Peripartum cardiomyopathy: a rare cause of acute heart failure.

A woman in her early 30s presented herself with acute dyspnoea and elevated D-dimers 5 weeks after delivery of her second child. Echocardiographic findings showed signs of acute left ventricular failure, and an MRI confirmed a non-ischaemic dilated left heart failure compatible with peripartum cardiomyopathy. The antihormonal therapy with bromocriptine during 6 weeks and an intensive heart failure therapy led to an amelioration of the heart function within 3 years, but full recovery was not yet observed.

Necrotising coronaritis with fatal outcome.

A 56-year-old woman presented with acute onset of typical chest pain. She was diagnosed with acute coronary syndrome with ST-segment elevation myocardial infarction. Although significant obstructive coronary artery disease was ruled out by coronary angiography, cardiac MRI showed transmural necrosis of the lateral free wall with extensive microvascular obstruction consistent with ischaemic heart disease. Within 48 hours after initial presentation, the patient suddenly arrested due to pulseless electrical activity with futile resuscitation efforts. Autopsy revealed myocardial perforation with extensive haematothorax due to pericardial laceration, caused by the mechanical chest compressions. Eventually, histology identified diffuse necrotising coronary vasculitis as a rare cause of ischaemic heart disease.

Accuracy of tissue Doppler estimation of the right atrial pressure in anesthetized, paralyzed, and mechanically ventilated patients.

The ratio of tricuspid peak early inflow velocity to peak early diastolic velocity of the lateral tricuspid annulus (the E/Ea ratio) measured by transthoracic echocardiography has been reported to correlate with right atrial (RA) pressure. In this study, the correlation between the E/Ea ratio and RA pressure was tested in 44 anesthetized, paralyzed, and mechanically ventilated patients by transesophageal echocardiography. Mean RA pressure and the following echocardiographic data were recorded simultaneously: tricuspid peak early inflow velocities by Doppler echocardiography, peak early diastolic velocity of the lateral tricuspid annulus by tissue Doppler imaging, and right ventricular and left ventricular end-diastolic areas. Linear regression did not indicate a correlation between the E/Ea ratio and RA pressure (r = -0.11, p = 0.48) or between the E/Ea ratio and the right or left ventricular end-diastolic area index; it revealed a weak correlation between RA pressure and the inspiratory plateau pressure and body mass index. In conclusion, the E/Ea ratio failed to predict RA pressure or planimetric indexes of ventricular preload in anesthetized, paralyzed, and mechanically ventilated patients. In these patients, RA pressure was largely influenced by extracardiac factors.

Effects of on-pump versus off-pump coronary artery bypass graft surgery on right ventricular function.

OBJECTIVES: Right ventricular dysfunction is a possible cause of cardiac failure after coronary surgery. The use of cardiopulmonary bypass is regarded as a major cause for its occurrence, and it has been postulated that performing coronary surgery without cardiopulmonary bypass might reduce ventricular dysfunction. Therefore, this prospective, randomized, controlled study tested the hypothesis that off-pump coronary surgery would better preserve right ventricular systolic and diastolic function than conventional bypass surgery. METHODS: Fifty patients scheduled for elective coronary artery bypass surgery were randomly assigned to conventional or off-pump surgery. Right ventricular function was assessed by intraoperative transesophageal echocardiography immediately before and after coronary surgery. Right ventricular ejection fraction was used as a marker of global systolic function and tricuspid early/late (atrial) ratio as a marker of the global diastolic function. Peak systolic and early diastolic velocities of the lateral tricuspid annulus were studied to assess systolic and diastolic function in the area of the right ventricular free wall. RESULTS: Surgery was completed according to randomization in 48 of 50 patients. Preoperative characteristics were similar in both groups. Intraoperative differences between the two groups included a higher volume of allogeneic blood transfusion in the conventional surgery group. At the end of surgery, global systolic right ventricular function was similarly maintained and diastolic function similarly impaired in both groups. There were no significant intergroup differences in any of the echocardiographic markers of right ventricular function. CONCLUSIONS: Off-pump surgery did not better preserve right ventricular systolic and diastolic function than did conventional coronary surgery.