McConnell's Sign in a Patient with Amniotic Fluid Embolism and Severe Right Ventricular Dysfunction.
Ontology highlight
ABSTRACT:
SUBMITTER: Hassan R
PROVIDER: S-EPMC8713000 | biostudies-literature |
REPOSITORIES: biostudies-literature
Similar Datasets
Project description:McConnell's sign is a well-established, specific echocardiographic sign for acute pulmonary embolism. Multiple theories have been proposed regarding the mechanism of McConnell's sign in the context of acute pulmonary embolism. Here, we present 2 patient cases in which McConnell's sign was seen with right ventricular ischemia without pulmonary embolism. (Level of Difficulty: Beginner.).
| S-EPMC9270620 | biostudies-literature
Project description:We conducted an evidence-based review of information about [corrected] amniotic fluid embolism (AFE). The estimated incidence of AFE is 1:15,200 and 1:53,800 deliveries in North America and Europe, respectively. The case fatality rate and perinatal mortality associated with AFE are 13-30% and 9-44%, respectively. Risk factors associated with an [corrected] increased risk of AFE include advanced maternal age, placental abnormalities, operative deliveries, eclampsia, polyhydramnios, cervical lacerations, [corrected] and uterine rupture. The hemodynamic response in [corrected] AFE is biphasic, with initial pulmonary hypertension and right ventricular failure, followed by left ventricular failure. Promising therapies include selective pulmonary vasodilators and recombinant activated factor VIIa. Important topics for future research are presented.
| S-EPMC3401570 | biostudies-literature
Project description:Highlights•McConnell's sign is not always demonstrated during a massive PE.•The pattern seen on echocardiography is another manifestation of right heart strain.•TAPSE and S? were unable to assess systolic function of the right ventricle.•Similarities arise between this case and takotsubo syndrome of the right ventricle.
| S-EPMC6302120 | biostudies-other
Project description:Myxomas are the most common cardiac tumors, accounting for about 50% of benign primary cardiac tumors, with the majority located in the left atrium, and 80% of which originate in the interatrial septum. We report two cases with severe cachexia, neurological sequelae, and severe biventricle dysfunction secondary to atrial myxomas with marked early improvement after tumor excision.
| S-EPMC5661318 | biostudies-literature
Project description:BackgroundPrevious studies have described echocardiographic indices of right ventricular (RV) diastolic function in patients with tetralogy of Fallot (TOF) but these indices have not been validated against invasive hemodynamic data. The purpose of this study was to determine echocardiographic predictors of severe RV diastolic dysfunction, and the impact of severe RV diastolic dysfunction on transplant-free survival.MethodsCohort study of TOF patients that underwent non-simultaneous cardiac catheterization and echocardiogram at Mayo Clinic. Based on prior studies we selected these indices for assessment: tricuspid E/A, E/e', deceleration time, pulmonary artery forward flow, dilated inferior vena cava (IVC), and hepatic vein diastolic flow reversal (HVDFR). RV diastolic function classes (normal, mild/moderate and severe dysfunction) were created using arbitrary cut-off points of the median values of right ventricular end-diastolic pressure (RVEDP) and right atrial pressure (RAP) for the cohort.ResultsAmong 173 patients (age 40 ± 13 years), 68 patients were classified as normal (RVEDP≤14 and RAP≤10), 37 as mild/moderate dysfunction (either RVEDP>14 or RAP>10), and 69 as severe dysfunction (RVEDP>14 and RAP>10). Of the indices assessed, dilated IVC had the best sensitivity of 95% (area under the curve [AUC] 0.689) while HVDFR had the best specificity of 69% (AUC 0.648) for detecting severe RV diastolic dysfunction. Severe RV diastolic dysfunction was an independent risk factor for death/transplant (hazard ratio 2.83, p = 0.009).ConclusionSevere RV diastolic dysfunction, as defined by invasive hemodynamic indices, was associated with poor prognosis. Echocardiographic indices can identify these high risk patients, and hence improve risk stratification in clinical practice.
| S-EPMC7297267 | biostudies-literature
Project description:ObjectiveTo optimize enhancement of pulmonary arteries and facilitate diagnosis of pulmonary embolism (PE), modern computed tomography angiography (CTA) contains a contrast bolus tracking system. We explored the diagnostic accuracy of the time-intensity curves given by this automated system to identify right ventricular dysfunction (RVD) in acute PE.Methods114 CTAs with a diagnosis of PE were reviewed. RVD was defined as right-to-left ventricular diameter ratio of 1 or greater. Four parameters on time-intensity curves were identified. Parameters between CTAs with and those without RVD were compared with the Wilcoxon rank-sum test. The ability of the four parameters to discriminate patients with RVD was explored by compiling the area under the operating curves (AUC).ResultsThe time needed by the contrast media to reach the pulmonary artery [8 seconds (IQR: 7-9) versus 7 seconds (IQR: 6-8), p<0.01], the time needed to reach 40 Hounsfield units (HU) [11 seconds (IQR: 8.5-14) versus 9.5 seconds (IQR: 8-10.5), p<0.01], and the contrast intensity reached after 10 seconds [19 HU (IQR: 4-67) versus 53 HU (IQR: 32-80), p<0.05] were all statistically different between CTA with and CTA without RVD. Those three parameters changed gradually across severity categories of RVD (p<0.05 for trend). Their AUC to identify RVD ranged from 0.63 to 0.66. The slope of contrast intensity over time was not informative: [31 HU/s (IQR: 20-57) in CTA with, compared to 36 HU/s (IQR: 22.5-53) in CTA without RVD, p = 0.60].ConclusionSeveral parameters of the time-intensity curve obtained by the bolus tracking system are associated with RVD assessed on CTA images. Of those, the time needed to reach a predefined threshold seems to be the easiest to obtain in any CTA without additional processing time or contrast injection. However, the performance of those parameters is globally low.
| S-EPMC4994948 | biostudies-literature
Project description:Several risk stratification tools are available to predict short-term mortality in patients with acute pulmonary embolism (PE). The presence of right ventricular (RV) dysfunction is an independent predictor of mortality and may be a more efficient way to stratify risk for patients assessed by a Pulmonary Embolism Response Team (PERT). We evaluated 571 patients presenting with acute PE, then stratified them by the pulmonary embolism severity index (PESI), by the BOVA score, or categorically as low risk (no RV dysfunction by imaging), intermediate risk/submassive (RV dysfunction by imaging), or high risk/massive PE (RV dysfunction with sustained hypotension). Using imaging data to firstly define the presence of RV strain, and plasma cardiac biomarkers as additional evidence for myocardial dysfunction, we evaluated whether PESI, BOVA, or RV strain by imaging were more appropriate for determining patient risk by a PERT where rapid decision making is important. Cardiac biomarkers poorly distinguished between PESI classes and BOVA stages in patients with acute PE. Cardiac TnT and NT-proBNP easily distinguished low risk from submassive PE with an area under the curve (AUC) of 0.84 (95% CI 0.73-0.95, p?<?0.0001), and 0.88 (95% CI 0.79-0.97, p?<?0.0001), respectively. Cardiac TnT and NT-proBNP easily distinguished low risk from massive PE with an area under the curve (AUC) of 0.89 (95% CI 0.78-1.00, p?<?0.0001), and 0.89 (95% CI 0.82-0.95, p?<?0.0001), respectively. In patients with RV dysfunction, the predicted short-term mortality by PESI score or BOVA stage was lower than the observed mortality by a two-fold order of magnitude. The presence of RV dysfunction alone in the context of acute PE is sufficient for the purposes of risk stratification. More complicated risk stratification tools which require the consideration of multiple clinical variables may under-estimate short-term mortality risk.
| S-EPMC6954969 | biostudies-literature
Project description: Not available
| S-EPMC7521904 | biostudies-literature
Project description:It has been stated that the interior of the right ventricle is as unique to each individual as one's fingerprint. This statement is backed by numerous publications which demonstrates considerable variation in the number, shape and configuration of papillary muscles inside the normal right ventricle.It has also been shown that these variants may be the cause of cardiac rhythm disorders.In this case report another potential complication of such right ventricular papillary muscle variants is proposed-these muscles may be the source of pulmonary emboli.The pathogenesis may be that of local stasis around these aberrant muscular structures and/or emboli may form inside the right ventricle as a result of cardiac rhythm disorders, induced by these muscles.It is proposed that in future the role of the right ventricle as the source of pulmonary emboli will become more apparent and an important part of the diagnostic work up in cases of idiopathic pulmonary embolism.
| S-EPMC2941134 | biostudies-literature
Project description:A young child presented with hepatomegaly, ascites, and bradycardia in the setting of coronavirus disease-2019. Permanent complete atrioventricular block and severe right heart failure were diagnosed. He was treated with surgical epicardial pacemaker implantation. This report is the first description of coronavirus disease-2019-induced permanent complete atrioventricular block in a child.
| S-EPMC8593395 | biostudies-literature