Edge-to-edge mitral valve plasty technique has been widely used to treat bileaflet prolapse. This procedure anchors the correspondence leaflets to create a double-orifice mitral valve. The original mitral valve anatomy is changed, and the opening of mitral valve is restricted. Little is known whether this procedure affects the left ventricular diastolic function.Thirty patients with mitral regurgitation were included in this study. Fifteen with posterior leaflet prolapse received quadrangular resection (group 1), 15 with anterior or bileaflet prolapse underwent edge-to-edge procedure (group 2). Acute hemodynamics was monitored with a Swan-Ganz catheter (Edwards Lifesciences LLC, Irvine, CA, USA). Left ventricular diastolic function was also evaluated with echocardiography in 28 patients with sinus rhythm. The ratio of peak E velocity and A velocity (E/A), the ratio of early diastolic peak flow velocity to early diastolic mitral annular movement velocity (E/Em), and the ratio of early diastolic mitral annular velocity to late diastolic mitral annular velocity (Em/Am) were measured before operation and one week after operation.Mitral valve area and mitral regurgitate grade decreased significantly after operation. There was no significant change in pulmonary artery wedge pressure between two groups and in each group before and after operation. Echocardiography evaluation showed there was no significant difference in E/A, E/Em, and Em/Am before and after operation between two groups and in each group.Edge-to-edge mitral valve plasty procedure has no significant impairment on left ventricular diastolic function. A double-orifice mitral valve has similar hemodynamic behavior with a physiological valve.
Rationale: Aortoesophageal fistula (AEF) is an exceedingly rare yet critically life-threatening condition, with mortality rates nearing 100% if not addressed promptly. AEF often develops in the context of thoracic aortic aneurysms, esophageal malignancies, or as a complication of foreign body ingestion and prior thoracic aortic surgeries. This study reports an exceptionally severe and clinically rare case of AEF associated with a pseudaneurysm induced by esophageal stenting. By disseminating this case, we aim to heighten awareness of AEF and emphasize the necessity for meticulous decision-making during esophageal stent placement, along with the importance of vigilant postoperative monitoring to enable early intervention. Patient concerns: A 70-year-old male presented with “food obstruction” and was subsequently diagnosed with esophageal malignancy. To alleviate the obstruction, he underwent esophageal stenting. Fifty-five days postprocedure, he experienced a sudden onset of “chest pain, vomiting of dark red blood, and melena,” prompting hospitalization for “gastrointestinal bleeding.” Diagnoses: Urgent computed tomography angiography revealed the emergence of a new pseudaneurysm at the lateral aspect of the esophageal stent, with direct communication between the aneurysm and the adjacent esophagus, raising the suspicion of AEF. Interventions: An urgent multidisciplinary emergency team was convened to execute critical interventions, including endoluminal stenting of the esophagus and thoracic endovascular aortic repair. Outcomes: The patient suffered a sudden and massive hematemesis, estimated at approximately 3000 mL, leading to his subsequent demise. Lessons: AEF is a rare cause of upper gastrointestinal bleeding. For patients suspected of AEF, it is imperative to conduct prompt and thorough computed tomography angiography while initiating an emergency surgical alert. The proximity of esophageal stents to the aorta may significantly elevate the risk of AEF; thus, a comprehensive risk assessment should precede stent placement in cases involving tumors adjacent to the aorta. Furthermore, postoperative surveillance is crucial to monitor potential aortic invasion by the tumor or the development of an aneurysm near the esophagus, facilitating timely intervention.
Objective To observe the impact of change declined of the right ventricular preload on hemodynamic and movement of the right heart after transcatheter closure of atrial septal defects using Amplatzer occluder. Methods Twenty five subjects (mean age 31.47±12.73 years, 8 men and 17 women) with secondum atrial septal defects underwent transthoracic echocardiography pre operation, 48-72 h post operation and follow up performed more than 3 months after operation. The diameter of atrial septal defect (ASD), the pulsed wave Doppler spectrums of the blood flow at the main pulmonary and inlet of the right ventricle, as well as tissue Doppler pulsed wave signal of the tricuspid annulus at anterior leaflets of tricuspid valves in the para sternal four chamber view were acquired. At each position, systolic, early and late diastolic velocities, pressure gradient and intervals were measured. Results All of the patients had been implanted one occluder under the guidance of the echocardiography successfully. Trivial residual shunts were observed at two patients 48-72 h post operation and disappeared after 3 months. After the operation, the preload of RV was declined immediately and the systolic movement speed and time interval of the right heart were decreased and shortened significantly, the ejection time was shortened and the blood peak velocity and pressure gradient in the systolic period were reduced, the early and late diastolic inflow blood velocities and pressure gradients also decreased significantly, the late diastolic movement velocities decreased. During the more than 3 months short time follow up, however, the hemodynamic parameters above had no significant difference compared with 48-72 h', the whole diastolic time was prolonged. Conclusion Preload of right heart changed quickly after the operation, and had a significant effect on the hemodynamic and the myocardial movements of right heart, which improved the RV functions segmentally.
Objective To investigate the value of high-frequency ultrasound on evaluation of structural changes of the radial artery 1 day and 1 month after percutaneous coronary intervention.Methods Totally 52 patients received percutaneous coronary interventions through radial artery.High-frequency probe(12 MHz) was used to observe the entire radial artery before,1 day and 1 month after intervention.The intima-media thickness(IMT) was measured and compared.Results IMT of the radial artery 1 day after intervention increased than that before intervention(both P0.001),decreased 1 month later(all P0.001),but IMT at that time still higher than that before intervention.The incidence of IMT increasing was 86.62%(44/52) and 57.69%(30/52) at 1 day and 1 month after intervention,respectively;That of partial radial artery stenosis 15% was 15.38%(8/52),and 9.62%(5/52),respectively;That of lumen occlusion was 9.62%(5/52) and 5.78%(3/52),respectively.Radial artery pseudoaneurysm occurred in 1 case after intervention,and then closed after intermittent compression for 48 h,and formed a hematoma of the forearm.Conclusion Percutaneous coronary intervention through the radial artery can cause injury of this artery.The injury responses and complications are obvious at 1 day after intervention,then reduce 1 month later,but IMT remain thicker than that before intervention.High frequency ultrasound is important in the evaluation of radial artery after intervention.
Objective To evaluate the clinical effect of the mitral valve plasty to treat the severe mitral valve insufficiency, at the same time, observe the change of the left ventricular function after the operation by echocardiography and the hemodynamic catheter monitoring. Methods Thirty patients with moderate to severer mitral valve insufficiency underwent echocardiography pre and post-operatively, and hemodynamic monitoring by using the Swan-Ganz catheter after anesthesia untill 12 h post-operation. Results In post-operating echocardiography, the regurgitations were found disappeared completely in 20 patients and the moderate regurgitation was found in 2 patients. The significant mitral valve stenosis had not been found in all patients. The volume at the end of the diastole of left ventricle, the stroke volume and the ejection fraction, as well as the pressure gradient between the left atrium-ventricle were declined significantly, the pulmonary arteriolar wedged pressure (PAWP), the mean pulmonary vessels pressure (MPAP), the pulmonary vessels resistant index (PVRI), and the systemic vessels resistant index (SVRI) were decreased, but the E/Em had no significant change. Conclusion The severity and cause of the mitral valve insufficiency assesses by echocardiography were confirmed in the operation, the evaluation on the left heart function and effect of the operation were the same as that with the hemodynamic monitoring.
High-grade stenotic or occlusive diseases of the common carotid artery (CCA) are not rare in clinical practice and can be seen in diverse cardiovascular diseases, including atherosclerosis, vasculitis, thrombosis, dissection etc. Collateral circulation often forms secondary to these obstructive lesions to maintain cerebral perfusion. Herein, we describe and analyze nine patients ([Table 1]) with a rare hemodynamic phenomenon “CCA steal”, resulting from severe obstructive diseases of the CCA, or both the right CCA and innominate artery (INA).
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