RESUMO
Incomplete ventricular septal tears are uncommon or probably underreported cardiac lesions caused by blunt chest trauma. This report describes two cases of incomplete ventricular septal tears that were not suspected clinically. Transthoracic and transesophageal echocardiography provided the diagnostic information in both of these cases. Despite associated valvular lesions, the patients' stable in-hospital course lead to the decision to treat them medically with no specific treatment to the incomplete ventricular septal tears. Accordingly, these two cases were observed for a mean period of 1.5 years with serial echocardiographic studies to track the natural history of these lesions. During the follow-up period, both of these cases did not manifest any changes in the extent of ventricular septal tear, septal structure, or any left-to-right shunting through the tear. There were no significant changes in left ventricular size, shape, or systolic function. Thus echocardiographic imaging proved to be useful both in initial diagnosis and follow-up.
Assuntos
Ecocardiografia , Traumatismos Cardíacos/etiologia , Traumatismos Torácicos/complicações , Ferimentos não Penetrantes/complicações , Adolescente , Adulto , Seguimentos , Traumatismos Cardíacos/diagnóstico por imagem , Traumatismos Cardíacos/tratamento farmacológico , Septos Cardíacos/lesões , Ventrículos do Coração/lesões , Humanos , Masculino , Fatores de TempoRESUMO
To evaluate the efficacy of University of Wisconsin solution for clinical heart transplantation, load-independent parameters were used to assess left ventricular function after transplantation. Donor hearts were arrested with and stored in buffered cold cardioplegic solution for control (n = 5) and University of Wisconsin solution for the experimental group (n = 5). Orthotopic transplantations were performed in a routine manner. Mean donor age (cardioplegic solution, 28 +/- 5.2 years; University of Wisconsin solution, 28 +/- 5.1 years) and ischemic times (cardioplegic solution, 181 +/- 27 minutes; University of Wisconsin solution, 224 +/- 23 minutes) were similar. Two hours after reperfusion of the heart, transesophageal echocardiography was used to image the left ventricle at the mid-papillary muscle level, and a high-fidelity catheter-tipped manometer was placed in the left ventricle to record left ventricular pressure simultaneously. These images were digitized during apneic baseline conditions and during an acute reduction in preload from inferior vena caval occlusion. The left ventricular cross-sectional areas were measured and matched with left ventricular pressure from the catheter-tipped manometer to reveal pressure-area relationships. The baseline parameters fractional area change and stroke force were calculated. End-systolic elastance, the slope of end-systolic pressure-area relationship and preload recruitable stroke force, the slope of stroke force versus end-diastolic area were calculated from the inferior vena cava occlusion measurements.(ABSTRACT TRUNCATED AT 250 WORDS)
Assuntos
Soluções Cardioplégicas/uso terapêutico , Transplante de Coração/fisiologia , Soluções para Preservação de Órgãos , Preservação de Órgãos , Função Ventricular Esquerda/fisiologia , Adenosina/uso terapêutico , Adolescente , Adulto , Alopurinol/uso terapêutico , Ecocardiografia Transesofagiana , Feminino , Glutationa/uso terapêutico , Rejeição de Enxerto/etiologia , Sobrevivência de Enxerto , Parada Cardíaca Induzida , Transplante de Coração/diagnóstico por imagem , Humanos , Insulina/uso terapêutico , Masculino , Pessoa de Meia-Idade , Rafinose/uso terapêutico , Processamento de Sinais Assistido por Computador , Volume Sistólico/fisiologia , Taxa de Sobrevida , Fatores de Tempo , Pressão Ventricular/fisiologiaRESUMO
Transient left ventricular dysfunction is commonly described in association with cardiopulmonary bypass (CPB). We evaluated changes in right ventricular (RV) function after elective cardiac surgery in 24 patients with normal preoperative cardiac function. In all, irrespective of distribution of coronary artery disease or use of pharmacologic support, a transient depression of RV systolic function with respect to both preinduction and initial postoperative (Postop) values occurred 262 +/- 116 min post-CPB as represented by a decrease in RV stroke volume index (25.0 +/- 1.7 vs. 33.4 +/- 1.9 ml/m2 Postop) and RV ejection fraction (31.0 +/- 2.2 vs. 45.6 +/- 2.5% Postop), and an increase in RV end-systolic and end-diastolic volume indices. This depression responded readily to pharmacologic therapy within 2 h, resolved within 24 h, and had no adverse consequences in these otherwise healthy patients. Further studies are needed to identify the cause of this phenomenon and its importance in patients with preexisting cardiac dysfunction.