

Lung transplantation in an intensive care patient with pulmonary alveolar microlithiasis - a case report

Introduction: Pulmonary alveolar microlithiasis (PAM) is an autosomal recessive disease characterized by the deposition of phosphate and calcium in the alveoli. The disease progresses asymptomatically until later stages. When it becomes symptomatic, lung transplantations performed before the onset of right heart failure may improve life expectancy and quality. Here we present a case report concerning the very first Turkish PAM patient to have undergone lung transplantation surgery. Patient information: A 52 year-old female, Caucasian patient, already diagnosed with PAM in infancy, was admitted to the intensive care unit, diagnosed with pneumonia and hospitalized for 20 days. We decided to refer the patient to a specialized center for lung transplantation. Bilateral lung transplantation was performed in Vienna 14 months later and no recurrence was observed during the first postoperative year. Conclusion: Bilateral lung transplantation may improve both the life expectancy and the quality of life of PAM diagnosed patients with severe respiratory failure who do not suffer from right heart failure. The risk of recurrence should not be considered as a justifying reason to avoid transplantation as a treatment method.

Ileal Carcinoid with Liver Metastasis Presenting after Ten Years with Abdominal Mass and Right Heart Failure: Report of a Case

A case of ileal carcinoid metastatic to the liver is reported. The diagnosis was made and treatment given ten years after the detection of a left hypervascular liver mass, which was first confounded with a hemangioma. The onset of right heart failure led to surgical replacement of the tricuspid and pulmonary valves. After cardiac surgery the patient underwent an ileal resection and left hepatectomy for a cystic left liver metastasis. Isolated right heart failure and cystic degeneration of a liver metastasis are uncommon features of metastatic carcinoid tumors; only a few cases have been described in the literature. Cardiac surgery is recommended before liver surgery to reduce venous pressure and consequent bleeding during hepatectomy. Surgical treatment of liver metastases may relieve endocrine symptoms and result in an overall five-year survival rate of 47%.

Production and reversibility of right ventricular hypertrophy and right heart failure in dogs

Combined heart-lung transplantation has been used for end-stage primary pulmonary hypertension. Experience with single-lung transplantation for other conditions suggested that associated severe right ventricular dysfunction resulting from increased afterload would recover after placement of a satisfactory lung allograft. Early experience with the application of single-lung transplantation for pulmonary hypertension supports this contention. We devised a reversible canine model of chronic progressive pressure-overloaded right heart failure by pulmonary artery banding to study the echocardiographic, hemodynamic, and pathological reversibility of the failing right heart. Clinical right heart failure was defined as the development of ascites and pleural effusions. Right heart failure developed in 23 dogs 67 to 348 days after banding, and they were divided into two groups to determine its early and long-term effects. Group 1 dogs (n = 11) were either sacrificed immediately after the onset of right heart failure (n = 5) or unbanded (n = 6); group 2 dogs (n = 12) were maintained in right heart failure for 3 months and then either sacrificed (n = 6) or unbanded. Unbanded dogs in both groups were observed for 4 additional months before sacrifice. A control group of 6 normal dogs was sacrificed for pathological comparisons. After unbanding, the right ventricular systolic pressure fell from 97 ± 17 mm Hg (group 1) and 88 ± 31 mm Hg (group 2) to 44 ± 11 mm Hg and 47 ± 13 mm Hg, respectively. Despite this persistent gradient across the pulmonary artery, echocardiographic and hemodynamic measures of right ventricular function returned to normal, albeit more slowly in the group 2 dogs. Pathologic examination revealed incomplete regression of hypertrophy and persistent mild fibrosis in both groups. There was no difference in the degree of recovery between the acute and chronic failure groups. These results suggest that reduction of pulmonary afterload permits right ventricular recovery and supports the application of lung transplantation in patients with severe pulmonary hypertension.

Recovery of elevated atrial natriuretic peptide in pressure-overload right heart failure

Elevation of the plasma concentrations of immunoreactive atrial natriuretic peptide (ANP) was observed in canine chronic right heart failure (RHF) secondary to right ventricular (RV) pressure overload. Pressure overload on the right heart was gradually increased using an inflatable cuff. The interval between banding and the onset of RHF was 152 ± 52 days. Seventeen RHF dogs were produced and divided into Group I ( n = 11) and Group II ( n = 6). At the onset of RHF, Group I dogs were either sacrificed for study of the heart, or unbanded to allow recovery from RHF. The dogs in Group II were maintained in RHF for 3 additional months before being either sacrificed or unbanded. Following unbanding, the ANP level of Group I recovered from 108 ± 36 ( n = 11) to 20 ± 6 pg/ml ( n = 6) at 1 month and was maintained at 27 ± 7 pg/ml (baseline, 21 ± 5 pg/ml, n = 11) at 4 months. ANP levels of Group II declined from 165 ± 55 ( n = 6) to 87 ± 2 pg/ml ( n = 3) at 1 month and further decreased to 42 ± 14 pg/ml ( n = 3) 4 months after unbanding. Thus, compared to Group I, Group II had a high ANP level before unbanding and a delay in recovery of the ANP levels despite normalization of the right atrial pressure (RAP). Four months after release of pressure overload, the right atrial hypertrophy persisted in the unbanded dogs; however, Group I unbanded dogs showed a better reversal of the right atrial hypertrophy than Group II unbanded dogs. We concluded that in chronic RHF, decrease of the elevated ANP levels depends on normalization of the right atrial pressure and persistent mild increase of ANP levels may correlate with the remaining hypertrophy of the right atrium.

Hypoplastic Pulmonary Arteries and Aorta with Obstructive Uropathy in 2 Siblings

Two sisters who presented with diffuse hypoplasia of pulmonary arteries, relative hypoplasia of ascending aorta, obstructive uropathy, bilateral ureteral reflux, and hydronephrosis, are described. The subsequent course was characterized by progressive and gradual onset of right heart failure, failure to thrive, chronic malabsorption and systemic hypertension. The syndrome which appears to be transmitted by autosomal recessive inheritance can possibly represent a generalized hypoplasia and growth failure of a part or the entire arterial system. Peripheral pulmonary stenosis can occur as an isolated lesion or in association with other congenital cardiac anomalies, as well as in rubella syndrome and the syndrome of supravalvular aortic stenosis. This communication reports two siblings with a hitherto unreported combination of hypoplastic pulmonary arteries, and aorta with identical genito-urinary tract abnormalities.