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Infective Endocarditis
Published in Mary N. Sheppard, Practical Cardiovascular Pathology, 2022
Right-sided infective IEs is less common, accounting for only 5–10% of cases. It is usually associated with IV drug use, cardiac device infection, central venous catheters, HIV and congenital heart disease. Infections in IV drug abusers are marked by the diversity and unique nature of the organisms. S. aureus, fungal and enterococcal infections are all common. Fungal isolates make up 10% of cases in drug addicts. Pseudomonas aeruginosa and Pseudomonas cepacia make up close to 50% of isolates in drug addicts, being almost unique to this group of patients. The tricuspid valve is most affected. Nonbacterial (marantic) endocarditis has been described in HIV, usually clinically silent and manifests with large, friable, sterile vegetations on the cardiac valves, which can lead to pulmonary embolization. Patients with low CD4 counts have a poorer prognosis when they develop IE. Rates of infective endocarditis have decreased with the advent of ARV therapy. In addition to features of sepsis, patients often have respiratory symptoms resulting from pulmonary emboli, pneumonia and pulmonary abscess formation. Treatment of IE in active IV drug users (involving the tricuspid valve in more than 70% of cases) is challenging because of low compliance with treatment–5-year survival is about 50% in patients needing surgery.
The Mitral Valve
Published in Theo Kofidis, Minimally Invasive Cardiac Surgery, 2021
Nirav C Patel, Meghan K Torres, Jonathan M Hemli
At this point, a thorough and complete interrogation of the mitral valve utilizing three-dimensional TEE is absolutely imperative in order to generate a model of the valve and engender a detailed plan for the operation. Any unexpected findings should be noted, and, if the surgeon is not comfortable proceeding, there should be no hesitation in electively converting the surgical strategy to a sternotomy approach, even at this early stage. The tricuspid valve should also be examined, with detailed measurements of its annular dimensions, in order to determine whether a concomitant tricuspid procedure should be undertaken as well.
Electrophysiology
Published in A. Bakiya, K. Kamalanand, R. L. J. De Britto, Mechano-Electric Correlations in the Human Physiological System, 2021
A. Bakiya, K. Kamalanand, R. L. J. De Britto
The cardiopulmonary system consists of blood vessels that carry nutrients and oxygen to the tissues and removes carbon dioxide from the tissues in the human body (Humphrey & McCulloch, 2003; Alberts et al., 1994). Blood is transported from the heart through the arteries and the veins transport blood back to the heart. The heart consists of two chambers on the top (right ventricle and left ventricle) and two chambers on the bottom (right atrium and left atrium). The atrioventricular valves separates the atria from the ventricles. Tricuspid valve separates the right atrium from the right ventricle, mitral valve separates the left atrium from the left ventricle, pulmonary valve situates between right ventricle and pulmonary artery, which carries blood to the lung and aortic valve situated between the left ventricle and the aorta which carries blood to the body (Bronzino, 2000). Figure 3.9 shows the schematic diagram of heart circulation and there are two components of blood circulation in the system, namely, pulmonary and systemic circulation (Humphrey, 2002; Opie, 1998; Milnor, 1990). In pulmonary circulation, pulmonary artery transports blood from heart to the lungs. The blood picks up oxygen and releases carbon dioxide at the lungs. The blood returns to the heart through the pulmonary vein. In the systemic circulation, aorta carries oxygenated blood from the heart to the other parts of the body through capillaries. The vena cava transports deoxygenated blood from other parts of the body to the heart.
First Trimester Prenatal Diagnosis of a Conotruncal Anomaly Using Spatiotemporal Image Correlation Imaging Confirmed by Conventional Autopsy
Published in Fetal and Pediatric Pathology, 2022
Balaganesh Karmegaraj, Vani Udhayakumar, Gigi Selvan
External examination of the fetus showed no obvious congenital anomalies. The heart was dissected using the approach described by Erickson [4] and described according to the sequential segmental analysis proposed by Anderson et al. [5] There was usual arrangement of the abdominal and thoracic organs. The heart was in the left hemithorax (Figure 2A). The inferior caval vein was intact and drained into the right sided atrium. There were bilateral superior caval veins with no bridging vein, right sided aortic arch with mirror image branching and normal thymus gland (Figure 2B-D) The pulmonary veins drained normally into the left sided atrium. The right sided atrial appendage was larger and more pyramidal (Figure 2A). The left sided atrial appendage was finger like (Figure 2B). The right atrium opened into the anterior ventricle through a morphologically normal tricuspid valve. The left atrioventricular connection was normal. There was a large subaortic VSD (Figure 2D) and great arteries disproportion [main pulmonary artery (MPA) < Ascending Aorta (AO)] (Figure 2B). The MPA arose from the left side of the ascending aorta with confluent branch pulmonary arteries and the ductus arteriosus was absent confirming the diagnosis of Type I Truncus arteriosus. (Figure 3 (E-G)). Retrospective rendering of the stored STIC movies confirmed the origin of MPA from the left side of AO (Figure 1 E&F).
TVARC: Medicine at Its Best
Published in Structural Heart, 2021
To say that the TVARC workshop was comprehensive would be an understatement. It began with a session dedicated to delineate the status of the field at the current time. The anatomy, pathology, and hemodynamics of the regurgitant tricuspid valve were reviewed. The diagnosis, quantitation and management of TR, or lack thereof, was discussed. An important focus was placed upon the desires of the TR patient, and issues of quality of life and fragility. The status of ongoing trials was presented and a major emphasis was placed upon trial design. The pros and cons of the optimal patients to include, efficacy and safety endpoints, duration of follow, and statistical approaches of future trials was fully deliberated. Last, but certainly not least, regulatory considerations in achieving approval and reimbursement of new therapies were an integral part of the meeting. I think it is safe to say that no stone was left unturned.
Carcinoid Heart Disease
Published in Structural Heart, 2020
Amin Sabet, Mina Haghighiabyaneh, Chirag Rajyaguru, Ajit Raisinghani, Daniel Kupsky, Anthony N. DeMaria
Involvement of the tricuspid valve usually results in valvular regurgitation and, less frequently, stenosis. As for the pulmonic valve, plaque deposition leads to adherence of the leaflets to the pulmonary-arterial endocardium resulting in a mixture of stenosis and regurgitation. Simultaneous involvement of both tricuspid and pulmonic valves strongly suggests CHD as the diagnosis. Left heart involvement is unusual (10%) and is most commonly seen with either bronchial carcinoid, right-to-left intracardiac shunt or in patients with extensive liver metastasis. In these cases, markedly elevated levels of circulating vasoactive substances overwhelm the pulmonary and hepatic degradative capacity.8,10,16,32 Interestingly, patent foramen ovale appears to be more common in patients with carcinoid syndrome and carcinoid heart disease (41% and 59%, respectively).33