Left ventricular mass regression in patients without patient-prosthesis mismatch after aortic valve replacement for aortic stenosis.
- 作者列表："Hachiro K","Kinoshita T","Asai T","Suzuki T
OBJECTIVES:The relationship between the degree of a postoperative effective orifice area and temporal regression of a left ventricular mass after aortic valve replacement for aortic stenosis is unclear in patients without patient-prosthesis mismatch. We therefore investigated the relationship and independent predictors of left ventricular mass regression. METHODS:Among 307 consecutive patients who underwent aortic valve replacement for aortic stenosis between 2008 and 2013, 223 patients receiving a periodic inspection by echocardiography for at least 3 consecutive years after surgery without patient-prosthesis mismatch were enrolled in the present study. Temporal regression of left ventricular mass index was compared between two groups that were classified equally according to effective orifice area index obtained at a 1-week postoperative echocardiographic examination: < 1.20 cm2/m2 (n = 112) and > 1.20 cm2/m2 (n = 111). We also determined the predictors affecting left ventricular mass regression. RESULTS:No difference existed in the preoperative left ventricular mass index between the two groups (p = 0.431). Temporal regression of the left ventricular mass index was similar in the two groups. The independent predictors of left ventricular mass regression were male gender (p = 0.007) and preoperative left ventricular mass index (p = 0.003), but valve size was not (p = 0.641). CONCLUSIONS:There was no relationship between the degree of postoperative effective orifice area and temporal regression of the left ventricular mass in patients without patient-prosthesis mismatch. The independent predictors of left ventricular mass regression were male gender and preoperative left ventricular mass index.
目的: 主动脉瓣狭窄主动脉瓣置换术后有效开口面积与左心室质量随时间消退的关系尚不清楚。因此，我们研究了左心室质量回归的关系和独立预测因素。 方法: 在2008年至307年间因主动脉瓣狭窄行主动脉瓣置换术的2013例连续患者中，223例术后至少连续3年接受超声心动图检查而无患者-假体不匹配的患者入选本研究。比较两组左心室质量指数的时间回归，根据术后1周超声心动图检查获得的有效瓣口面积指数等分: <1.20平方厘米/m2 (n = 112) 和> 1.20平方厘米/m2 (n = 111)。我们还确定了影响左心室质量消退的预测因子。 结果: 两组术前左室质量指数差异无统计学意义 (p = 0.431)。两组左心室质量指数的时间回归相似。左心室质量回归的独立预测因素是男性 (p = 0.007) 和术前左心室质量指数 (p = 0.003)，但瓣膜大小不是 (p = 0.641)。 结论: 在无患者-假体不匹配的患者中，术后有效开口面积的程度与左心室质量的时间回归之间没有关系。左心室质量回归的独立预测因素为男性和术前左心室质量指数。
METHODS::We present the case of a 61-year-old woman with a large tumoral infiltration extending from the pelvis throughout the inferior vena cava inferior to the right atrium, protruding into the right ventricle and right ventricular outflow tract. She had been treated 10 years before for low-grade endometrial stromal sarcoma by hysterectomy and adnexectomy followed by hormone- and radio-therapy. Due to cancer recurrence, she underwent peritonectomy, appendectomy, and resection of terminal ileum.
METHODS:AIMS:Significant platelet activation after long stented coronary segments has been associated with periprocedural microvascular impairment and myonecrosis. In long lesions treated either with an everolimus-eluting bioresorbable vascular scaffold (BVS) or an everolimus-eluting stent (EES), we aimed to investigate (a) procedure-related microvascular impairment, and (b) the relationship of platelet activation with microvascular function and related myonecrosis. METHODS AND RESULTS:Patients (n=66) undergoing elective percutaneous coronary intervention (PCI) in long lesions were randomised 1:1 to either BVS or EES. The primary endpoint was the difference between groups in changes of pressure-derived corrected index of microvascular resistance (cIMR) after PCI. Periprocedural myonecrosis was assessed by high-sensitivity cardiac troponin T (hs-cTnT), platelet reactivity by high-sensitivity adenosine diphosphate (hs-ADP)-induced platelet reactivity with the Multiplate Analyzer. Post-dilatation was more frequent in the BVS group, with consequent longer procedure time. A significant difference was observed between the two groups in the primary endpoint of ΔcIMR (p=0.04). hs-ADP was not different between the groups at different time points. hs-cTnT significantly increased after PCI, without difference between the groups. CONCLUSIONS:In long lesions, BVS implantation is associated with significant acute reduction in IMR as compared with EES, with no significant interaction with platelet reactivity or periprocedural myonecrosis.
METHODS:BACKGROUND:Aortopulmonary window is an uncommon congenital heart disease, with untreated cases not surviving beyond childhood. However, very rarely it can present in adult patients with features of pulmonary hypertension. Clinically these patients cannot be differentiated from other more common conditions with left to right shunt. Transthoracic echocardiography if performed meticulously, can depict the defect in aortopulmonary septum. RESULTS:We report a case of large unrepaired aortopulmonary window in a 23 years old patient, diagnosed on transthoracic echocardiography.