Background: Central venous pressure (CVP) is indicator of preload and used to determine intravascular volume status. An invasive method such as central venous catheter placement is required in order to measure CVP. However, it is associated with many complications. Instead, sonographic measurement of inferior vena cava (IVC) represents effective and non-invasive method of estimating CVP and recommendations are provided by the American Society of Echocardiography (ASE). There are various methods to calculate and estimate CVP using ultrasound. One of the ultrasonographic (US) technique for obtaining the JVP from a high-resolution B-mode sonogram sequences (US-JVP), recording the changes in IJV-CSA (cross section area) over the cardiac cycle (CC) has been proposed which appears to have potential as an approach for estimating CVP.Patients and Methods: It is a prospective double blinded observational study conducted at tertiary hospital among 40 consenting patients.Results: We found that 27 patients (67.5%) had correct prediction of CVP by USG with measured CVP after transducing central venous catheter at baseline (supine position). Similarly, 19 patients (47.5%) had correct prediction of CVP with measured CVP after passive leg raising. We found that 14 patients (35%) had 10% rise in mean arterial pressure on passive leg raising. We denoted these patients as Responders. We found that both responders and non-responders had poor correlation with CVP prediction. Also IVC diameters and collapsibility index did not predict the fluid responsiveness of the patients. Spearman correlation coefficient was used to study correlation between two quantitative variables. In our study, we found a strong positive correlation between predicted CVP (determined by USG parameters) and measured CVP (determined by transducing central venous catheter on monitor) at baseline (supine position) and after passive leg raising. Multivariate regression analysis was done to find the significant predictor of CVP which was found to be IVC maximum diameter (p value 0.01) determined by USG.Conclusion: Bedside USG in preoperative patients can be used as a simple and reliable method to calculate IVC diameters and collapsibility index to predict CVP. It requires minimal training and correlates well with real time transduced CVP. In our study of 40 patients we aimed to study the ability of the ultrasound guided measurements of the Inferior Vena Cava in predicting the Central Venous Pressure (CVP). A strong positive correlation was found between the predicted CVP and measured/transduced CVP in supine position 8 (baseline) and after passive leg raising. On multivariate regression analysis, the IVC maximum diameter determined by USG was found to be the significant predictor of CVP. No significant correlation was noted between IVC parameters, Collapsibility index and CVP values to predict fluid responsive nature of the patients.
Computer- and robotic-assisted total knee replacement procedures have been shown to improve the accuracy of the implant size. It also allows dynamic confirmation of the implant and limb alignment during total knee arthroplasty (TKA). The major inhibition of the arthroplasty surgeon in adapting to the robotic-assisted TKA (RA-TKA) is the extra time spent during the registration process and milling of the bone with the robot. The aim of the study was to ascertain the extra time spent during these 2 steps as compared to the conventional TKA (C-TKA).
Introduction: Omecamtiv mecarbil (OM) is a novel selective cardiac myosin activator that has been shown to improve cardiac function in patients with HFrEF. Proposed mechanism of action suggests that it increases myocardial systolic function and systolic ejection time without associated increases in intracellular concentrations of calcium or the rate of change in left ventricular pressure or any direct effects on vascular tissue, cardiovascular receptors, or ion channels. Methods: Systematic review identified phase II/III randomized controlled trials (RCTs) evaluating OM versus placebo. Mean Difference (MD) of different echocardiographic parameters from baseline and Odds Ratios (OR) of cardiovascular (CV) death (along with 95% confidence intervals; CI) were extracted to compute pooled MD and OR using RevMan v.5.3. Random effects model was employed when there was significant heterogeneity (>40%, as assessed by I-squared). Results: Four RCTs were finalized (n=9331; OM: 4722, placebo: 4609). Majority of the patients were males (n=7359; 79%), of white ethnicity (n=7345; 78.7%), and had ischemic heart failure (n=5109; 54.7%). All patients had EF <40% and were on guideline-directed therapy. When patients were pooled for stroke volume; OM increased mean SV to 4.34 ml from baseline as compared to placebo (MD 4.34, 95% CI 2.03-6.65; p=0.0002; I 2 =0%). Mean LV ejection time increased to 32 milliseconds (ms) (MD 32.60, 27.34-37.87; p<0.00001; I 2 =84%). OM resulted in 1.68 mm reduction in mean LV end-systolic diameter (MD -1.68; -2.73 to -0.62; p=0.002; I 2 =0%)). However, reduction in mean end-diastolic diameter (MD -1.05; -1.98 to -0.12; p=0.34; I 2 =42%) was statistically non-significant. Mean LV Fractional Shortening improved to 2% with OM but was statistically insignificant (MD 2.18; 0.54-3.82; p=0.09; I 2 =42%). OM resulted in slightly decreased heart rate (MD -1.77 beats/min; -2.29 to -1.24; p<0.00001; I 2 =0%) with no effect on mean systolic BP (MD -0.05; -0.73 to 0.64; p=0.89; I 2 =0%). In terms of CV mortality, OM decreased the odds for mortality but results were statistically non-significant (OR 0.93, 95% CI 0.80 to 1.08; p=0.34; I 2 = 0%). Conclusion: Omecamtiv mecarbil improved the echocardiographic parameters in patients with HFrEF.
Aneurysms of the sinus of Valsalva are rare congenital lesions. Less often, they are encountered secondary to trauma, infective endocarditis or syphilis. The majority of these aneurysms arise from the right coronary sinus. The present report describes a rare case of an aneurysm arising from the noncoronary sinus of Valsalva and rupturing into the right atrium. Patients with unruptured aneurysms often remain asymptomatic. Rupture of the aneurysm usually causes the appearance of a continuous murmur in the left sternal border. Common sites of rupture include the right ventricle, right atrium or left atrium. Surgical repair is usually associated with a favourable outcome.
Solid organ transplants are slowly increasing across the world. As the societies evolve and communities begin to realize the value of organ donation after brain death, the number of donations after brain death will continue to the rise. These numbers, however, encouraging are far inadequate to meet the demands from the ever-growing number of recipients. This gap is filled in some measure by live donors who are subjected to an invasive procedure to provide kidneys, part of the liver, or even lung. In comparison, the patients with end-stage heart disease have no such options and continue their vigil on the waiting list. This has also led to a huge increase in the number of implantable devices like the left ventricular assist device in developing countries in recent times.
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