scholarly journals Impact and evolution of right ventricular dysfunction after successful MitraClip implantation in patients with functional mitral regurgitation

2016 ◽  
Vol 11 ◽  
pp. 90-98 ◽  
Author(s):  
Cosmo Godino ◽  
Anna Salerno ◽  
Michela Cera ◽  
Eustachio Agricola ◽  
Gabriele Fragasso ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Functional Mitral Regurgitation

scholarly journals P1328 A bridge to sucess

2020 ◽  
Vol 21 (Supplement_1) ◽  
Author(s):  
S Ranchordas ◽  
P Oliveira ◽  
M Madeira ◽  
M Marques ◽  
T Nolasco ◽  
...  
Keyword(s):  
Heart Failure ◽  
Pulmonary Artery ◽  
Right Ventricular ◽  
Tricuspid Regurgitation ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Functional Mitral Regurgitation ◽  
Assist Device ◽  
Post Operative Period ◽  
Work Up

Abstract A 36-old-man was admitted in hospital with fever and cough, fatigue, rapidly progressive exertional dyspnoea and orthopnoea. Transthoracic echocardiogram (TTE) revealed a mildly dilated left ventricle (LV) with very low ejection fraction (EF), normally sized right chambers, severe right ventricular dysfunction, moderate tricuspid regurgitation and pulmonary artery systolic pressure (PASP) of 52mmHg. The diagnosis of myocarditis was suspected, and he was transferred to the ICU in our centre to proceed the diagnostic work up. Cardiac magnetic resonance showed a severely dilated LV with an EF of 13% and a transmural fibrotic scar on the lateral wall, without signs of myocardial oedema. There was an apical thrombus. Right ventricular EF was 25%. Coronary angiography showed thrombotic occlusion of the circumflex artery with delayed filling of marginal branches. Endomyocardial biopsy was performed but no myocardial lesion was seen. Temporary inotropic support was needed for low cardiac output. Optimized therapy for heart failure and anticoagulation were given and he received an implantable cardioverter defibrillator before discharge in NHYA class II. Two months later, he was re-admitted in his local hospital, complaining of cough with sputum, fever and shortness of breath. He was hypotensive, tachycardic and cyanotic. Blood workup revealed renal failure, coagulopathy and liver dysfunction with C-reactive protein of 10 mg/dL, but no leucocytosis. NT pro-BNP was 2459 pg/mL. Empirical antibiotics and inotropes were started. TTE revealed an EF of 10-15%, moderate functional mitral regurgitation, right ventricular dysfunction, moderate tricuspid regurgitation, and a PASP of 50 mmHg. He was transferred back to our centre. On admission, he was hemodynamically stable with perfusions of dobutamine and noradrenaline. Work up for inclusion in heart transplant waiting list was initiated. However, he deteriorated rapidly. It was decided to implant a biventricular assist device (BiVAD) for circulatory support as bridge to transplant. A short/medium term assist device was chosen as it was expected that a donor would be found in less than a month, and if this was not the case, it could be upgraded to a medium/long term device. Cannulas for LVAD were introduced on the LV apex and ascending aorta and for RVAD in the femoral vein and pulmonary artery. Good flows were achieved on both devices and there were no complications in the immediate post-operative period. He was extubated and weaned off inotropes on day 2. On day 9, a heart donor was found, and he was transplanted. No complications occurred in the post-operative period. He was discharged home on day 24, and resumed an active life. This case illustrates the usefulness of temporary devices to bridge critically ill candidates to heart transplantation. Also, it emphasizes the importance of identifying patients who definitely need a BiVAD when end-stage heart failure involves both ventricles. Abstract P1328 Figure.

Unmasking right ventricular dysfunction in chronic rheumatic mitral regurgitation

2019 ◽  
Vol 30 (4) ◽  
pp. 216-221
Author(s):  
Ruchika Meel ◽  
Ferande Peters ◽  
Elena Libhaber ◽  
Mohammed Essop
Keyword(s):  
Mitral Regurgitation ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction

Impact of right and left ventricular dysfunction on long-term outcome of moderate to severe secondary mitral regurgitation patients without surgical/interventional treatment

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
K Hu ◽  
M Schuckart ◽  
D Liu ◽  
V Schimpf ◽  
F Hermann ◽  
...  
Keyword(s):  
Mitral Regurgitation ◽  
Right Ventricular ◽  
Ventricular Dysfunction ◽  
Right Ventricular Dysfunction ◽  
Left Ventricular ◽  
Interventional Treatment ◽  
Lv Dysfunction ◽  
Biventricular Function ◽  
Secondary Mitral Regurgitation

Abstract Background Secondary mitral regurgitation (SMR) is common in aging population and related with poor outcome. Impact of right ventricular (RV) dysfunction with or without left ventricular (LV) dysfunction in this population remains unclear. The purpose of this study was to investigate the prevalence of isolated RV dysfunction and biventricular dysfunction, and to determine their prognostic implication in moderate to severe SMR without surgical/interventional treatment. Methods A total of 1090 consecutive moderate to severe SMR patients without surgical/interventional treatment hospitalized in our hospital center between 2009 and 2018 (aged 75±12 years, 60.4% male) were included. Transthoracic echocardiography was performed at baseline to define the cardiac morphology, function and severity of MR. Clinical and echocardiographic characteristics were analyzed. All patients completed at least 1-year clinical follow-up by reviewing the medical records or telephone interview. The primary endpoint was defined as all-cause death. Results A total of 521 patients (47.8%) reached the primary endpoint during the follow-up period [median 23 (8–40) months]. Mean left ventricular ejection fraction (LVEF) was 44.6±16.2%, and percent of patients with LVEF <50% (LV dysfunction) was 59.3%. RV dysfunction was defined as a reduced tricuspid annular plane excursion (TAPSE<17mm) or an increased systolic pulmonary artery disease (sPAP>40mmHg). Patients were divided into 4 subgroups: 1) preserved biventricular function: n=136 (12.5%); 2) isolated LV dysfunction: n=97 (8.9%); 3) isolated RV dysfunction: n=308 (28.3%); 4) biventricular dysfunction: n=549 (50.4%). The mortality in above group was 27.2%, 36.1%, 50.0%*† and 53.7%*†, respectively (*P<0.05 vs preserved biventricular function; †P<0.05 vs. isolated LV dysfunction). Multivariable survival analysis showed that isolated LV dysfunction (adjusted HR 1.78, P=0.016), isolated RV dysfunction (HR 1.59, P=0.013), or biventricular dysfunction (HR=2.14, P<0.001) were independently associated with increased all-cause mortality, after adjustment for age, sex and other clinical covariates associated with mortality including NYHA class, atrial fibrillation, hypertension, diabetes, hyperuricemia, coronary artery diseases, chronic respiratory diseases, sleep disturbance, and kidney dysfunction. Conclusions Right ventricular dysfunction is associated with significantly higher mortality in patients with secondary mitral regurgitation without surgical/interventional treatment as compared to patients with preserved biventricular function and isolated LV dysfunction. Future studies are warranted to observe if operative strategy could significantly improve the outcome in SMR patients complicating with right ventricular dysfunction. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): German Federal Ministry of Education and Research

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