Hemodynamics in mitral regurgitation – before and after correction with MitraClip

Haemodynamic changes in mitral regurgitation underlie triggering of patient’s symptoms and development of heart failure. A number of endovascular methods for the correction of mitral regurgitation successfully counteract pathological hemodynamics and thus manage to improve both the manifestations of heart failure and the patient's symptoms. This article is a review of the physiology of the mitral valve and the changes that occur in the presence of mitral regurgitation. The peculiarities of the hemodynamics of the left atrium in the conditions of mitral regurgitation and after some types of transcatheter treatment – edge-to-edge correction of the valve with Mitraclip and the implantation of an occluder in paraprosthetic mitral regurgitation are considered. The change in left atrial parameters immediately after correction of the defect is of value both for the assessment of immediate procedural success and for the patient's prognosis.

Estimation of haemodynamic changes in varicocele testis and results after microsurgical sub-inguinal varicocelectomy

Introduction: Varicocele is among the most frequently encountered, surgically correctable causes of male infertility. Since varicocele is a primary abnormality of testicular vessels, a thorough understanding of haemodynamic changes in the microcirculation of varicocele testis is needed. Objectives: To estimate changes in the microcirculation of varicocele testis and correlate them with symptomatic and semen parameters changes before and after varicocelectomy. Material and methods: This prospective, observational study includes 47 patients of age group 18–40 years who underwent microsurgical varicocelectomy during June 2016 to April 2018 at a tertiary medical institute. Testicular haemodynamic was evaluated using a colour spectral doppler study (PSV-Peak systolic velocity/ESV-End diastolic velocity/RI-Resistive index/PI-Pulsatility index). Semen analysis parameters and testicular blood flow were compared with pre-operative values. Results: RI in the capsular artery of varicocele affected testis, which was 0.61 ± 0.11 (mean ± SD), significantly reduced to 0.56 ± 0.09 (mean ± SD) in post-operative follow-up, indicating improved perfusion. Pre-operative sperm density was noted to be 15.94 ± 7.88 (mean ± SD), which improved to 28.41 ± 10.99, Progressive sperm motility from 33.81 ± 10.88 to 38.32 ± 9.21 and morphology from 36.13 ± 10.68 to 41.43 ± 9.29 on 6-month follow-ups ( p < 0.05). Conclusion: Varicocele testis is associated with altered testicular haemodynamic, which insults spermatogenesis. Microsurgical varicocelectomy with testicular artery and lymphatic preservation leads to correction of this altered haemodynamic state and improves the testicular microcirculation.

STUDY OF THE EFFECT OF PROPOFOL & ETOMIDATE AS AN INDUCTION AGENT ON HAEMODYNAMIC CHANGES DURING INDUCTION & ENDOTRACHEAL INTUBATION

Introduction: Laryngoscopy and subsequent tracheal intubation cause a fugitive tachycardia and hypertension as a result of sympathoadrenal stimulation. Careful selection of anestheshetic is thus required, as cardiovascular reserve is decreased in certain patients, so as to avoid undue depressions of cardiac and circulatory function Aims And Objectives: This randomized double blind prospective study had been designed for comparative evaluation of inj propofol 2.5 mg/kg, inj Etomidate 0.3 mg/kg an induction agent on haemodynamic changes such as HR, SBP, DBP, MAP and oxygen saturation during induction and tracheal intubation and also to study the adverse effects the two drugs under study Material And Methods: After approval from medical ethics committee, Dr D Y Patil Medical College and Hospital, Pune, the study was carried out on sixty (60) patients undergoing elective surgeries under standard general anesthesia. ? All patients were premedicated with Ondansetron 0.1mg/kg i.v., inj midazolam 0.02mg/kg and inj fentanyl 2 mcg/kg i.v. ? All patients pre-oxygenated with 100% oxygen for 3 min, all vital parameters recorded (T1) ? Group P received inj. propofol 2.5 mg/kg i.v. and group E received Etomidate 0.3mg/kg i.v. over 30 sec and vital parameters recorded as (T2) ? Inj succinylcholine as muscle relaxant given after administering induction agent, laryngoscopy and tracheal intubation attempted with appropriate sized endotracheal tube. All vital parameters recorded during laryngoscopy(T3), periodic monitoring of vital parameters carried out at 1,2,3,5 and 10 minutes intervals post intubation ? Further the patient was maintained on O2 /N2O / Isoflurane and Vecuronium i.v. top-ups as and when required ? At the end of surgery, patient reversed with inj. Glycopyrrolate 0.008mg/kg i.v. along with inj. Neostigmine 0.05mg/kg intravenously and extubated after gaining consciousness and adequate power ? Patient shifted to recovery room observed for any side effects such as nausea, vomiting, Result: The demographic profile was comparable. There was no statistically considerable difference between the two study groups with respect to baseline parameters of HR, SBP, DBP, MAP and SpO2. There was decrease in mean heart rate seen in group P compared to group E at post induction (T2), after intubation 1 min, 2min, the values were statistically significant with P value <0.05,.and decrease in mean SBP, mean DBP AND MAP in group P compared to group E at post induction (T2), after intubation 1,2 3, 5 min values were statistically significant with p value <0.05 Pain on injection was more in group P 26 out of 30(86.7%) than group E, which was statistically significant with p value <0.05 Incidence of myoclonus was more in group E 23 patients out of 30(76.7%) compared to group P which was statistically significant with p value <0.05. In group P 2 out of 30 patients (6.7%) had vomiting and in group E 3 out of 30 patients (10%) had vomiting, difference was statistically insignificant with p value >0.05 Conclusion: A• Both, Propofol and etomidate are safe induction agents A• Etomidate maintains better haemodynamic stability than propofol as induction agent A• Pain on injection was more with propofol. However, myoclonus was more with etomidate A• Both drugs were associated with no significant side effects/complication.

Autonomic Dysfunction Post-Inoculation with ChAdOx1 nCoV-19 Vaccine

This report describes persistent paresthesia, haemodynamic changes including orthostatic tachycardia, and skin colour changes due to autonomic dysfunction after a single dose of the ChAdOx1-nCoV-19 vaccine (AstraZeneca) in a healthy 29-year-old male.

Review of the Development of Haemodynamic Modelling Techniques to Capture Flow Behaviour in Arteries Affected by Aneurysm, Atherosclerosis and Stenting

Cardiovascular diseases (CVDs) are the leading cause of death in the developed world. CVD can include atherosclerosis, aneurysm, dissection or occlusion of the main arteries. Many CVDs are caused by unhealthy haemodynamics. Some CVDs can be treated with the implantation of stents and stent grafts. Many investigations have sought to understand the effects stents and stent grafts have on arteries and the haemodynamic changes post-treatment. Many studies on stent haemodynamics have been carried out using Computational Fluid Dynamics (CFD), and have yielded significant insight into the effect of stent mesh design on near wall blood flow and improving haemodynamics. Particle Image Velocimetry (PIV) has also been used to capture behaviour of fluids that mimic physiological haemodynamics. However, PIV studies have largely been restricted to unstented models or intra-aneurysmal flow rather than peri or distal stent flow behaviours. PIV has been used both as a standalone measurement method and as a comparison to validate the CFD studies. This article reviews the successes and limitations of several experimental methods used to investigate the haemodynamic effects of stents. The review includes an overview of physiology and relevant mechanics of arteries as well as consideration of boundary conditions and the working fluids used to simulate blood for each modelling method along with the benefits and limitations introduced.

Assessment of Doppler haemodynamic changes suggestive of portal hypertension in cirrhotic HCV patients after sustained virological response to direct antiviral agents

Background Egypt has the highest prevalence rate of HCV in the world. About 14.7% of the Egyptian people have HCV antibodies and 9.8% have an active infection. The death rate due to liver disease about 40,000 each year (near10% of all deaths). It is the second after the cardiac diseases. Aim of Work to assess Doppler haemodynamic changes suggestive of portal hypertension in cirrhotic HCV Egyptian patients after sustained virological response to direct antiviral agents, and their correlation with liver stiffness measurements by Fibroscan. Patients and Methods This prospective cohort study was conducted at Viral Hepatitis Unit at Ain Shams University Hospital and Al-Agouza Police Hospital during the period from May 2018 to July 2019. The study included 50 Egyptian treatment-naïve chronic hepatitis C patients with cirrhosis on Sofosbuvir, Daclatasvir for 12 weeks. Patients were subjected to history and full physical examination, radiology assessment (Abdominal Ultrasound and color Doppler), Upper GI endoscopy and Fibroscan before treatment and 6 months after treatment. Followed up with CBC, AST, ALT, Total bilirubin, Albumin, creatinine and Coagulation profile before and after 12 weeks of treatment And HCV RNA by PCR and HCV CORE Antigen before and then after 12 weeks of treatment. Results Treatment with sofosbuvir plus Daclatasvir for 12weeks resulted in undetectable HCV RNA by PCR in 100% of the patients at the end of treatment. There was a significant improvement in portal hemodynamics 6 months after treatment as well as a significant correlation between Doppler indices and fibroscan. Conclusion: Doppler portal hypertensive parameters, as a marker of portal hypertension, were improved in parallel with the improvement in fibroscan values after viral clearance and its improvement in the current study mandate urgent treatment to avoid possible complications.

Use of Phentolamine Mesylate in Implant Surgery: Analysis of Adverse Effects and Haemodynamic Changes

The clinical application of phentolamine mesylate (PM) as an anaesthetic reversal agent has been documented in the paediatric population and in conservative dentistry, but no studies have been conducted regarding dental implant surgery. A prospective randomised study was conducted on 60 patients eligible for mandibular implant treatment, randomly divided between a control group (CG) and an experimental group (EG), to whom PM was administered. Haemodynamic changes, adverse effects and patient satisfaction were assessed. No statistically significant differences in haemodynamic changes and postoperative pain were found between CG and EG (p < 0.05), except for systolic blood pressure (SBP), which increased slightly in EG, without posing a risk to patients. There were no differences in the occurrence of adverse effects between the two groups, except for greater difficulty in chewing and biting (p < 0.05) in CG and greater pain in the injection area (p = 0.043) in EG. Among EG patients, 83.3% reported that they would request PM again for future dental treatment. The use of PM offers an alternative to implant surgery, thereby increasing patients’ quality of life without increasing the risks.

Anaesthetic management using remimazolam in a patient with severe aortic stenosis: a case report

Background The administration of general anaesthesia in patients with aortic stenosis (AS) requires careful attention to haemodynamics. We used remimazolam for the induction and maintenance of anaesthesia in a woman with severe AS undergoing a total mastectomy. Case presentation An 81-year-old woman with severe AS was scheduled to undergo a total mastectomy. We decided to administer total intravenous anaesthesia with remimazolam to minimize haemodynamic changes. Although the patient showed transient hypotension after anaesthesia induction, the cardiac index was preserved with a low dose of continuous noradrenaline. The anaesthesia was then safely maintained without a decrease in the patient’s cardiac index. Conclusions General anaesthesia using remimazolam preserved cardiac output in this patient; therefore, remimazolam can be safely used to avoid the risk of cardiac suppression in patients with severe AS.

Use of Phentolamine Mesylate in Implant Surgery. Analysis of Adverse Effects and Haemodynamic Changes

The clinical application of Phentolamine Mesylate (PM) as an anaesthetic reversal agent has been documented in paediatric patients and in conservative dentistry, but no studies have been found in implant surgery. A prospective randomised study was conducted in 60 patients eligible for mandibular implant treatment, randomly divided between the Control Group (CG) and Experimental Group (EG), who were administered PM. Haemodynamic changes, adverse effects and patient satisfaction were assessed. No statistically significant differences in haemodynamic changes and postoperative pain were found between CG and EG (p&amp;lt;0.05), except for Systolic Blood Pressure (SBP) which increased slightly in EG, without posing a risk to the patient. There were no differences in the presence of adverse effects between the two groups, except in the CG which presented greater difficulty in chewing and biting (p&amp;lt;0.05) and the EG with greater pain in the injection area (p=0.043). 83.3% of the EG patients would request PM again for future dental treatment. The use of PM offers an alternative in implant surgery, without increasing the risks and increasing the patient's quality of life.