CHIMNEY TECHNIQUE IN ABDOMINAL AORTIC ANEURYSM WITH RENAL ARTERIES INVOLVEMENT
TECNICA CHIMNEY IN ANEURISMA DELL’AORTA ADDOMINALE CON COINVOLGIMENTO DELLE ARTERIE RENALI
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
A 75-year-old man with a history of HIV, kidney disease, and heart disease was admitted for pacemaker implantation. Initially, only mild tricuspid regurgitation was observed. However, 6 months later, severe right heart failure developed and echocardiography showed severe tricuspid regurgitation. 3D echocardiography revealed that the pacemaker lead was impeding closure of the tricuspid valve, causing iatrogenic functional tricuspid regurgitation. The pacemaker lead was responsible for incomplete coaptation of the tricuspid valve leaflets, a rare but severe complication of pacemaker implantation.
This document discusses guidelines for performing tricuspid valve surgery. It notes that 30-50% of patients who undergo isolated mitral valve replacement later develop moderate or severe tricuspid regurgitation. The document recommends considering combined tricuspid valve surgery during left-sided valve surgery if the tricuspid regurgitation grade is greater than 2/4 or the tricuspid annular diameter is 40mm or larger, in order to prevent late tricuspid regurgitation and right ventricular dysfunction. A strategy based on both tricuspid regurgitation grade and annular diameter is associated with better outcomes than one based on regurgitation grade alone.
CHIMNEY TECHNIQUE IN ABDOMINAL AORTIC ANEURYSM WITH RENAL ARTERIES INVOLVEMENT
TECNICA CHIMNEY IN ANEURISMA DELL’AORTA ADDOMINALE CON COINVOLGIMENTO DELLE ARTERIE RENALI
(Chirurgia Vascolare-ULSS 15 Alta Padovana)
(Vascular Surgery -ULSS 15 Alta Padovana)
A 75-year-old man with a history of HIV, kidney disease, and heart disease was admitted for pacemaker implantation. Initially, only mild tricuspid regurgitation was observed. However, 6 months later, severe right heart failure developed and echocardiography showed severe tricuspid regurgitation. 3D echocardiography revealed that the pacemaker lead was impeding closure of the tricuspid valve, causing iatrogenic functional tricuspid regurgitation. The pacemaker lead was responsible for incomplete coaptation of the tricuspid valve leaflets, a rare but severe complication of pacemaker implantation.
This document discusses guidelines for performing tricuspid valve surgery. It notes that 30-50% of patients who undergo isolated mitral valve replacement later develop moderate or severe tricuspid regurgitation. The document recommends considering combined tricuspid valve surgery during left-sided valve surgery if the tricuspid regurgitation grade is greater than 2/4 or the tricuspid annular diameter is 40mm or larger, in order to prevent late tricuspid regurgitation and right ventricular dysfunction. A strategy based on both tricuspid regurgitation grade and annular diameter is associated with better outcomes than one based on regurgitation grade alone.
El documento describe la regurgitación tricúspide en contexto. Explica la anatomía, las causas, la fisiopatología y la evaluación de la regurgitación tricúspide, incluidos los mecanismos, la cuantificación mediante ecocardiografía y la resonancia magnética. También analiza los factores de riesgo asociados con un grado postoperatorio más alto de regurgitación tricúspide y las indicaciones quirúrgicas.
Ebstein's anomaly is a rare heart defect where the tricuspid valve, which separates the right atrium and ventricle, is abnormally located low in the right ventricle. This causes the right atrium to enlarge and the right ventricle to have two sections - an upper atrialized section and a lower functional section. Symptoms range from none in mild cases to cyanosis, heart failure and arrhythmias in severe cases. Diagnosis involves echocardiogram, ECG and chest x-ray. Treatment options include medications, surgery to repair or replace the valve, and management of complications like heart failure. Prognosis depends on severity of symptoms, with earlier presentation indicating poorer prognosis.
The document discusses when to consider tricuspid valve repair. Tricuspid regurgitation is associated with poor prognosis, especially when secondary to left-sided heart lesions, cardiomyopathy, pulmonary hypertension, or in the setting of LVAD placement or heart transplantation. Tricuspid valve repair is indicated for severe, symptomatic primary tricuspid regurgitation, and may also be considered for significant functional regurgitation concurrent with mitral valve surgery, after isolated mitral valve surgery if regurgitation is severe, or when placing a continuous-flow LVAD. Prophylactic tricuspid annuloplasty during heart transplantation reduces the severity of post-operative regurgitation and is associated with improved long-term survival
Ebstein’s anomaly is a rare congenital heart disorder occurring in ≈1 per 200 000 live births and accounting for <1% of all cases of congenital heart disease. This anomaly was described by Wilhelm Ebstein in 1866 in a report titled, “Concerning a very rare case of insufficiency of the tricuspid valve caused by a congenital malformation.” The patient was a 19-year-old cyanotic man with dyspnea, palpitations, jugular venous distension, and cardiomegaly. At autopsy, Ebstein described an enlarged and fenestrated anterior leaflet of the tricuspid valve. The posterior and septal leaflets were hypoplastic, thickened, and adherent to the right ventricle. There was also a thinned and dilated atrialized portion of the right ventricle, an enlarged right atrium, and a patent foramen ovale. By 1950, only 3 cases of this anomaly had been published.
The document discusses tricuspid valve stenosis and insufficiency. It defines the conditions as a narrowing or stiffening of the tricuspid valve opening (stenosis), or the valve not closing tightly enough to prevent leakage (insufficiency). Causes can include rheumatic fever, infections, congenital malformations, and tumors. Risks include right heart failure and liver congestion. Diagnosis involves physical exams, echocardiograms, and cardiac catheterization. Treatment options include medications, valve repairs such as annuloplasty or valvuloplasty, and valve replacements. Complications include heart failure, endocarditis, and liver cirrhosis.
Este documento describe los conceptos clave de la educación a distancia y las modalidades de enseñanza mediada por tecnología. Explica que la educación a distancia utiliza las TIC para mediar la enseñanza a través de Internet y propone formas específicas de interacción entre estudiantes y profesores de manera no presencial. Luego describe tres modalidades: extended learning, que extiende la enseñanza presencial mediante tecnología; blended learning, que combina enseñanza presencial y a distancia; y educación
Marc Gerdisch, MD, a senior partner with Cardiac Surgery Associates and chief of cardiovascular and thoracic surgery at Franciscan St. Francis Health, specializes in performing complex heart valve surgery. Throughout his career he has performed over 5,000 innovative surgical procedures, as well as created new heart surgery processes. Dedicated to helping others outside the realm of medicine, Dr. Marc Gerdisch supports Sycamore School in Indianapolis.
This document provides information on Ebstein's anomaly, including its anatomy, embryology, clinical presentation, diagnosis, and natural history. Some key points:
- Ebstein's anomaly is a congenital defect involving downward displacement of the tricuspid valve into the right ventricle. This can cause dilation of the right atrium and dysfunction of the right ventricle.
- Clinical presentation varies from neonatal congestive heart failure to later cyanosis, arrhythmias, and right heart failure in adults. Associated defects are common.
- Diagnosis is made through echocardiogram demonstrating displacement of the tricuspid valve leaflets. Other tests like ECG, chest x-ray, and
El documento describe la regurgitación tricúspide en contexto. Explica la anatomía, las causas, la fisiopatología y la evaluación de la regurgitación tricúspide, incluidos los mecanismos, la cuantificación mediante ecocardiografía y la resonancia magnética. También analiza los factores de riesgo asociados con un grado postoperatorio más alto de regurgitación tricúspide y las indicaciones quirúrgicas.
Ebstein's anomaly is a rare heart defect where the tricuspid valve, which separates the right atrium and ventricle, is abnormally located low in the right ventricle. This causes the right atrium to enlarge and the right ventricle to have two sections - an upper atrialized section and a lower functional section. Symptoms range from none in mild cases to cyanosis, heart failure and arrhythmias in severe cases. Diagnosis involves echocardiogram, ECG and chest x-ray. Treatment options include medications, surgery to repair or replace the valve, and management of complications like heart failure. Prognosis depends on severity of symptoms, with earlier presentation indicating poorer prognosis.
The document discusses when to consider tricuspid valve repair. Tricuspid regurgitation is associated with poor prognosis, especially when secondary to left-sided heart lesions, cardiomyopathy, pulmonary hypertension, or in the setting of LVAD placement or heart transplantation. Tricuspid valve repair is indicated for severe, symptomatic primary tricuspid regurgitation, and may also be considered for significant functional regurgitation concurrent with mitral valve surgery, after isolated mitral valve surgery if regurgitation is severe, or when placing a continuous-flow LVAD. Prophylactic tricuspid annuloplasty during heart transplantation reduces the severity of post-operative regurgitation and is associated with improved long-term survival
Ebstein’s anomaly is a rare congenital heart disorder occurring in ≈1 per 200 000 live births and accounting for <1% of all cases of congenital heart disease. This anomaly was described by Wilhelm Ebstein in 1866 in a report titled, “Concerning a very rare case of insufficiency of the tricuspid valve caused by a congenital malformation.” The patient was a 19-year-old cyanotic man with dyspnea, palpitations, jugular venous distension, and cardiomegaly. At autopsy, Ebstein described an enlarged and fenestrated anterior leaflet of the tricuspid valve. The posterior and septal leaflets were hypoplastic, thickened, and adherent to the right ventricle. There was also a thinned and dilated atrialized portion of the right ventricle, an enlarged right atrium, and a patent foramen ovale. By 1950, only 3 cases of this anomaly had been published.
The document discusses tricuspid valve stenosis and insufficiency. It defines the conditions as a narrowing or stiffening of the tricuspid valve opening (stenosis), or the valve not closing tightly enough to prevent leakage (insufficiency). Causes can include rheumatic fever, infections, congenital malformations, and tumors. Risks include right heart failure and liver congestion. Diagnosis involves physical exams, echocardiograms, and cardiac catheterization. Treatment options include medications, valve repairs such as annuloplasty or valvuloplasty, and valve replacements. Complications include heart failure, endocarditis, and liver cirrhosis.
Este documento describe los conceptos clave de la educación a distancia y las modalidades de enseñanza mediada por tecnología. Explica que la educación a distancia utiliza las TIC para mediar la enseñanza a través de Internet y propone formas específicas de interacción entre estudiantes y profesores de manera no presencial. Luego describe tres modalidades: extended learning, que extiende la enseñanza presencial mediante tecnología; blended learning, que combina enseñanza presencial y a distancia; y educación
Marc Gerdisch, MD, a senior partner with Cardiac Surgery Associates and chief of cardiovascular and thoracic surgery at Franciscan St. Francis Health, specializes in performing complex heart valve surgery. Throughout his career he has performed over 5,000 innovative surgical procedures, as well as created new heart surgery processes. Dedicated to helping others outside the realm of medicine, Dr. Marc Gerdisch supports Sycamore School in Indianapolis.
This document provides information on Ebstein's anomaly, including its anatomy, embryology, clinical presentation, diagnosis, and natural history. Some key points:
- Ebstein's anomaly is a congenital defect involving downward displacement of the tricuspid valve into the right ventricle. This can cause dilation of the right atrium and dysfunction of the right ventricle.
- Clinical presentation varies from neonatal congestive heart failure to later cyanosis, arrhythmias, and right heart failure in adults. Associated defects are common.
- Diagnosis is made through echocardiogram demonstrating displacement of the tricuspid valve leaflets. Other tests like ECG, chest x-ray, and
This document discusses the treatment of pulmonary arterial hypertension (PAH), including:
- Approved PAH therapies such as endothelin receptor antagonists, phosphodiesterase-5 inhibitors, and prostanoids.
- The three main pathways involved in PAH pathogenesis.
- Treatment recommendations for PAH associated with congenital heart disease, including the use of PAH-specific therapies.
- Evidence that PAH-specific therapies can reduce mortality in patients with Eisenmenger syndrome.
- Lung transplantation is an option for patients with inadequate response to maximal PAH therapy.
H trattamento dell’ipertensione arteriosa polmonareguch-piemonte
This document discusses the treatment of pulmonary arterial hypertension. Pulmonary arterial hypertension has several underlying causes, with the most common being idiopathic pulmonary arterial hypertension at around 50% of cases. Medications are the primary treatment and work to dilate blood vessels and improve heart function. These include endothelin receptor antagonists, phosphodiesterase type-5 inhibitors, prostanoids, and soluble guanylate cyclase stimulators. In severe cases, lung transplantation may be considered.
33. La Risonanza Magnetica:
valutazione “all inclusive”
•E’ il Gold Standard per il calcolo:
‐ Frazione di rigurgito valvolare
‐ Volumi teledastolici e telesistolici
‐ Frazione d’eiezione
•Consente la valutazione:
‐ Anatomia e flusso relaHvo dei rami polmonari
‐ Dimensioni aorta ascendente, coronarie
‐ Presenza di fibrosi muscolare: rischio aritmico
50. Ebstein Anomaly
(1) adherence of the septal and posterior leaflets
to the underlying myocardium (failure of delamination
during embryologic development);
(2) downward (apical) displacement of the functional annulus
(3) dilation of the “atrialized” portion of the right ventricle
(4) redundancy, fenestrations, and tethering of the anterior leaflet
(5) dilation of the right atrioventricular junction (true tricuspid
annulus)
