Fast technology development over the past decade as well as changes in practical echocardiography (EchoCG) lead to have given rise to a need in the update of previous guidelines for cardiac chambers quantification, which was the aim of this publication by working group of the Association of Cardiovascular Surgeons of Ukraine and Ukrainian Society of Cardiology. This paper provides up-to-date evidence-based data regarding reference ranges for all cardiac chambers, including available data regarding 3D-echocardiography and myocardial deformation (strain), based on the wide range of studies of healthy individuals found in many databases in healthy individuals. In addition, this document contains an attempt to adjust several minor controversies from previous guidelines. This document is based on “Recommendations for Cardiac Chamber Quantification by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging” (2015) adapted according to the local peculiarities and printed abridged. Full content of “Cardiac Chamber Quantifica-tion by Echocardiography in Adults: Recommendations from the Association of Cardiovascular Surgeons of Ukraine and Ukrainian Society of Cardiology” is available online at the official Website https://amosovinstitute.org.ua of the National Amosov Institute of Cardiovascular Surgery of the NAMS of Ukraine. This paper contains key recommendations, reference ranges and quantification methods in pictures and tables.
With a mortality rate of 1 % to 5 %, surgical treatment of cardiac myxomas (CM) may be complicated by the development of intra- or postoperative bleeding, among other things. The aim. To present an unusual case of surgical treatment of left atrial myxoma with the occurrence of intraoperative bleeding, which was due to extremely rare features of the coronary circulation with a special blood supply to the base of the CM. Case report. Female patient R., 65 years old, case record No.3686, was admitted to the National Amosov Institute of Cardiovascular Surgery of the National Academy of Medical Sciences of Ukraine with diagnosis of CM. Coronary angiography revealed unique features of coronary circulation: an arteriovenous malformation from the distal parts of the circumflex branch of the left coronary artery with discharge into the right parts of the heart was revealed. On 9/20/2022, urgent operation of resection of the myxoma of the left atrium (LA) was performed. After removal of the myxoma and sealing of the heart, accumulation of arterial blood was found in the area of the inferior vena cava (IVC) and the interatrialsulcus. Revision of the left atrium cavity was performed again:all intracardiac sutures in the area of the myxoma base were duplicated. After repeated resealing of the heart chambers, bleeding from the IVC region stopped after administration of protamine sulfate and tight tamponade of the space under the IVC. Tampons were removed from the pericardial cavity after 72 hours. Results. The source of the bleeding could be the site of the malformation of the coronary arteries, which is a tangle of small vessels located in the projection of the base of the myxoma below the point where the IVC meets the right atrium. During the histological examination of the myxoma, large full-blood vessels of the sinusoidal type were revealed, around which, due to damage to their thin walls, hematomas formed, giving the tumor a spotted appearance. The peculiarity of this tumor was the presence of a very large vascular plexus at its base; it had the appearance of a cluster of sections of numerous, different-sized, deformed and remodeled arteries. These data were confirmed by coronary angiography. Conclusions. Studying the data of coronary angiography with the analysis offeatures of localization of coronary arteries, as well as the presence of possible coronary malformations, can provide information that allows predicting the possibility of their damage, especially in the case of localization in the place of possible surgical manipulation. In the event of bleeding, one of the optimal methods of its elimination is the use of long-term tamponade.
Дилатаційна кардіоміопатія (ДКМП) визначається наявністю дилатації лівого шлуночка або обох шлуночків та систолічною дисфункцією за відсутності патологічних умов навантаження або ішемічної хвороби серця, достатніх, щоб пояснити ці зміни. Це гетерогенна група захворювань, що часто має генетичне підґрунтя. Серцево-судинна візуалізація є надзвичайно важливою для встановлення діагнозу, оцінювання прогнозу та лікування. Мультимодальний підхід до візуалізації забезпечує найповнішу оцінку всіх аспектів, пов’язаних із цим захворюванням. Цей документ має на меті забезпечити детальні рекомендації з використання мультимодальної візуалізації відповідно до клінічних вимог з урахуванням сучасних світових доказових даних і рекомендацій та з адаптацією до існуючих практик в Україні. Вибір того чи іншого засобу візуалізації має базуватися на конкретних клінічних умовах та індивідуальному контексті. Методи візуалізації розглядаються з точки зору «клінічно релевантних» та засобів, що «можуть використовуватися». До сьогодні лишаються певні пробіли в доказовій базі щодо впливу мультимодальної візуалізації на ведення та лікування пацієнтів з ДКМП, що свідчить про важливість подальших досліджень у цьому напрямку.
Various studies demonstrate that recurrence of cardiac myxoma (CM) occurs in 2.1–5.3% of cases. In cases of treatment of familial myxoma, the need for reoperations can reach 20–25%. It should be taken into account that among all benign cardiac tumors, CM is detected in up to 80% of cases, and the need for its surgical removal is beyond doubt. The aim. To present a case that is of particular interest due to an unusual multiple myxomas lesion of the heart of multi-chamber localization. Material and methods. This article presents an unusual case of detecting multiple myxomas of multi-cameral heart lesions 6 years after removal of myxoma of the left atrium of typical localization. The distinguishing feature of the course of the disease lies in the fact that in this case, a careful study of the life history did not reveal the characteristic signs of familial myxomas and Carney complex which is most often characteristic of multi-chamber lesions of the heart by a tumor process. At the same time, during the surgical removal of the myxoma of the left ventricle, the myxomas of the left and right atrium were revealed, which began to grow. A technical feature of the removal of the left ventricular myxoma of the apical localization was the use of video cameras and instruments for thoracoscopic surgery, which greatly facilitated revi-sion and removal of the hard-to-reach neoplasm. Our experience in surgical treatment of CM equals to 868 operations. Wherein, repeated operations performed in 12 patients were due to recurrence or appearance of a tumor in place other than the primary localization. Conclusions. CM recurrence is one of infrequent complications in the postoperative period, which, however, requires some vigilance and annual Echo monitoring. In the vast majority of cases, CM was represented by the so-called sporadic myxomas, which are more often localized in the left atrium, and rarely recur. If CM is suspected, it is necessary to exclude the possibility of “myxoma syndrome”, which has the frequency of 0.8%, according to our data. The use of the instruments for thoracoscopic surgery can greatly facilitate the removal of hard-to-reach heart tumors localization.
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