• Korean Journal of Radiology
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• 제22권8호
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• pp.1253-1265
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• 2021

Objective: To investigate the prognostic value of preoperative cardiac magnetic resonance imaging (MRI) for long-term major adverse cardiac and cerebrovascular events (MACCEs) in patients undergoing tricuspid valve (TV) surgery for functional tricuspid regurgitation (TR). Materials and Methods: The preoperative cardiac MR images, New York Heart Association functional class, comorbidities, and clinical events of 78 patients (median [interquartile range], 59 [51-66.3] years, 28.2% male) who underwent TV surgery for functional TR were comprehensively reviewed. Cox proportional hazards analyses were performed to assess the associations of clinical and imaging parameters with MACCEs and all-cause mortality. Results: For the median follow-up duration of 5.4 years (interquartile range, 1.2-6.6), MACCEs and all-cause mortality were 51.3% and 23.1%, respectively. The right ventricular (RV) end-systolic volume index (ESVI) and the systolic RV mass index (RVMI) were higher in patients with MACCEs than those without them (77 vs. 68 mL/m², p = 0.048; 23.5 vs. 18.0%, p = 0.011, respectively). A high RV ESVI was associated with all-cause mortality (hazard ratio [HR] per value of 10 higher ESVI = 1.10, p = 0.03). A high RVMI was also associated with all-cause mortality (HR per increase of 5 mL/m² RVMI = 1.75, p < 0.001). After adjusting for age and sex, only RVMI remained a significant predictor of MACCEs and all-cause mortality (p < 0.05 for both). After adjusting for multiple clinical variables, RVMI remained significantly associated with all-cause mortality (p = 0.005). Conclusion: RVMI measured on preoperative cardiac MRI was an independent predictor of long-term outcomes in patients who underwent TV surgery for functional TR.

• Journal of Chest Surgery
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• 제18권4호
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• pp.667-672
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• 1985

Primary cardiac tumors are uncommon in all age group. In contrast, tumors metastatic to the heart are significantly more common. On rare occasions, tumor may extend into the heart chamber via inferior vena cava from other parts of the body, such as liver, kidney, and uterus cava. With recent advancement in diagnostic imaging modalities and surgical techniques, cardiac tumors are now potentially curably form of heart disease. The most important factor in diagnosing the tumor is a high index of clinical suspicion. Six patients underwent surgical removal of intracardiac tumor during a 5-year period. The mean age of the 4 women and two men was 40 years [range 23 to 60]. All patients were operated on in the last five years of the studied period. All patients had symptoms varying in duration from 1 month to 4 years [average 13 months]. 2-Dimensional echocardiography contributed most to preoperative diagnosis, confirming presence of an intracardiac tumor in all examined patients. Of the six intracardiac tumor, 5 were myxomas [4 left atrial and 1 right ventricular] and one right atrial metastasis from hepatocellular carcinoma of the liver. In all cases, tumor masses were successfully excised. One patient expired after the operation on account of low cardiac out-put syndrome. Remained one patient among six, tumor mass extended into RA and RV with a stalk via IVC. On later follow-up study showed cold area on liver scan [hepatocellular ca.], so she was transferred to internal medicine, department for chemotherapy. Follow up results showed no signs of tumor recurrence in 4 myxoma cases.

• Journal of Chest Surgery
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• 제48권3호
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• pp.164-173
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• 2015

Background: Hypertrophied myocardium is especially vulnerable to ischemic injury. This study aimed to compare the early and late clinical outcomes of three different methods of myocardial protection in patients with aortic stenosis. Methods: This retrospective study included 225 consecutive patients (mean age, 65{\pm}10 years; 123 males) with severe aortic stenosis who underwent aortic valve replacement. Patients were excluded if they had coronary artery disease, an ejection fraction <50%, more than mild aortic regurgitation, or endocarditis. The patients were divided into three groups: group A, which was treated with antegrade and retrograde cold blood cardioplegia; group B, which was treated with antegrade crystalloid cardioplegia using histidine-tryptophan-ketoglutarate (HTK) solution; and group C, treated with retrograde cold blood cardioplegia. Results: Group A contained 70 patients (31.1%), group B contained 74 patients (32.9%), and group C contained 81 patients (36%). The three groups showed significant differences with regard to the proportion of patients with a New York Heart Association functional classification ${\geq}III$ (p=0.035), N-terminal pro-brain natriuretic peptide levels (p=0.042), ejection fraction (p=0.035), left ventricular dimensions (p<0.001), left ventricular mass index (p<0.001), and right ventricular systolic pressure (p <0.001). Differences in cardiopulmonary bypass time (p=0.532) and aortic cross-clamp time (p=0.48) among the three groups were not statistically significant. During postoperative recovery, no significant differences were found regarding the use of inotropes (p=0.328), mechanical support (n=0), arrhythmias (atrial fibrillation, p=0.347; non-sustained ventricular tachycardia, p=0.1), and ventilator support time (p=0.162). No operative mortality occurred. Similarly, no significant differences were found in long-term outcomes. Conclusion: Although the three groups showed some significant differences with regard to patient characteristics, both antegrade crystalloid cardioplegia with HTK solution and retrograde cold blood cardioplegia led to early and late clinical results similar to those achieved with combined antegrade and retrograde cold blood cardioplegia.