Ehokardiografska procjena bolesnika s mehaničkom potporom srcu Heart Mate II

Echocardiography plays an important role in evaluating patients both before and after the implantation of mechanical circulatory support devices. It consists of a standard examination expanded to specific aspects of ventricular assist devices. The scope of examination varies according to the type of the device, the method of implantation and the localization of the inflow and outflow cannulas. This article is focused on the echocardiographic examination of patients undergoing the implantation of the HeartMate II (Thoratec) – a continuous-flow ventricular assist device. It provides a review of all the important parts of the examination, including the preoperative, the intraoperative and the postoperative examination. The utilization of transthoracic and transesophageal echocardiography is presented. The methods of diagnosing the malfunction of the device are also discussed. The author emphasizes that the assessment of a patient with a mechanical assist device is a complex and an interdisciplinary challenge, where echocardiography is crucial in the assessment of the patients with mechanical circulatory support devices.Ehokardiografija igra ključnu ulogu u kliničkoj prognozi pacijenta prije i poslije ugradnje uređaja za mehaničku potporu srcu i cirkulaciji. Ova metoda uključuje standardni pregled sa specifičnim pogledom na ventrikularni potporni uređaj. Područje pregleda ovisi o vrsti uređaja, metodi implantacije i smještaju ulazne i izlazne kanile. Ovaj članak opisuje ehokardiografski pregled pacijenta te što je sve potrebno sagledati prilikom preoperativnog, intraoperativnog i postoperativnog pregleda. Prikazan je način upotrebe transtorakalnog i transezofagijskog ehokardiografa. Opisuju se i metode dijagnosticiranja nepravilnog rada uređaja za mehaničku potporu. Autor naglašava kompleksnost dijagnostike pacijenata s ugrađenom mehaničkom potporom srcu i cirkulaciji te prikazuje ehokardiografiju kao neophodnu dijagnostičku metodu kod ovih pacijenata

The effect of acetylsalicylic acid dosed at bedtime on the anti-aggregation effect in patients with coronary heart disease and arterial hypertension: A randomized, controlled trial

Background: Acetylsalicylic acid (ASA) is one of the basic drugs used in the secondary prevention ofcoronary artery disease (CAD), and in most cases it is taken in the morning in one daily dose. It is suggestedthat the morning peak of platelet aggregation is responsible for the occurrence of myocardial infarctionsand strokes. Hence, the aim of the study was to observe the effect of ASA (morning vs. evening)dosing on the anti-aggregative effect of platelets in patients with CAD and arterial hypertension (AH).Methods: The study involved 175 patients with CAD and AH. Patients were randomly assigned toone of two study groups, taking ASA in the morning or in the evening. The patients had two visits, onebaseline and another after 3 months from changing the time of ASA dosage. The platelet aggregationwas determined using the VerifyNow analyzer.Results: In the ASA evening group, a significant reduction in platelet aggregation was obtained. Inthe ASA morning group, a significant difference in response to ASA was observed, depending on sex. Inmen, the reactivity of platelets decreased, but in women it increased.Conclusions: In the group of patients with CAD and AH, bedtime ASA dosing is associated witha significant reduction in platelet aggregation. The response to ASA may differ between sexes. The benefitgained by changing the drug administration from the morning to the evening is greater in women

Comparative analysis of cardiac function before LVAD implantation in patients with and without early, acute right heart failure: insights from cardiac magnetic resonance

BackgroundEarly acute right heart failure (eaRHF) during left ventricular assist device (LVAD) implantation significantly impacts patient survival and complicates perioperative management. Although numerous clinical, echocardiographic, and hemodynamic risk factors have been identified, accurately predicting eaRHF remains challenging. Cardiac magnetic resonance (CMR) provides a precise, non-invasive evaluation of cardiac structure and function and may enhance risk stratification eaRHF. This study aims to assess the predictive value of preoperative CMR-derived parameters, comparing their utility to established echocardiographic and right heart catheterization (RHC) markers for identifying eaRHF.MethodsThis retrospective analysis was conducted on 55 patients who received CMR before LVAD implantation at our center between 2018 and 2024. Of these 55 patients, 40 had image quality sufficient for offline analysis. Patients receiving a temporary right ventricular assist device (tRVAD) intraoperatively were defined as having eaRHF. Receiver Operating Characteristic (ROC) analysis was used to evaluate the predictive capability of CMR, echocardiographic, and RHC parameters.ResultsTen patients (25%) developed eaRHF. Preoperative bilirubin levels were significantly higher in the eaRHF group (1.6 mg/dl vs. 1.1 mg/dl, p = 0.010). Echocardiographic Tricuspid Annular Plane Systolic Excursion (TAPSE) tended to be lower in eaRHF patients (12 mm vs. 18 mm, p = 0.080). RHC parameters, specifically right ventricular stroke work index (RV-SWI; p < 0.001), cardiac output (CO; p = 0.003), and cardiac index (CI; p = 0.004), were significantly lower in eaRHF patients. CMR showed significantly higher RV end-diastolic volumes (RV-EDV, 288.4 ml vs. 216.7 ml, p = 0.046) and indexed RV-EDV (RV-EDVi, 135.4 ml/m2 vs. 104.7 ml/m2, p = 0.033) in the eaRHF group. ROC analysis identified CO (AUC = 0.90, sensitivity = 100%, specificity = 72%, p < 0.001), CI (AUC = 0.88, sensitivity = 83%, specificity = 83%, p < 0.001), and RV-SWI (AUC = 0.86, sensitivity = 83%, specificity = 86%, p < 0.001) as strong predictors. Moderate predictive values were observed for RV-EDVi (AUC = 0.73, p = 0.040) and RV global radial strain (RV-GRS; AUC = 0.70, p = 0.044).ConclusionHemodynamic parameters from RHC demonstrated the strongest predictive capability for eaRHF. However, selected CMR-derived parameters, especially indexed RV-EDV and RV GRS, offer moderate predictive value and may serve as adjunctive tools in preoperative risk stratification for LVAD candidates

High proportion of genetic cases in patients with advanced cardiomyopathy including a novel homozygous Plakophilin 2-gene mutation

Cardiomyopathies might lead to end-stage heart disease with the requirement of drastic treatments like bridging up to transplant or heart transplantation. A not precisely known proportion of these diseases are genetically determined. We genotyped 43 index-patients (30 DCM, 10 ARVC, 3 RCM) with advanced or end stage cardiomyopathy using a gene panel which covered 46 known cardiomyopathy disease genes. Fifty-three variants with possible impact on disease in 33 patients were identified. Of these 27 (51%) were classified as likely pathogenic or pathogenic in the MYH7, MYL2, MYL3, NEXN, TNNC1, TNNI3, DES, LMNA, PKP2, PLN, RBM20, TTN, and CRYAB genes. Fifty-six percent (n = 24) of index-patients carried a likely pathogenic or pathogenic mutation. Of these 75% (n = 18) were familial and 25% (n = 6) sporadic cases. However, severe cardiomyopathy seemed to be not characterized by a specific mutation profile. Remarkably, we identified a novel homozygous PKP2-missense variant in a large consanguineous family with sudden death in early childhood and several members with heart transplantation in adolescent age

Clinical impact and 'natural' course of uncorrected tricuspid regurgitation after implantation of a left ventricular assist device: an analysis of the European Registry for Patients with Mechanical Circulatory Support (EUROMACS)

OBJECTIVES: Data on the impact and course of uncorrected tricuspid regurgitation (TR) during left ventricular assist device (LVAD) implantation are scarce and inconsistent. This study explores the clinical impact and natural course of uncorrected TR in patients after LVAD implantation. METHODS: The European Registry for Patients with Mechanical Circulatory Support was used to identify adult patients with LVAD implants without concomitant tricuspid valve surgery. A mediation model was developed to assess the association of TR with 30-day mortality via other risk factors. Generalized mixed models were used to model the course of post-LVAD TR. Joint models were used to perform sensitivity analyses. RESULTS: A total of 2496 procedures were included (median age: 56 years; men: 83%). TR was not directly associated with higher 30-day mortality, but mediation analyses suggested an indirect association via preoperative elevated right atrial pressure and creatinine (P = 0.035) and bilirubin (P = 0.027) levels. Post-LVAD TR was also associated with increased late mortality [hazard ratio 1.16 (1.06-1.3); P = 0.001]. On average, uncorrected TR diminished after LVAD implantation. The probability of having moderate-to-severe TR immediately after an implant in patients with none-to-mild TR pre-LVAD was 10%; in patients with moderate-to-severe TR pre-LVAD, it was 35% and continued to decrease in patients with moderate-to-severe TR pre-LVAD, regardless of pre-LVAD right ventricular failure or pulmonary hypertension. CONCLUSIONS: Uncorrected TR pre-LVAD and post-LVAD is associated with increased early and late mortality. Nevertheless, on average, TR diminishes progr

Paraprosthetic leak closure 28 years after mitral caged-ball Starr-Edwards implantation

In this case report, we present a patient 28 years after mitral valve replacement with the Starr-Edwards prosthesis complicated by periprosthetic leak with severe aortic stenosis and moderate tricuspid regurgitation. We successfully repaired the periprosthetic regurgitation in a patient with extensive mitral annular calcification, without replacement of the valve. No apparent structural deterioration on the caged-ball valve was found. Moreover, aortic valve replacement and tricuspid annuloplasty were performed. One month after reoperation, the patient remained stable with improved clinical status and without any evidence for further paravalvular leak