The Chronological Demographics of Ventricular-Arterial Decoupling in Patients with Sepsis and Septic Shock: A Prospective Observational Study.

BACKGROUND: Ventricular-arterial coupling (V-A coupling) recently gathers attention from clinicians to evaluate the interaction between afterload and left ventricular systolic function. We aimed to describe the chronological demographics of V-A decoupling in patients with sepsis and septic shock through the clinical course. METHOD: We conducted a single-center prospective observational study comprising adult patients with sepsis and septic shock admitted to the tertiary care hospital between 04/2017 and 03/2019. Patients' characteristics, lab data on admission, and echocardiographic parameters including Ea and Ees on the day- 1, 2, 3, 7, and 14-28 were collected. V-A decoupling was defined as Ea/Ees ≥ 1.36. RESULTS: Seventy-one patients with sepsis or septic shock were enrolled. The prevalence of V-A decoupling was as follows; day-1: 25.4%, day-2: 23.8%, day-3: 13.3%, day-7: 18.5%, day-14-28: 30.3%, respectively. Ea was higher in patients with V-A decoupling than those without throughout the clinical course (day1; 2.8 vs. 1.8, p < 0.01, day2; 2.7 vs. 1.9, p < 0.01, day3; 2.8 vs. 2.1, p = 0.06, day7; 2.7 vs. 1.9, p = 0.02, day14-28; 2.4 vs. 1.8, p = 0.08). This increase in Ea was mainly induced by reduced stroke volume (SV) as well as high systolic blood pressure (SBP) in the earlier course of sepsis but only by increased SBP in the later course of sepsis. Ees was lower in patients with V-A decoupling than those without throughout the clinical course (day1; 1.3 vs. 2.1, p < 0.01, day2; 1.5 vs. 2.3, p < 0.01, day3; 1.6 vs. 2.3, p = 0.02, day7; 1.8 vs. 2.3, p = 0.01, day14-28; 1.2 vs. 1.9, p = 0.07). CONCLUSION: We reported that V-A decoupling was commonly seen in patients with sepsis and septic shock. In patients with V-A decoupling, both Ea and Ees were significantly altered, but the causes of these alterations appeared to be changing over the clinical course of sepsis.

Haemoptysis and bronchial congestion due to pulmonary vein stenosis after maze procedure.

Pulmonary vein stenosis (PVS) is a rare disease that can cause haemoptysis. Acquired PVS is indicated as a complication associated with cardiac catheter intervention; however, the maze procedure has not been reported to induce PVS. Here, we describe the diagnosis and treatment strategy for the first case of PVS with haemoptysis due to the maze procedure. A 56-year-old man who underwent the maze procedure seven years previously was referred for repeated haemoptysis. Contrast-enhanced computed tomography (CT) revealed complete occlusion of the left superior pulmonary vein. Bronchoscopy revealed localized bronchial congestion and varices. He was diagnosed with PVS due to the maze procedure, and he underwent catheter-balloon angioplasty. After treatment, haemoptysis disappeared and bronchial congestion and varices improved. History of cardiac ablation (surgical or catheter intervention) and localized bronchial congestion findings might facilitate the accurate diagnosis of PVS with haemoptysis. Catheter-balloon angioplasty is a minimally invasive treatment for PVS.