Complications of the Mustard Operation

1986 ◽  
Vol 8 (4) ◽  
pp. 106-126
Keyword(s):  
Heart Block ◽  
Normal Sinus Rhythm ◽  
Venous Blood ◽  
Resting Heart Rate ◽  
Normal Sinus ◽  
Mustard Operation ◽  
Mitral Orifice ◽  
The Mean ◽  
Degree Heart Block

Eight pediatric cardiac centers pooled clinical and ECG data from 372 patients who survived the Mustard operation (intraatrial baffle directing pulmonary venous blood to the tricuspid orifice and systemic venous blood to the mitral orifice) for at least 3 months. The follow-up period ranged from 0.4 to 15.9 years, and the mean age at operation was 2 years. The mean resting heart rate for patients who had the Mustard operation was consistently lower than age-matched controls. During the year of operation, 76% of patients had normal sinus rhythm; this percentage declined yearly to 57% by the end of the eighth postoperative year. Active arrhythmias increased after the tenth year. Second or third-degree heart block occurred in 33% of patients during the year of operation and changed very little thereafter. Of the total 372 patients, 39 received pacemakers, 52% during the year of surgery and 48% evenly distributed throughout the follow-up period.

scholarly journals Transient Congenital Complete Heart Block: A Case Report

Children ◽  
2021 ◽  
Vol 8 (9) ◽  
pp. 790
Author(s):  
Ying-Tzu Ju ◽  
Yu-Jen Wei ◽  
Ming-Ling Hsieh ◽  
Jieh-Neng Wang ◽  
Jing-Ming Wu
Keyword(s):  
Heart Block ◽  
Rare Case ◽  
Complete Heart Block ◽  
Normal Sinus Rhythm ◽  
Structural Heart Disease ◽  
Normal Heart ◽  
Complete Atrioventricular Block ◽  
Normal Sinus ◽  
Congenital Complete Heart Block ◽  
Complete Atrioventricular

Congenital complete heart block is defined as a complete atrioventricular block occurring prenatally, at birth, or within the first month of life. Congenital complete heart block has a high mortality rate, and in infants with normal heart morphology, it is often associated with maternal connective tissue disease. In these latter cases, neonatal congenital complete heart block is usually irreversible. We present a rare case of a female neonate who had bradycardia noted at a gestational age of 37 weeks. Her mother had no autoimmune disease history. She had no structural heart disease, and the serology surveys for autoantibodies including SSA/Ro and SSB/La were all negative. Without intervention or medication, her congenital complete heart block completely recovered to a normal sinus rhythm within 5 days. The cause of the transient congenital complete heart block was unknown in this case.

The Adams-Stokes syndrome during normal sinus rhythm and transient heart block

1963 ◽  
Vol 12 (4) ◽  
pp. 505-515 ◽  
Author(s):  
Lewis S. Schwartz ◽  
Sidney P. Schwartz
Keyword(s):  
Sinus Rhythm ◽  
Heart Block ◽  
Normal Sinus Rhythm ◽  
Normal Sinus

scholarly journals The change in NT-pro-BNP and post-PTMC echocardiography parameters in patients with mitral stenosis. A pilot study

2017 ◽  
Vol 55 (2) ◽  
pp. 75-81
Author(s):  
Morteza Safi ◽  
Fariba Bayat ◽  
Zahra Ahmadi ◽  
Masood Shekarchizadeh ◽  
Isa Khaheshi ◽  
...  
Keyword(s):  
Sinus Rhythm ◽  
Pressure Gradient ◽  
Mitral Stenosis ◽  
Normal Sinus Rhythm ◽  
Left Atrial Volume ◽  
Normal Sinus ◽  
Mean Pressure ◽  
Percutaneous Transvenous Mitral Commissurotomy ◽  
Pulmonary Arterial ◽  
The Mean

Abstract Background. The change in the level of NT-pro-BNP (N-terminal-pro-Brain Natriuretic Peptide) is now considered as a reflection of the hemodynamic alterations and its circulatory reductions reported early after successful PTMC (percutaneous transvenous mitral commissurotomy). The present study aims to assess the change in the level of NT-pro BNP following PTMC in patients with mitral stenosis and also to determine the association between circulatory NT-pro-BNP reduction and post-PTMC echocardiography parameters. Methods. Twenty five symptomatic consecutive patients with severe MS undergoing elective PTMC were prospectively enrolled. All patients underwent echocardiography before and also 24 to 48 hours after PTMC. Peripheral blood samples were taken for measurement of NT-pro-BNP before as well as 24 to 48 hours after PTMC. The patients were also classified in group with normal sinus rhythm or having atrial fibrillation (AF) based on their 12-lead electrocardiogram. Results. It was shown a significant decrease in the parameters of PPG (Peak Pressure Gradient), MPG (Mean Pressure Gradient), PHT (Pressure Half Time), PAP (Pulmonary Arterial Pressure), LAV (Left Atrial Volume), and also a significant increase in MVA (Mitral Valve Area) RVS (Right Ventricular S velocity), and strains of lateral, septal, inferior and anterior walls of LA following PTMC. The mean LVEF remained unchanged after PTMC. The mean NT-pro-BNP before PTMC was 309.20 ± 17.97 pg/lit that significantly diminished after PTMC to 235.72 ± 22.46 pg/lit (p = 0.009). Among all echocardiography parameters, only MPG was positively associated with the change in NT-pro-BNP after PTMC. Comparing the change in echocardiography indices between the patients with normal rhythm and those with AF, lower change in PAP was shown in the group with AF. However, more change in the level of NT-pro-BNP after PTMC was shown in the patients with AF compared to those without this arrhythmia. Conclusion. PTMC procedure leads to reduce the level of NT-pro-BNP. The change in NT-pro-BNP is an indicator for change in MS severity indicated by decreasing MPG parameter. Lower change in PAP as well as higher change in NT-pro-BNP is predicted following PTMC in the group with AF compared to those with normal sinus rhythm.

scholarly journals IMMUNOMODULATION IN GERONTOPERIODONTOLOGY: EFFECTS IN HUMORAL IMMUNITY

2018 ◽  
Vol 14 (3) ◽  
pp. 22-28 ◽  
Author(s):  
Сергей Крайнов ◽  
Sergej Krajnov ◽  
Александра Попова ◽  
Alexandra Popova ◽  
Ирина Алеханова ◽  
...  
Keyword(s):  
Elderly Patients ◽  
Humoral Immunity ◽  
Conventional Treatment ◽  
Venous Blood ◽  
Combined Treatment ◽  
Elderly Persons ◽  
Mean Values ◽  
Substantial Growth ◽  
The Mean

Background. The article has explored the problem of the humoral immunity recovery of elderly patients with chronic generalized periodontitis. Such immunological indicators as the immunoglobulin concentrations were used as detectors of inflammatory-destructive disease. Polyoxidonium has been suggested as an immunomodulator, as it promotes faster immune and clinical recovery compared to the conventional treatment regimens. Goals To assess the dynamics of clinical indicators and indicators of humoral immunity (sIgA, IgA, IgG and IgM levels), depending on immunomodulation, is added to the combined treatment regimen of elderly patients with periodontitis. Methods. Two patient cohorts of 69 elderly persons with chronic generalized periodontitis were examined. The conventional treatment was administered in both patient groups. The patients in the second cohort, along with other medications, received Polyoxidonium. The examination included gingival fluid and venous blood sampling, estimation of sIgA, IgA, IgG and IgM concentration as well as evaluation of PMA and SBI indices reduction. Results. The study has revealed the rise of IgG and IgM in venous blood. The recovery trend was observed in both cohorts, with a more marked dynamics in the second one. The mean values of antibodies concentration in the 2-nd group (since the 14th day) were statistically significant compared to the similar measures in the 1st one. After 3 months follow-up the substantial growth of immunoglobulins concentration was registered in the 1st cohort, whereas the 2nd one still showed the recovery trend. Results. The study has revealed the rise of IgG and IgM in venous blood. The recovery trend was observed in both cohorts, with a more marked dynamics in the second one. The mean values of antibodies concentration in the 2-nd group (since the 14th day) were statistically significant compared to the similar measures in the 1st one. After 3 months follow-up the substantial growth of immunoglobulins concentration was registered in the 1st cohort, whereas the 2nd one still showed the recovery trend. Conclusions. The inclusion of immunomodulator Polyoxidonium into the conventional treatment protocol of periodontitis promotes the immunologic reactivity recovery of elderly patients and the improvement of the therapeutic intervention effectiveness over the longer term.

scholarly journals Bucindolol Decreases Atrial Fibrillation Burden in Patients with Heart Failure and the ADRB1 Arg389Arg Genotype

2021 ◽  
Author(s):  
Jonathan P. Piccini ◽  
Christopher Dufton ◽  
Ian A. Carroll ◽  
Jeff S. Healey ◽  
William T. Abraham ◽  
...  
Keyword(s):  
Heart Failure ◽  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Normal Sinus Rhythm ◽  
Left Ventricular ◽  
Rhythm Control ◽  
Left Ventricular Ejection ◽  
Ventricular Ejection Fraction ◽  
Normal Sinus

Background - Bucindolol is a genetically targeted β-blocker/mild vasodilator with the unique pharmacologic properties of sympatholysis and ADRB1 Arg389 receptor inverse agonism. In the GENETIC-AF trial conducted in a genetically defined heart failure (HF) population at high risk for recurrent atrial fibrillation (AF), similar results were observed for bucindolol and metoprolol succinate for the primary endpoint of time to first atrial fibrillation (AF) event; however, AF burden and other rhythm control measures were not analyzed. Methods - The prevalence of ECGs in normal sinus rhythm, AF interventions for rhythm control (cardioversion, ablation and antiarrhythmic drugs), and biomarkers were evaluated in the overall population entering efficacy follow-up (N=257). AF burden was evaluated for 24 weeks in the device substudy (N=67). Results - In 257 patients with HF the mean age was 65.6 ± 10.0 years, 18% were female, mean left ventricular ejection fraction (LVEF) was 36%, and 51% had persistent AF. Cumulative 24-week AF burden was 24.4% (95% CI: 18.5, 30.2) for bucindolol and 36.7% (95% CI: 30.0, 43.5) for metoprolol (33% reduction, p < 0.001). Daily AF burden at the end of follow-up was 15.1% (95% CI: 3.2, 27.0) for bucindolol and 34.7% (95% CI: 17.9, 51.2) for metoprolol (55% reduction, p < 0.001). For the metoprolol and bucindolol respective groups the prevalence of ECGs in normal sinus rhythm was 4.20 and 3.03 events per patient (39% increase in the bucindolol group, p < 0.001), while the rate of AF interventions was 0.56 and 0.82 events per patient (32% reduction for bucindolol, p = 0.011). Reductions in plasma norepinephrine (p = 0.038) and NT-proBNP (p = 0.009) were also observed with bucindolol compared to metoprolol. Conclusions - Compared with metoprolol, bucindolol reduced AF burden, improved maintenance of sinus rhythm, and lowered the need for additional rhythm control interventions in patients with HF and the ADRB1 Arg389Arg genotype.

scholarly journals Lyme carditis presenting as atrial fibrillation in a healthy young male

2019 ◽  
Vol 12 (6) ◽  
pp. e229261 ◽  
Author(s):  
Muhammad Asim Shabbir ◽  
Muhammad Hamza Saad Shaukat ◽  
Muhammad Hashaam Arshad ◽  
Joseph Sacco
Keyword(s):  
Atrial Fibrillation ◽  
Sinus Rhythm ◽  
Heart Block ◽  
Normal Sinus Rhythm ◽  
Young Male ◽  
Rare Presentation ◽  
Normal Sinus ◽  
Lyme Carditis ◽  
Appropriate Treatment ◽  
High Degree

We present a case of a 23-year-old man coming with palpitations, found to be in atrial fibrillation (AF). He was initially managed with metoprolol for rate-controlled therapy—reverted to normal sinus rhythm and discharged home. He returned a few days later—this time in varying degrees of atrioventricular block including transient complete heart block. He was empirically started on intravenous ceftriaxone for suspected Lyme carditis, which subsequently led to the resolution of high-degree heart block. Lyme immunoglobulin G (IgG) and IgM returned positive. Follow-up ECG after the course of antibiotic exhibited normal sinus rhythm. AF is a rare presentation of Lyme disease but still exists. It should be considered in terms of appropriate treatment, especially in Lyme-endemic areas.

Balloon dilation of stenosed systemic venous pathways following the Mustard operation

1995 ◽  
Vol 5 (3) ◽  
pp. 238-242 ◽  
Author(s):  
Narayanswami Sreeram ◽  
Venkateswararao Dikkala ◽  
Robert Arnold
Keyword(s):  
Pressure Gradient ◽  
Balloon Dilation ◽  
Mustard Operation ◽  
Mean Pressure ◽  
Angiographic Data ◽  
Alternative Measures ◽  
The Mean ◽  
Term Management

SummaryStenoses of the systemic venous pathways are a potentially dangerous complication after the Mustard operation. The acute and intermediate-term efficacy of balloon dilation of these stenoses has not previously been studied in a large group of patients. A retrospective analysis of clinical and angiographic data, with prospective clinical and echocardiographic follow-up, was performed in a consecutive group of 25 patients (17 male, 8 female) who underwent balloon dilation of the superior or inferior caval venous pathways. For 17 dilations of stenoses in the superior pathway, the mean pressure gradient decreased from 9.1±5.7 to 3.4±2.3 mm Hg (p<0.01), while the diameter of the stenosis increased from 5.9±2.9 to 11.2±3.0 mm (p<0.01). For 25 dilations of the inferior pathway, the mean gradient decreased from 4.3±1.8 to 1.4±1.1 mm Hg (p<0.01), while the diameter of the stenosis increased from 7.3±1.5 to 10.6±2.3 mm (p<0.01). Over a median follow-up of 3.5 years, 16 patients have been without symptoms or signs suggestive of recurrence of stenoses. In the remaining nine patients, 11 further procedures were performed at a median of 3.1 years after initial dilation. In five patients who had previously undergone dilation of the superior (3), inferior (1) or both (1) pathways, further dilations of the same pathway(s) and/or stent implantations were performed. Three patients, including one in whom superior caval venous stenosis had recurred, had developed a new stenosis of a previously undilated pathway, while in two patients no further dilations were required. Balloon dilation offers an alternative to reoperation for stenoses of the systemic venous pathways after the Mustard operation, and appears to provide satisfactory intermediate-term palliation. Recurrences of stenoses in previously dilated pathways, and new stenoses in previously unobstructed pathways, are commonly seen at follow-up. Alternative measures, such as placement of stents, need to be considered in the long-term management of these patients.

scholarly journals Atypical chest pain in a young woman with an interatrial bronchogenic cyst

2021 ◽  
Vol 14 (4) ◽  
pp. e241736
Author(s):  
Essam Saad ◽  
Pooja Singh ◽  
Marc Iskandar
Keyword(s):  
Emergency Department ◽  
Chest Pain ◽  
Sinus Rhythm ◽  
Cardiac Mri ◽  
Bronchogenic Cyst ◽  
Normal Sinus Rhythm ◽  
Pathology Report ◽  
Atypical Chest Pain ◽  
Normal Sinus

A 31-year-old woman presented to the emergency department with atypical retrosternal chest pain and dyspnoea. Investigations initially revealed atrial flutter on her electrocardiogram and an interatrial septal mass on CT angiography of the chest. Additional workup with cardiac MRI and transoesophageal echocardiogram were able to delineate the cardiac mass. Electrophysiology and cardiothoracic surgery were consulted. The mass was excised in the same hospitalisation and the pathology report demonstrated a bronchogenic cyst. After mass excision, the patient chest pain has decreased, and she reverted back to normal sinus rhythm. On further follow-up, her flecainide and metoprolol were stopped.

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