Subvalvular left ventricular false aneurysm complicating mitral valve replacement

Surgical replacement of the mitral valve by a prosthetic valve may lead to localized disruption of atrioventricular continuity resulting from direct surgical trauma or from delayed rupture of the weakened annulus. Such disruption leads to subepicardial hematoma formation that may remain localized if pericardial adhesions are present. Of two patients who suffered this complication, the first died of rupture of the epicardial hematoma. The hemorrhage in the second patient was contained by pericardial adhesions and had organized, thus resulting in a subannular left ventricular false aneurysm. The aneurysm was found incidentally at autopsy after the patient died of cerebral embolism from prosthetic valve thrombi.     

Morphological and functional characteristics of myocytes isolated from human left ventricular aneurysms

Isolated single myocytes were prepared from myocardium of developing ventricular aneurysms and from myocardium within the scar of chronic ventricular aneurysms. The morphology and function of the individual cells were compared. The cells from developing aneurysms were rod-shaped, with a distinct sarcomeric structure, but did not contract even in the presence of high calcium concentrations. The sarcomere length was significantly higher than that of cells from chronic aneurysms and approached the theoretical point at which no contraction can occur. Cells from chronic aneurysms were either rod-shaped and contractile, or rounded due to hypercontracture of the myofilaments. Electron microscopy of cells from developing aneurysms confirmed the presence of elongated sarcomeres, a loss of the actin-myosin interdigitation, and damage to the contractile proteins which was particularly evident in the thin filaments. Cells with similar characteristics have also been isolated from a ruptured, ischaemic papillary muscle. These changes, which are due either to ischaemia or to overstretching of cells, may account for the weakness of the wall of developing aneurysms and be a cause of rupture or enlargement.     

Ischemic dilatative cardiomyopathy and aneurysms of the left ventricular cavity: transplantation vs alternative surgery

Patients with terminal end-stage heart failure due to severe coronary disease associated with dilatative cardiomyopathy have an annual mortality of 30-50%. Between July 1997 and December 1999, 21 patients at the University Hospital in Frankfurt, and 25 patients from Skopje underwent total circular repair with simultaneous coronary artery bypass.     

The effects of left atrial and left ventricular cannulation on left ventricular function

A study in anesthetised dogs was undertaken to investigate the immediate effects of cannulation of the heart for left heart bypass on left ventricular function. Twenty-six mongrel dogs were studied. In the first group of 13 dogs (Group A), left atrial cannulation was performed through the atrial appendage and in the second group of 13 dogs (Group B), the left ventricular apex was also cannulated. Systemic blood pressure, heart rate, left atrial pressure, left ventricular end diastolic pressure and dP/dT showed no difference in left ventricular function between Groups A and B. Global ejection fraction (EF) measured by injection of technetium99m-labelled human serum albumen with gated left ventricular imaging, showed no significant difference between the two groups but analysis of the regional contribution to global EF in Group B dogs demonstrated a significant reduction in left ventricular function at the site of ventricular cannulation (P less than 0.05). These findings, together with other reported disadvantages of left ventricular cannulation, suggest that the left atrium is the preferred site for cannulation when left heart bypass is required. Many reports attest to the value of mechanical circulatory support in patients with ventricular dysfunction who cannot be weaned from cardiopulmonary bypass (2, 4, 10, 11, 15). Initial support is commonly provided by an intra-aortic balloon pump but, in more severe cases, use of a left ventricular assist device may be warranted. More recently, such devices have also been employed in the management of patients with cardiogenic shock refractory to medical therapy (10).(ABSTRACT TRUNCATED AT 250 WORDS)     

Cardiac papillary fibroelastoma in left ventricular apex.

Papillary fibroelastoma (PF) is a rare benign heart tumor and represents less than 10% of primary cardiac tumors. It mainly affects the cardiac valves and is often discovered during open heart surgery or autopsy. We present a case of a patient who was detected with a left ventricular apex tumor during the evaluation of the transient ischemic attack. The patient underwent surgery, and subsequently, macroscopic and microscopic examination confirmed the diagnosis of PF.     

Putative radionuclide features of left ventricular hypertrophy.

Distinctive changes in the left ventricular cavity seen with nuclear ventriculographic studies are described. These changes are postulated to be uniquely associated with left ventricular hypertrophy.     

Successful implantation of HeartWare HVAD left ventricular assist device with concomitant ascending and sinus of valsalva aneurysms repair

Coexistence of aortic disease is an uncommon finding in end-stage heart failure patients requiring left ventricular assist device (LVAD) placement. A 38-year-old man with non-ischemic dilated cardiomyopathy was admitted in stage D heart failure. Preoperative computed tomography demonstrated multiple saccular aneurysms of the ascending aorta and sinus of valsalva. We successfully performed complex aortic surgery and the implantation of a continuous-flow LVAD (HeartWare HVAD) (HeartWare International, Framingham, MA). The postoperative course was uneventful. The patient is currently listed for heart transplantation.     

Pathologic evidence of extensive left ventricular involvement in arrhythmogenic right ventricular cardiomyopathy.

Arrhythmogenic right ventricular cardiomyopathy (also known as arrhythmogenic right ventricular dysplasia) is characterized by adipose or fibroadipose tissue replacement of the right ventricular myocardium, whereas the left ventricle is substantively spared. Two cases of the disease with evidence of extensive left ventricular involvement at pathologic examination are described. Hearts from two patients who died suddenly showed full-thickness right ventricular fatty infiltration associated with extensive left ventricular involvement (greater than 50% of myocardial thickness). These findings might explain the reported clinical features of left ventricle dysfunction in a subset of patients with arrhythmogenic right ventricular cardiomyopathy. In view of the biventricular involvement of the disease, it should simply be termed "arrhythmogenic cardiomyopathy."     

Effect of intrathoracic pressure on left ventricular performance.

Left ventricular dysfunction is common in respiratory-distress syndrome, asthma and obstructive lung disease. To understand the contribution of intrathoracic pressure to this problem, we studied the effects of Valsalva and Müller maneuvers on left ventricular function in eight patients. Implantation of intramyocardial markers permitted beat-by-beat measurement of the velocity of fiber shortening (VCF) and left ventricular volume. During the Müller maneuver, VCF and ejection fraction decreased despite an increase in left ventricular volume and a decline in arterial pressure. In addition, when arterial pressure was corrected for changes in intrapleural pressure during either maneuver it correlated better with left ventricular end-systolic volumes than did uncorrected arterial pressures. These findings suggest that negative intrathoracic pressure affects left ventricular function by increasing left ventricular transmural pressures and thus afterload. We conclude that large intrathoracic-pressure changes, such as those that occur in acute pulmonary disease, can influence cardiac performance.     

Familial left ventricular hypertrabeculation in two blind brothers.

So far, left ventricular hypertrabeculation (LVHT) has been described to occur only sporadically. In a 49-year-old man with Leber's hereditary optic neuropathy (LHON) due to the primary LHON mutation G3460A, arterial hypertension was reported since 2000 and palpitations since 1995. ECG revealed Wolff-Parkinson-White syndrome. Transthoracic echocardiography and cardiac MRI showed myocardial thickening and LVHT. Pindolol markedly improved the cardiac abnormalities. Surprisingly, LVHT was also found in the 50-year-old brother of the index patient who also had LHON and also carried the G3460A mtDNA mutation. This brother also had Wolff-Parkinson-White syndrome and myocardial thickening, but without hypertension. It is concluded that LVHT, previously described to occur only sporadically, may be hereditary in single cases.     

Human left ventricular ultrastructure. Clinical and laboratory catheterization correlation.

Biopsy specimens of the myocardium for electron microscopical study were taken from patients who were having surgical operations for correction of aortic and mitral valve lesions. Ultranstructural changes characteristic of hypertrophy and ischemia were found in the left ventricles of groups with aortic and mitral lesions. The severity of the cardiomyopathy was greater in hearts that had aortic lesions than in those that had mitral lesions. Both groups, however, displayed degenerative changes to an extent not readily appreciated or expected when their clinical histories and catheterization data were obtained.     

老年高血压状态下左心室构型与左心房和左心室容积

背景：研究表明,左心房容积可反映左心室充盈压、心房结构重塑及神经激素的活动,左心房容积扩大是预测慢性心力衰竭不良预后的一个强有力的标志。 目的：观察老年原发性高血压患者在不同左心室构型情况下左心房容积和左心室容积的变化。 方法：采用超声心动图对129例老年原发性高血压患者(高血压组)和125名体检血压正常的老年人(对照组)的左心房容积和左心室容积相关指标进行测量,并依据Ganau标准对左心室几何构型进行分型;同时对老年高血压患者进行动态血压监测,依据血压节律进行分组比较。 结果与结论：与对照组比较,高血压组左心房容积、左心房容积指数、左心室收缩末期容积、左心室舒张末期容积均明显增大(P < 0.05);同时,在高血压组内,病程和动态血压昼夜节律对左心室几何构型的分布有影响,且左心室构型异常者上述指标较左心室构型正常者增大更明显(P < 0.05)。提示,老年原发性高血压患者病程和非杓型血压节律对左心室构型存在重要影响,左心房容积和左心室容积的变化与左心室构型的改变相伴随。     

Microprocessor-based left ventricular cineangiogram analyser

Medical &; Biological Engineering &; Computing -