Physiologic correlates of tricuspid annular plane systolic excursion in 1168 healthy subjects.

BACKGROUND: TAPSE provides a simple, reproducible estimate of the longitudinal function of the right ventricle (RV). However, the normal limits and physiologic correlates of tricuspid annular plane systolic excursion (TAPSE) are not exactly known. The aim of this study was to explore the full spectrum of TAPSE values and determine the physiologic correlates of TAPSE. METHODS AND RESULTS: From June 2007 to December 2013, 1168 healthy subjects [mean age 45.1±16years, range 16 to 92; 555 (47.5%) men] underwent comprehensive transthoracic echocardiography (TTE) as recommended by current guidelines. TAPSE values were higher in men than women (24.0±3.5 vs 23.2±3.0mm, p value<0.0001) but did not vary according to age. On multivariable linear regression analysis, cardiac output, RV basal and longitudinal dimensions were the only variables independently associated with TAPSE (ß coefficient=0.161, 0.116 and 0.115 respectively). On the other hand echocardiographically-derived systolic pulmonary artery pressure (SPAP), pulmonary vascular resistance and mitral E/e' ratio were significantly higher in older subjects. Therefore a significant decrease of TAPSE/SPAP was detected in >60years old cohort (p=0.0001). CONCLUSIONS: Our large cohort of healthy subjects provides sex and age-based TAPSE and TAPSE/SPAP normal cut-offs. TAPSE was found to be higher in men but not influenced by age. It was mainly correlated with echo-Doppler indices reflecting pre-load as opposed to afterload. On the other hand a significant decrease of TAPSE/SPAP with older age was registered as a direct consequence of increased SPAP with aging.

Takotsubo cardiomyopathy after acute myocardial infarction: An unusual case of possible association.

Takotsubo cardiomyopathy is an acute reversible clinical condition mimicking an acute myocardial infarction. Although a normal coronary artery tree is frequently detected, the concurrence of coronary artery disease is a common finding in a substantial proportion of patients. We report an unusual case of takotsubo cardiomyopathy in post-menopausal women after emotional stress, occurring after inferior ST-segment elevation myocardial infarction. The possible association between takotsubo cardiomyopathy and coronary artery disease is discussed.

Normal values of aortic root dimensions in healthy adults.

The reported ranges of aortic root (AR) diameters are limited by small sample size, different measurement sites, and heterogeneous cohorts. The aim of this study was to explore the full spectrum of AR diameters by 2-dimensional transthoracic color Doppler echocardiography (TTE) in a large cohort of healthy adults. From June 2007 to December 2013, a total of 1,043 Caucasian healthy volunteers (mean age 44.7 ± 15.9 years, range 16 to 92 years, 503 men [48%]) underwent comprehensive TTE. TTE measurements of the AR were made at end-diastole in parasternal long-axis views at 4 levels: (1) annulus, (2) sinuses of Valsalva, (3) sinotubular junction, and (4) proximal ascending aorta. The absolute aortic diameters were significantly greater in men than in women at all levels, whereas body surface area-indexed aortic diameters were greater in women (p = 0.0001). No significant gender differences were registered for sinuses of Valsalva and sinotubular junction to annulus diameter ratios (p = 0.9), whereas ascending aorta to annulus diameter ratio was higher in women (p = 0.0001). There was a straight correlation between aortic diameters (absolute and indexed values), their ratios, and age in both genders (p = 0.0001). In conclusion, we provide the full range of AR diameters by TTE. Knowledge of upper physiological limits of aortic dimensions is mandatory to detect aorta dilatation, follow up the disease over time, and plan appropriate therapeutic interventions.

Combined thoracic endovascular aortic repair and neurosurgical intervention for injury due to posterior spine surgery.

Aortic injuries represent a rare but life-threatening complication of spinal surgery. Perforation of the aorta due to pedicle screw penetration or misplacement can lead to immediate bleeding with hemodynamic instability or to pseudoaneurysm development with delayed risk of rupture, which can occur weeks to months later. Recently, thoracic endovascular aortic repair (TEVAR) in aortic trauma has contributed to a reduction of both mortality and morbidity. The literature on this subject is reviewed.

Ipsilateral jugular to distal subclavian vein transposition to relieve central venous hypertension in rescue vascular access surgery: a surgical report of 3 cases.

Central venous thrombosis may often arise following central venous cannulation for temporary haemodialysis access. Venous thrombosis may be clinically asymptomatic due to the presence of collateral circulation. However, if an arteriovenous (AV) fistula is prepared below the obstructed venous segment, then symptoms may occur. Central venous hypertension interferes with dialysis, compromises limb function and threatens its safety. Percutaneous treatment is mostly used. However, in some cases endovascular treatment may not be as easy and long term patency uncertain.We report our experience on 3 patients on chronic hemodialysis treatment presenting with a patent AV fistula and ipsilateral subclavian vein chronic fibrotic obstruction. They were treated by ipsilateral internal jugular to distal subclavian vein transposition. Two separate surgical incisions were performed to expose the subclavian vein distally to the occlusion and the jugular vein that was distally ligated and transposed. There was no mortality nor significant postoperative complications. Resolution of hypertensive symptoms was achieved within 3-4 weeks in all patients. The AV fistula was used for dialysis treatment starting from the first postoperative day. At follow-up (mean 13 months), there was no recurrence of upper limb venous hypertension.In patients with subclavian occlusion and ipsilateral low flow, patent AV fistula, jugular to distal subclavian vein transposition may prove useful in cases when percutaneous angioplasty is technically not feasible or long term patency is not expected.